DemoFileUnlockAppForCompleteData-2024-01-09-10-55-49-7151 Flashcards

Question

Atomoxetine (Strattera) is a non-stimulant drug for Attention-Deficit Hyperactivity Disorder (ADHD) that acts by inhibiting 5HT and NA reuptake.

Answer 1

Atomoxetine (Strattera) is a non-stimulant drug for Attention-Deficit Hyperactivity Disorder (ADHD) that acts by inhibiting 5HT and NA reuptake.2nd-line therapy for ADHD; no potential for addiction and favorable side-effect profile

Answer 2

What is the diagnostic criteria for adjustment disorder? Must arise *within 3 months* of the stressor, and unless it is a chronic stressor, it must resolve within 6 months Axis I or bereavement criteria must not be met in order for this diagnosis to be given.Bereavement is when someone has died

Answer 3

La belle indifférence is a feature of Conversion Disorder that involves the patient showing a characteristic lack of concern .

Answer 4

Which SNRI is typically avoided in hypertensive patients? Venlafaxine It can increase diastolic BP.

Answer 5

Which typical antipsychotic is associated with a purple grey metallic rash over sun-exposed areas and jaundice? Chlorpromazine

Answer 6

Which atypical antipsychotic has the highest risk of EPS and hyperprolactinaemia? Risperidone (Ripserdal) FGA and risperidone (atypical) are the antipsychotics with the highest potential for increasing prolactin

Answer 7

What is the treatment for neurosyphilis in a patient with penicillin allergy? IV penicillin after desensitisation Allergy = treat with doxycycline Allergy + neurosyphilis or pregnancy = desensitization to penicillin

Answer 8

Denys-Drash Syndrome is a tumour syndrome that involves Wilms' Tumour (Nephroblastoma), nephropathy and genital abnormalities.Denys Dick Drash

Answer 9

What WBC level is seen on lumbar puncture in bacterial meningitis? >1000

Answer 10

What is the treatment for Streptococcal Pharyngitis with penicillin allergy? Macrolides; or Clindamycin Both for 10 days.

Answer 11

Sydenham's Chorea is a neurological feature of Acute Rheumatic Fever that presents with emotional instability and involuntary movements.

Answer 12

Which class of asthma involves symptoms with ≥2 exacerbations per week but not daily? Mild persistent Exacerbations limit daily activity.

Answer 13

How many night symptoms are seen in severe persistent Asthma (Reactive Airway Disease)? 4-7 times per week (high-dose ICS + LABA)

Answer 14

What is the antipsychotic drug of choice for anorexia nervosa after CBT and nutritional rehabilitation fails? Olanzapine

Answer 15

Annular rash with bright red outer border and partial central clearing is diagnostic for ___.Erythema migrans (Lyme disease)

Answer 16

A capillary (fingerstick) lead level >5 mcg/dL needs to be confirmed with which test? Venous lead measurement

Answer 17

A patient is going to begin treatment for a HER2-(+) invasive ducal carcinoma and therapy containing trastuzumab is planned. What should be done prior to starting the medication in this patient? Echocardiography Baseline assessment of cardiac function as Herceptin is cardiotoxic

Answer 18

Microscopic Polyangiitis is a small vessel vasculitis that presents similarly to Wegener Granulomatosis, but lacks nasopharyngeal involvement and granulomas.

Answer 19

Which type of primary headache may occasionally present with Horner syndrome? Cluster headache

Answer 20

What is the diagnostic test for Pseudotumour Cerebri (Benign/Idiopathic Intracranial hypertension)? Lumbar puncture with normal CSF but increased opening pressure Remember, a negative CT/MRI is also required.

Answer 21

Which vitamin toxicity can be a cause of Pseudotumour Cerebri (Idiopathic Intracranial hypertension)? Vitamin A Withdraw vitamin supplementation if this is suspected.

Answer 22

At what age is the herpes zoster (shingles) vaccine recommended in all adults? >60 years old To prevent shingles and mitigate symptoms if shingles does occur.

Answer 23

What head CT/MRI findings are associated with Huntington Disease? Caudate nucleus atrophy

Answer 24

A patient with multiple sclerosis develops worsening focal neurological deficits while on chronic suppressive therapy. New MRI shows new, multiple white matter lesions. Which drug is most likely to have caused this? Natalizumab It targets α-4 integrinIt has been known to predispose to progressive multifocal leukoencephalopathy (PML).

Answer 25

A patient presents with muscle atrophy, fasciculations of the tongue and extremities, upwards babinski and hyper-reflexia of the extremities. Which demyelinating disorder is the most likely diagnosis? Amyotrophic lateral sclerosis Know the signs of UMN and LMN lesions!*Involves asymmetric UMN and LMN lesions, with LMN symptoms predominating in later stages.Typically spares the eyes and sphincters.There is no sensory loss no matter what the gunner says on rounds.Other symptoms may include emotional lability and weight loss.

Answer 26

A patient with known myasthenia gravis presents to the ER in life-threatening condition. She has diffuse, severe, overwhelming muscle weakness with respiratory involvement. Aside from intubation, what is the next best step? IVIG; or plasmapharesis Don't forget to manage and protect the airways!This is acute myasthenic crisis.

Answer 27

How do the brain CT findings in Alzheimer's Disease differ from Pick's Disease? AD = diffuse cortical atrophy (parietal and temporal)PD = frontal and hypothalamic degeneration (frontal and temporal)

Answer 28

Which organic cause of dementia is associated with the triad of urinary incontinence, ataxic gait and dementia? Normal Pressure Hydrocephalus (NPH) aka Wet, Wobbly and WackyDue to decreased CSF absorption.

Answer 29

What is the treatment of choice in a depressed patient with poor appetite, weight loss, or insomnia? Mirtazapine -Increases appetite, weight gain, and sedation-Trazodone also helps with insomnia, but not weight gain

Answer 30

Body dysmorphic disorder is the diagnosis when patients have an imagined or slight defect in appearance, causing distress and impaired ability to function in a social or occupational setting.Treatment? CBT; SSRIs. -If the only concern is body shape and weight, anorexia nervosa is the more accurate diagnosis.-If the only concern is sex characteristics, gender identity disorder is the more accurate diagnosis.-Flaws are mild or not observable by others

Answer 31

What is the only illicit drug that causes vertical nystagmus? PCP Can also cause horizontal and rotatory nystagmus.

Answer 32

What life-threatening reaction is associated with Nevirapine HIV therapy? Liver failure

Answer 33

A patient and his friends all present with headache, dyspnea, nausea, and vomiting. He states that they were camping and cooking food in their cabin. One patient has pinkish skin. What is the most likely diagnosis? Carbon monoxide poisoning

Answer 34

A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the best initial test? CXR This is aortic dissection.While CXR is not as sensitive, it is quick, cheap and widening of the mediastinum on CXR is a big clue.CXR is the best initial testAngiogram is the most accurate testAll other tests are helpful, but have the same accuracy (MRA = CTA = TEE)

Answer 35

A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the most accurate test? Angiogram This is aortic dissectionCXR is the best initial testAngiogram is the most accurate test but also the most invasive. It can cause anaphylaxis or AKI, but is the most sensitive and most specific.All other tests are helpful, but have the same accuracy (MRA = CTA = TOE)

Answer 36

Manage with weight-bearing assisting mechanical devices and treat underlying condition

Answer 37

What is the treatment for intermittent asthma (symptoms <2 days/week, nighttime awakenings <2x/month)? A rescule inhaler (SABA PRN) Typically a SABA, but may be an inhaled anticholinergic as well

Answer 38

What is the treatment for mild persistent asthma (> 2 days/week, nighttime awakenings 3-4 times/month)? SABA + low dose ICS

Answer 39

What is the treatment for moderate persistent asthma? SABA + low-dose ICS + LABA You cannot give LABA without an ICS/steroids. That will increase mortality and is always the wrong answer.If the patient is on a LABA, they must be on steroids. Period.

Answer 40

A patient with ARDS is placed on PEEP after intubation. Shortly after, he develops hypotension. A medical student noticed tracheal deviation to the left during rounds. What test should be ordered to confirm the most likely diagnosis? CXR to diagnose tension pneumothorax Complications of PEEP:- Barotrauma; typically involves worsening SOB after PEEP has been given to the pt- Pneumothorax; suspect this if the patient becomes hypotensive and mediastinal shift/tracheal deviation; diagnosed with CXR; treatment with needle decompression; can be secondary to barotrauma

Answer 41

What ECG findings are classically associated with pulmonary embolism? S1Q3T3 Or right heart strain - ST depression and T wave inversion in the right leads (aVR, II, V5 and V6).This is rarely seen (sinus tachy is the most common!) S1-Q3-T3 - prominent S in lead I- Q wave in lead III- T-wave inversion in lead III- indicative of R heart strain

Answer 42

A patient is thought to have a pulmonary embolism but cannot tolerate IV contrast due to severe renal disease. What other diagnostic test can be ordered to help in the workup? V/Q scan

Answer 43

Which type of glomerulonephritis is associated with asthma alongside the hematuria? Churg-Strauss syndrome Glomerulonephritis general key points:- the differential for the type of glomerulonephritis is extensive- RBC casts are typical of GN- Definitive diagnosis is via biopsy- Important to rule out nephrotic syndrome with UA spot test or 24 hr urine collection

Answer 44

A patient undergoing elective cholecystectomy receives an abdominal U/S that incidentally reveals a renal cyst. It is small, non-loculated, and non-septated. No echoes are seen on the U/S. What is the most likely diagnosis? Simple Renal Cyst Simple Renal Cyst key points:- must be small, non-loculated, non-septated and no echoes on U/S- If truly simple, and asymptomatic, let it be- If signs and symptomsdevelop, consider excision or biopsy

Answer 45

A patient undergoing elective cholecystectomy receives an abdominal CT that incidentally reveals a renal cyst. It is large, septated, and loculated. What is the most appropriate next step? Biopsy (this is a complex renal cyst; CT-guided needle biopsy) Complex Renal Cyst key points:- must be large, septated, or loculated- more likely to cause symptoms than simple cysts- common signs and symptoms: flank mass, haematuria, pyelonephritis, pain- If truly complex, biopsy that sucker to rule out malignancy- CT-guided needle biopsy is typically the method of choice

Answer 46

A patient presents complaining of dysphagia. He states that it feels like a knot or ball of food is stuck in his chest. You suspect achalasia. Barium swallow reveals a bird's beak sign. What is the most appropriate next test? Manometry and Endoscopy (rule out cancer) Achalasia key points:- Ba swallow is the best initial test- Manometry follows here and offers more info- Endoscopy must be done to rule out cancer- treatment is preferred w/ Heller myotomy (balloon dilatation can cause perforation; botox is less effective)

Answer 47

A female patient with a past medical history of autoimmune disorders presents with AST and ALT in the 1000s after an outpatient lab test. You suspect autoimmune hepatitis. Which antibodies are associated with this disorder? Anti-smooth muscle; Anti-LKM

Answer 48

Glomerular crescent formation on light microscopy is associated with ___.Rapidly progressive glomerulonephritis (RPGN)

Answer 49

Folic acid--- Reduces incidence of ADRs

Answer 50

Sjogren's syndrome

Answer 51

What is the most effective treatment for stopping an acute attack of a cluster headache? 100% oxygen Ergotamines and Triptans are effective but not as rapid-acting as 100% oxygen.

Answer 52

TMP/SMX is used in HIV-positive patients to prevent opportunistic infections caused by Pneumocystis jiroveci and Toxoplasma gondii when CD4 count is < 200 for PCP, 100 for Toxo .Azithromycin is recommended for prophylaxis against MAC when CD4 count is < 50 .

Answer 53

Tick-borne paralysis is characterized by rapidly progressive ascending paralysis, absence of fever and sensory abnormalities, and normal CSF exam.The next best step is a meticulous search for a tick and removal of tick results in spontaneous improvement in most patients .Guillain-barre may be hard to distinguish but is usually not as rapid, CSF abnormalities, and autonomic dysfunction. A meticulous tick exam is easy to perform and should be done first.

Answer 54

A brain that has seized for >5 minutes (status epilepticus) is at increased risk for cortical laminar necrosis due to excitatory toxicity. Can lead to persistent neurologic deficits and recurrent seizures.

Answer 55

Patients with adult-onset asthma and symptoms that are worse after meals, exercise, or laying down are likely to have GERD as a primary trigger.When suspected, a trial of PPIs can be both diagnostic and therapeutic.Mechanisms by which GERD exacerbates Asthma1) Increased vagal tone2) Heightened bronchial reactivity3) Microaspiration of gastric contents into the upper airway

Answer 56

What is the best initial pharmacological treatment for Rosacea? Metronidazole Avoid triggers — hot weather, spicy food, alcohol, high temperature, etc.

Answer 57

Bacillary angiomatosis is a bacterial infection that presents in HIV patients with exophytic purple skin masses and visceral angioma-like blood vessel growths. Treat with antibiotics

Answer 58

A 65 years old man with a past medical history of uncontrolled hypertension presents to the ER complaining of AMS, blurry vision, headache and dyspnea. Physical exam reveals a BP of 200/140 mmHg and papilledema. There are no other abnormalities. What is the most likely diagnosis? Hypertensive Emergency/Crisis Hypertensive Urgency vs. Emergency key points:- Urgency is > 180/110 without end organ damage and is treated with PO meds- Emergency/Crisis is >180/110 with end organ damage and is treated with IV meds (stroke, MI, papilloedema, flash pulmonary oedema, headache, chest pain, etc...)

Answer 59

Hepatitis C can be asymptomatic or develop fatigue, arthralgias, weakness, weight loss, and serum transaminases can be elevated or normal. Extrahepatic manifestations include:Heme: Essential mixed cryoglobulinemia Renal: MPGN Skin: Porphyria cutanea tarda , lichen planus Endocrine: increased risk for diabetes

Answer 60

An elderly patient presents complaining of back pain. He states that the pain shoots down his right leg, but is alleviated when he is hunched over forward. You suspect spinal stenosis. What is the best diagnostic test? MRI X-ray will show degenerative joint changes, but MRI is the best confirmatory test

Answer 61

Patients with aortic regurgitation present with wide pulse pressure (e.g., 150/45 mmHg), water hammer pulse, and LV enlargement that causes a pounding sensation and increased awareness of the heartbeat.

Answer 62

A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. What is the most likely diagnosis? Sarcoidosis Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat

Answer 63

A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. You suspect sarcoidosis. What is the best initial diagnostic test? CXR Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat

Answer 64

A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. follow up lymph node biopsy reveals noncaseating granulomas. She is diagnosed with sarcoidosis. What is the treatment? Prednisone (clear top choice and most patients respond) Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat

Answer 65

A patient presents with fever and cough. Physical exam reveals foul breath. CXR reveals a cavitary lesion in the right lung. You suspect a lung abscess. An incision and drainage with culture is done. Until the culture is complete, what is the most appropriate empiric treatment? Clindamycin Lung Abscess key points:- abscesses don't just form out of nowhere; these patients typically have an aspiration risk- empiric treatment with clindamycin is recommended (again, due to the aspiration risk; most lung abscesses involve anaerobes)- aspiration risk is typically secondary to seizure, alcoholism, MS or stroke - give proper treatment once culture and sensitivity return

Answer 66

A patient presents with fever, cough, night sweats, weight loss and hemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is also positive. What is the most appropriate next step in management? This is a diagnosis of active TB; start RIPE therapy (2 months of RIPE + 4 months of isoniazid and rifampin)

Answer 67

A patient presents with fever, cough, night sweats, weight loss and haemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is negative. What is the most appropriate next step in management? INH for 9 months Collect early morning sputum and get atleast 3 cultures 8 hrs apart.To help ensure a true result, get 3 early morning sputums 24 hrs apart.Your last ditch effort if you have a very high suspicion of TB is nucleic acid assay.

Answer 68

A patient has fever, headache, and a stiff neck. CT scan rules out intracranial mass, so an LP is safely performed. LP rules out bacterial meningitis. The patient also has a targetoid rash and recent travel to the north-east American coast. Lyme antibody testing returns positive. What is the most appropriate next step in management? IV Ceftriaxone Not doxycycline, which is used for Lyme arthralgia, not Lyme meningitis

Answer 69

A patient is diagnosed with syphilis and is given the appropriate penicillin treatment. Following treatment, the patient develops fever and his symptoms worsen. What is this phenomenon called? Jarisch-Herxheimer reaction Treat with aspirin.This is secondary to widespread endotoxin release following the death of bacteria. - while classically associated with syphilis and other spirochete diseases, it can occur in other casesdue to rapid lysis of spirochetes; self-limited and resolves spontaneously within 48 hours

Answer 70

A patient presents complaining of pruritis. Physical exam reveals visible burrow marks on the skin and webbed spaces between fingers. You suspect scabies. What is the diagnostic test? Scraping and magnification of the burrows/lesions

Answer 71

A patient is diagnosed with Lyme disease. She has erythema migrans, arthralgias, and AV block. What is the treatment? IV ceftriaxone

Answer 72

What is the notable side effect of the anti-HIV drug indinavir? Nephrolithiasis indigo princess

Answer 73

Patient presents with swollen, erythematous lower left leg that has sharpy defined borders. Physical exam reveals a red, hot, swollen lesion with erythematous streaks. He also complains of fever and chills. What is the most likely diagnosis? Erysipelas -the red streaks are characteristic of ascending lymphadenitis known to be involved with the condition

Answer 74

A 80 year old patient presents complaining of a pigmented lesion on his face. Physical exam reveals a large, brown, greasy-looking, and crusted pigmented lesion that appears stuck on the patients face. What is the most likely diagnosis? Seborrheic keratosis Very common in the elderly

Answer 75

When discussing HIPAA information with employees, it is required to have verbal or written authorization.HIPPA does not require the provider to obtain proof of identity of phone callers.The best practice when giving HIPAA info is to disclose only the minimum necessary information .

Answer 76

A 40 years old patient has a bullous/blistering disease with oral mucosal involvement. Physical exam reveals a positive Nikolsky's Sign. What is the most likely diagnosis? Pemphigus vulgaris

Answer 77

Which age group is typically affected by bullous pemphigoid? >60 Pemphigus vulgaris = <60

Answer 78

A patient presents complaining of blistering/bullous disease. Physical exam reveals that the blisters are found in sun exposed areas only. He has hepatitis C. What is the most accurate diagnostic test? 24 hr urine collection (increased uroporphyrinogen is diagnostic)

Answer 79

A 24 hr urine collection to gauge for increased uroporphyrins is the most accurate test for porphyria cutanea tarda. Which enzyme is deficient in this disease? Uroporphyrinogen decarboxylase

Answer 80

A patient comes in complaining of spots on his skin. Physical exam reveals multiple, small, sharply-demarcated patches of hypo- and depigmentation on the face and hands. What is the most likely diagnosis? Vitiligo

Answer 81

A female patient presents with patchy hair loss. Her past medical history is significant for OCD. Physical exam reveals patchy alopecia and a headful of hair at different lengths. What is the most likely diagnosis? Trichotillomania

Answer 82

A patient is diagnosed with trichotillomania. Which GI disorder should you worry about? SBO secondary to bezoar (eating hair)

Answer 83

A patient who develops polyarthralgia, tenosynovitis, and painless vesiculopustular skin lesions have the classic triad for disseminated gonococcal infection .

Answer 84

Which antibodies are associated with autoimmune hepatitis? Anti-smooth muscle Ab

Answer 85

Which antibodies are associated with Sjogren's Syndrome? Anti-Ro (SS-A) and Anti-La (SS-B) Ayrobeela = A-Ro, B-La

Answer 86

Which antibodies are associated with polymyositis? Anti-Jo ab Anti-Jo1, anti-SRP, anti-Mi2

Answer 87

A patient with a history of SLE presents complaining of severe joint pain. You suspect a lupus flare. Your smart medical student suggests that we should check complement levels. How do complement levels change in a lupus flare? Decrease If complement levels are normal, it is likely not a flare.If complement levels are decreased, it is likely a flare.

Answer 88

Lupus nephritis and subsequent renal failure is a major contributor to mortality in SLE. What test is imperative in investigating the severity of lupus nephropathy? Biopsy Performing screening UA's are imperative. If things are off, perform biopsy.Only a biopsy will be able to tell us the severity of lupus nephropathy (i.e. nephritis, or glomerulosclerosis, or glomerular scarring). It also guides treatment (e.g. scarring is not treatable).

Answer 89

A patient with a history of SLE presents complaining of severe joint pain. She is diagnosed with a lupus flare. Labs also reveal proteinuria. What test must be performed before administering therapy? Kidney biopsy Biopsy is indicated to establish histopathologic type and determine severity of of renal involvement

Answer 90

Vesicular rash in the trigeminal distribution and dendriform corneal ulcers are associated with ___.Herpes zoster ophthalmicus--- This is a medical emergency treat empirically with high-dose acyclovir and refer to ophthalmology to prevent blindness.

Answer 91

Which crystal deposition disease is associated with rhomboid-shaped crystals? Pseudogout (calcium pyrophosphate crystals)

Answer 92

What is the first line treatment for acute pseudogout? NSAIDs (traditionally indomethacin)

Answer 93

A 30 years old male patient presents complaining of lower back pain and morning stiffness. He states that the pain decreases with activity and increases with rest. What is the most likely diagnosis? Ankylosing spondylitis This is a pretty unique feature of AS (back pain that improves with exercise and worsens with rest).

Answer 94

A patient presents complaining of dry eyes, dry mouth and some facial swelling. Physical exam reveals keratoconjunctivitis, xerostomia and bilateral parotid enlargement. You suspect Sjogren's syndrome. What is the best initial diagnostic test? Anti-SS-A-(Ro) and anti-SS-B-(La) testing (best initial blood test); Schirmer tear production test (best overall initial test) Sjogren's Syndrome diagnosis key points:- often a part of another autoimmune disease (esp SLE), but can be solo; diagnosis clinical but needs confirmation- best initial blood test is SS-A-Ro and SS-B-La testing- best initial overall test is the Schirmer tear production test with a fliter paper on the eye- most accurate test is a lip or parotid biopsy looking for the lymphocytic infiltration- Rose bengal staining reveals an abnormal corneal epithelium if performed

Answer 95

What is the best initial therapy for carpal tunnel syndrome? NSAIDs + wrist splint (immobilise the hand in a position that relieves pressure) Pts should also avoid manual activity.Steroid injections help if splint + NSAIDs do notSurgery can be curative and typically involves decompression by cutting open the flexor retinaculum

Answer 96

A patient is diagnosed with SLE and started on hydroxychloroquine. What toxicity should monitored for? Retinal toxicity (do dilated eye exams to gauge)

Answer 97

A female patient presents with rampant dental caries and dyspareunia. Which autoimmune disorder is the likely cause? Sjogren Syndrome Just a reminder that SS can cause both.Dental caries secondary to lack of salivaDyspareunia secondary to lack of vaginal secretions

Answer 98

What is the most dangerous complication of Sjogren Syndrome? Lymphoma Increased risk of lymphomas (B-cell and MALT)

Answer 99

Which cause of megaloblastic anaemia is associated with an elevated level of methylmalonic acid? Vitamin B12 deficiency Megaloblastic anaemia workup key points:- if MCV > 100, get a PBS to test for megaloblastic anaemia- if PBS reveals megaloblastosis, check B12/folate- if b12/folate is equivocal, check methylmalonic acid--- if MMA is normal, it is a folate deficiency--- if MMS is elevated, it is a vitamin B12 deficiency

Answer 100

What is the treatment for paroxysmal nocturnal haemoglobinuria? Eculizumab Complement-mediated hemolysis relies on factors C5-C9, among others. Eculizumab targets a key component of this mechanism reducing the intravascular hemolysis.

Answer 101

Which form of acute leukemia is associated withPAS, CALLA and TdT proteins? ALL AML = myeloperoxidase = makes sense with AML being myeloidALL = cALLa, PAS, + TdT = makes sense with ALL being lymphocytic

Answer 102

A patient suspected of having lymphoma undergoes an excisional biopsy of a nontender lymph node which reveals reed-sternberg cells. What is the diagnosis? Hodgkin's Lymphoma Reed–Sternberg cells are large and are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an owl's eye appearance). Reed–Sternberg cells are CD30 and CD15 positive. The presence of these cells is necessary in the diagnosis of Hodgkin's lymphoma – the absence of Reed–Sternberg cells has very high negative predictive value.

Answer 103

A patient with lymphoma begins to develop cyclical fevers that come and go randomly over weeks. What type of lymphoma does he likely have? Hodgkin's (these are Pel-Epstein fevers)

Answer 104

A patient is diagnosed with multiple myeloma. What imaging should be performed? Full body XR skeletal survey looking for lytic bone lesions/pathological fractures The bone lesions in MM are exclusively lytic.

Answer 105

Which plasma cell disorder is associated with hyperviscosity syndrome and peripheral neuropathy? Waldenstrom's Macroglobulinaemia

Answer 106

What is the treatment for Thrombotic Thrombocytopenic Purpura? Plasma exchange i.e. either take out the antibodies and give back lots of ADAMTS-13 or give ADAMTS-13 onlyDo.... not.... give.... fucking... platelets.....

Answer 107

The 1st line treatment of choice for adjustment disorder is psychodynamic psychotherapy or brief cognitive psychotherapy .

Answer 108

Sublimation is a mature ego defense that involves replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system. An aggressive person who channels their aggression into sports

Answer 109

Diabetic neuropathy is a common complication of diabetes mellitus. How often should it be tested for? Annually via monofilament Just think of Dr. D in 3rd year and you will never forget this, brah.

Answer 110

Hypercalcemia of malignancy and hypervitaminosis D secondary to granulomatous disease both present with similar calcium lab panels (increased Ca, increased PO4, decreased PTH). What lab test can be ordered to discern between the two? 1,25-Vitamin D levels (to confirm hypervitaminosis); or PTH-rp levels (to confirm paraneoplastic syndrome) If you're asked this, use the history to discern which one you need (i.e. history suggestive of sarcoid/TB vs. a lung mass)

Answer 111

Ulcerative colitis involves an increased risk of cancer as there is longstanding inflammation. As such, colonoscopy screening is important. When should it begin? Start 8 years after diagnosis and continue with q1y screening

Answer 112

Non-tender, firm, hyperpigmented nodules <1 cm in diameter and found most commonly on the lower extremities are likely to be ___.Dermatofibroma

Answer 113

Mixed connective tissue disease-Varying clinical findings-Wink wink poke poke

Answer 114

What part of the brain is affected in Alzheimer's? Nucleus basalis of Meynert The hippocampus is also damaged. You will see cortical atrophy on imaging.

Answer 115

Sialadenosis (benign, non-inflammatory painless enlargement of the salivary glands) is associated with ___ (3).Advanced liver disease (e.g. alcoholic and non-alcoholic cirrhosis)Malnutrition (e.g. bulimia nervosa)Altered dietary patterns (e.g. diabetes mellitus)

Answer 116

Describe the setting changes that should be made for a patient on ventilator support when:1) PaO2 is too low2) PaO2 is too high3) PaCO2 is too low4) PaCO2 is too high1) Increase FiO2 or positive end-expiratory pressure (PEEP)2) Decrease FiO2 or PEEP--- Prevents free radical damage3) Decrease tidal volume (preferred) or respiratory rate4) Increase tidal volume (preferred) or respiratory rate

Answer 117

Lateral femoral cutaneous nerve compression causes pain and parasthesias over the anterolateral thigh.Also called meralgia paresthetica It may be precipitated by a sudden increase in weight, an injury, or during pelvic surgery.

Answer 118

Which types of tumors may secrete EPO (causing polycythemia vera)? Renal cell carcinoma and hepatocellular carcinoma

Answer 119

Identify the following EKG: Premature atrial contraction Also known as a PAC or Atrial Premature Beat, these occur when part of the atria sends out a depolarisation wave a little too early. Clues include: 1. The P wave of the PAC looks different from the other P waves, since it starts at a diff location in the atria 2. The P wave and subsequent QRS complex come earlier than would be expected. 3. The QRS and T wave are followed by a relative pause before the SA node repolarises and initiates a normal beat. Hence, the Normal, Short, Long pattern.

Answer 120

Tetanus toxin (tetanospasmin) travels via retrograde transport to the spinal cord.GABA and glycine are inhibitory neurotransmitters, therefore, there is a lack of motor inhibition spastic paralysisVersus botulism is due to inhibition of Ach (excitatory) release, causing flaccid paralysis

Answer 121

Cleavage of SNARE proteins via tetanus toxins inhibits the the release of GABA and {{c2::glycine from Renshaw cells in the spinal cord.GABA and glycine are inhibitory neurotransmitters, therefore, there is a lack of motor inhibition spastic paralysisBotulism is due to inhibition of Ach (excitatory) release, causing flaccid paralysis

Answer 122

Does cleavage of SNARE via botulinum toxin prevent release of excitatory or inhibitory neurotransmitters? Excitatory (thus causing descending flaccid paralysis)

Answer 123

A 42 year old man has been fired from his job because of inappropriate behavior. For the past two months he has gradually developed very severe, “explosive” headaches that are located on the right side, above the eye. Neurologic exam shows optic nerve atrophy on the right, papilledema on the left, and anosmia. What is the most appropriate imaging study? MRI Foster-Kennedy syndrome - tumour in frontal lobe (right sided in this patient).

Answer 124

An elderly man is involved in a rear end automobile collision. He develops paralysis and burning pain of both upper extremities while maintaining good motor function in his legs. What is the most likely diagnosis? Central cord syndrome may be accompanied by localized deficit in pain and temperature sensation; typically occurs with hyperextension injuries in elderly patients with pre-existing degenerative changes in the cervical spine Spinal Cord Injuries1. Complete spinal cord injury: complete loss of motor and sensory function below level of lesion2. Brown-Sequard: clean cut injury (knife blade); ipsilateral paralysis and proprioception loss; contralateral pain and temp loss3. Central Cord Syndrome: elderly with forced hyperextension of neck (rear-end collision); paralysis, burning/loss of sensation in upper extremities, but distal extremities are spared 4. Anterior Cord Syndrome: burst fractures of vertebral bodies; distal paraplegia, bilateral loss of pain/temp; preservation of vibration and position (dorsal column unaffected)

Answer 125

Neurological symptoms with CD4 count <200; imaging shows multiple non-enhancing lesions PML (JC Virus)

Answer 126

The following neuroimaging is found in what congenital infection? CMV periventricular calcifications

Answer 127

What is the most likely diagnosis for linear ulcerations found in the esophagus on endoscopy? CMV

Answer 128

Ecthyma gangrenosum is a black necrotic skin lesion seen in patients with Pseudomonas. Ecthyma gangrenosum occurs from perivascular invasion and release of tissue-destructive exotoxins, causing vascular destruction and insufficient blood flowCommon in neutropenic, hospitalized, or burn patients, or patients with catheters

Answer 129

In rhabdomyolysis, urine is positive::+ or - for blood on dipstick and negative::+ or - for RBC on microscopy.Because dipstick picks up heme components, which myoglobin carries

Answer 130

What is the best noninvasive test to confirm diagnosis of H. pylori infection? Urea breath test

Answer 131

The axillary nerve may be injured by an anterior dislocation of the humerus

Answer 132

The radial nerve may be injured by a fracture of the midshaft of the humeruscauses weakness/paralysis of the hand and finger extensor muscles but sparing of the triceps (innervating fibers leave the nerve before it enters the radial groove)

Answer 133

The radial nerve may be injured by compression of the axilla (e.g. due to crutches or sleeping with arm over chair, Saturday night palsy )

Answer 134

Which nerve injury presents with wrist drop? Radial nerve injury

Answer 135

What is the treatment for Whipple Disease? IV Ceftriaxone and maintenance TMP-SMX for 1 year Lethal if left untreated

Answer 136

What is the toxic component in rhabdomyolysis that causes renal damage? Myoglobin

Answer 137

What rapid test can be done in the diagnosis of Histoplasmosis? Serum/urine rapid antigen test

Answer 138

What systemic fungi can produce verrucous skin lesions when disseminated? Blastomyces

Answer 139

What MSK pathology is characterized by impaired relaxation after a single muscle contraction? Myotonic dystrophy

Answer 140

What β-lactam antibiotic can be used for left-sided endocarditis caused by Strep viridans and Strep bovis? IV Penicillin G Most Viridans group streptococci are highly susceptible to penicillin and should be treated with IV aqueous penicillin G (NOT ORAL) or IV ceftriaxoneOral antibiotics are generally not recommended as initial therapy in pt. With IE

Answer 141

What is the cutaneous complication of vancomycin and how do you treat? Diffuse flushing (Red-man syndrome) due to histamine release; manage by slowing the rate of infusion or pre-treating with antihistamines

Answer 142

All ischemic stroke patients should be given aspirin as prophylaxis for secondary stroke.Aspirin is the only antiplatelet agent that is effective in reducing risk of early recurrence of ischemic stroke. Aspirin plus dipyridamole or clopidogrel is recommended for patients who have recurrent stroke on aspirin therapy

Answer 143

A patient has a stroke and an aspirin sensitivity. What drugs can be substituted in place of the aspirin? Clopidogrel or dipyridamole

Answer 144

A patient has a stroke, and is given aspirin as prophylaxis against a secondary stroke. They subsequently experience another stroke - what anti-platelet medications should now be administered? Aspirin in addition to clopidogrel or dipyridamole

Answer 145

What drugs should be used to treat Toxoplasmosis? Pyrimethamine/sulfadiazine

Answer 146

Pyrimethamine/sulfadiazine is used to treat what protozoal infection? Toxoplasmosis (HIV patient with headaches, FND, and multiple ring-enhancing lesions) pyramid hat = pyramethaminedyed eggs = sulfadiazine

Answer 147

Rapid DiagnosisTreatment of Nocardia Sulfonamides (TMP-SMX)

Answer 148

What is the substitute for patients with H. pylori who are penicillin-allergic? Metronidazole

Answer 149

What should be avoided with the use of Metronidazole? Alcohol due to disulfiram-like effect Disfulfiram is a drug given to alcoholics that inhibits aldehyde dehydrogenase-Can't metabolize acetaldehyde and produces warmth, flushing, sweating (unclear mechanism)

Answer 150

Does Parkinson's dementia develop before or after the diagnosis of Parkinson's disease? Dementia after the diagnosis of Parkinson's disease Dementia with Lewy Bodies: dementia develops before or at same time as ParkinsonismParkinson disease dementia: Parkinsonism predates cognitive impairment by >1 year

Answer 151

What anti-mycobacterial drug can cause drug-induced lupus? Isoniazid What antibody is characteristically elevated in drug-induced lupus? Anti-histone antibodies

Answer 152

What nerve injury is caused by tight clothing, obesity, and pregnancy? Lateral femoral cutaneous ( meralgia paresthetica ) decreased anterior and lateral thigh sensation

Answer 153

What movements are lost with peroneal nerve lesion? eversion and dorsiflexion ( foot drop ) PED = Peroneal Everts and Dorsiflexes

Answer 154

What nerve injury results in loss of hip abduction ( trendelenberg sign )? Superior gluteal nerve injury injury is ipsilateral to extremity on which the patient stands

Answer 155

IFN-⍺ is a therapy useful for multiple sclerosis that may produce a flu-like syndrome.

Answer 156

What antiretroviral therapy is associated with a type IV hypersensitivity reaction (Stevens-Johnson)? Abacavir

Answer 157

Abacavir hypersensitivity is associated with the HLA-B 57:01 allele.

Answer 158

Didanosine is an NRTI most commonly associated with which adverse effect? Pancreatitis

Answer 159

What anti-retroviral drugs can have hyperglycemia due to insulin resistance? Protease inhibitors

Answer 160

What anti-retroviral can produce nephrolithiasis? Indinavir indigo princess

Answer 161

What combination therapy is used for the treatment of Cryptococcal meningitis? Amphotericin B/Flucytosine .

Answer 162

Itraconazole is an -azole that is used to treat Sporothrix schenckii sporotrichosis.

Answer 163

What purine analog is used to treat Hairy cell leukemia? Cladribine

Answer 164

{{c2::S. epidermidis is a coagulase-negative, gram + organism that infects prosthetic devices (hip implants, heart valves) and IV catheters by producing biofilms .

Answer 165

What are the CNS complications of Nocardia? Brain abscess formation

Answer 166

Nocardia is a filamentous-branching gram-positive organism that can cause a brain abscess (fever + FND).

Answer 167

A spiral fracture occurs in response to a twisting force on the bone.Highly specific for child abuse if seen in a child with a suspicious history (in questions anyways, in real life it seems a little more controversial)

Answer 168

What is the classical presentation for multiple myeloma? CRAB: Hypercalcaemia, Renal failure, Anemia and Bone pain (osteolytic) XR of affected sites, labs for hypercalcaemia, UA (Bence-Jones) and SPEP (first) (monoclonal spike)

Answer 169

What is the first choice treatment for anterior shoulder dislocation? Closed reduction Check for neurovascular (axillary) injuries BEFORE closed reduction is attempted

Answer 170

What test is used to test for DeQuervain's tenosynovitis? Finkelstein's Due to inflammation of the abductor pollicis longus and extensor pollicis brevis and commonly seen in new mothers (strain from lifting new baby)Finkelstein test: patients make first while cupping the thumb abduct the wrist towards the ulnar side pain

Answer 171

What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with an inconclusive FAST examination? Diagnostic peritoneal lavage (DPL) *DPL is only used for blunt, NOT penetrating abdominal trauma evaluation (penetrating trauma warrants immediate surgical laparotomy in this scenario)

Answer 172

What type of bursitis is seen with repetitive kneeling? Prepatellar bursitis ( housemaid's knee )

Answer 173

How should displaced scaphoid fractures be managed? Surgical intervention

Answer 174

What cardiac complication is associated with succinylcholine in patients with skeletal muscle trauma? Cardiac arrhythmia secondary to hyperkalemia due to efflux of K+ ions following binding of succinylcholine to post-synaptic ACh receptors; also may occur in patients with burn injury and stroke

Answer 175

What anesthetic is associated with adrenal insufficiency, especially in elderly and critically ill patients? Etomidate due to inhibition of 11β-hydroxylase

Answer 176

In patients with traumatic spinal cord injury, urinary catheter placement can assess for urinary retention and prevent acute bladder distention/damage.

Answer 177

Do umbilical hernias typically require surgical intervention? No (most close spontaneously before age 5) spontaneous closure is less likely with large umbilical hernias; surgery IS recommended around age 5 for persistent hernias or if symptomatic (constipation, vomiting, pain)

Answer 178

What is the initial intervention for the management of stress fractures of the 2nd, 3rd, or 4th metatarsals? rest and simple analgesics (e.g. acetaminophen) non-union is uncommon (more common in fractures of fifth metatarsal shaft)

Answer 179

Treatment of acute adrenal insufficiency includes hydrocortisone or dexamethasone with aggressive fluid support.may be triggered in susceptible patients following acute illness or surgery Patients may require fludrocortisone (may have decreased aldosterone levels and fludrocortisone has mineralocorticoid properties)

Answer 180

Prolonged post-operative ileus is characterized by hypo -active bowel sounds.

Answer 181

Mechanical bowel obstruction is characterized by hyper -active bowel sounds

Answer 182

What class of analgesics may contribute to prolonged post-operative ileus? Opiates

Answer 183

What is seen on a joint XR for pseudogout? Chondrocalcinosis

Answer 184

What is the best initial test for microscopic polyangiitis? p-ANCA/MPO-ANCA Biopsy of any affected area (skin, lung, nerve) is the most accurate test.

Answer 185

What head and neck infection is characterized by trismus, muffled voice, and deviation of the uvula on physical exam? Peritonsillar abscess (quinsy) other symptoms include fever, pharyngeal pain, and earache

Answer 186

What is the treatment for peritonsillar abscess? incision & drainage + antibiotics

Answer 187

What class of drugs may precipitate symptoms of sphincter of Oddi dysfunction? Opioid analgesics (e.g. morphine)

Answer 188

What is the treatment of choice for compartment syndrome? Fasciotomy

Answer 189

What is the most critical prognostic indicator for compartment syndrome? Time to fasciotomy Prognosis depends on the amount of time that has elapsed prior to performing the facsiotomy:-<6 hours = almost complete recovery-6-12 = first necrosis; 68% chance of normal limb function returning->12 h = necrosis and normal limb function returns in 8% of cases

Answer 190

What is the procedure of choice to identify the site and attempt early therapeutic intervention for massive hemoptysis (> 600 mL/day)? Bronchoscopy initial management involves establishing an adequate patent airway, ventilation, and hemodynamic stability; patients who continue to bleed despite bronchoscopy and/or pulmonary artery embolization may need urgent surgical intervention

Answer 191

What is the treatment for post-operative acute mediastinitis? drainage, debridement, and antibiotics symptoms include fever, chest pain, leukocytosis, and mediastinal widening on CXR

Answer 192

What trauma pathology occurs when > 3 continuous ribs are fractured in > 2 places? Flail chest

Answer 193

How does the flail chest segment move with inspiration? Moves inward (paradoxical chest wall motion) due to negative intrathoracic pressure

Answer 194

What is the treatment for gallstone ileus? surgical removal of stone and cholecystectomy

Answer 195

What is the most likely cause of superficial unilateral hip pain of the upper lateral thigh in a middle-aged adult? Trochanteric bursitis pain is exacerbated by external pressure (e.g. lying on hip when going to sleep) or with external rotation

Answer 196

Which Ig is elevated in Waldenstrom's? IgM Multiple myeloma more likely to show IgG, IgA, and light chains*Credit to Dope

Answer 197

What acid-base disturbance is expected in patients with atelectasis? Respiratory alkalosis due to hyperventilation to compensate for hypoxemia

Answer 198

What brain injury typically occurs from traumatic acceleration/deceleration shearing forces? Diffuse axonal injury patients typically have coma with head CT showing diffuse small bleeds at the gray-white junction

Answer 199

Subdural hematoma occurs due to tearing of bridging veins .classically presents with symptoms of headache and confusion that occur gradually (1-2 days)

Answer 200

What type of surgical infection presents with intense pain in the wound, decreased sensitivity at wound-edges, cloudy-gray discharge, +/- crepitus? Necrotizing infection Key Points and Symptoms1. Pain, edema, erythema beyond surgical site2. Systemic signs3. Paresthesia at edges of wound4. Cloud-gray, purulent discharge ( dishwater drainage )5. Subcutaneous gas or crepitus6. Occur commonly in paients with diabetes and are usually polymicrobial7. Most important step is surgical exploration and debridement

Answer 201

What syndrome is characterized by a triad of respiratory distress, neurologic dysfunction, and petechial rash? Fat embolism syndrome

Answer 202

What pathology classically presents with periumbilical abdominal pain out of proportion to PE findings? Acute mesenteric ischemia

Answer 203

What imaging modality is preferred for diagnosis of acute mesenteric ischemia? CT angiography Same for chronic mesenteric ischemiaColonoscopy is indicated for ischemic colitis

Answer 204

Evaluation of kidney injury in blunt genitourinary trauma should include urinalysis and contrast-enhanced CT of abdomen/pelvis (imaging) in hemodynamically stable patients with evidence of microscopic hematuria.may warrant retrograde cystourethrogram if patients have gross hematuria, difficulty urinating, blood at the meatus, or suprapubic pain

Answer 205

Hemodynamically unstable patients with evidence of renal trauma should undergo IV pyelography::imaging prior to surgical evaluation.think this might be controversial but who knows?

Answer 206

What are the most important early steps (2) for managing flail chest? pain control and supplemental O2

Answer 207

What is used to manage respiratory failure secondary to flail chest? mechanical positive pressure ventilation (PPV) improves oxygenation and causes the flail segment to move normally; can result in lung puncture with tension pneumothorax due to sharp rib segments

Answer 208

What hip movement (flexion or extension) worsens the pain associated with a psoas abscess? Hip extension i.e. the psoas sign

Answer 209

How does cardiac index change in septic shock? Increased important distinguishing feature from cardiogenic and hypovolemic shock

Answer 210

If a patient with septic shock fails to respond to IV fluids, then vasopressors (e.g. dopamine) should be started to improve perfusion

Answer 211

What is the initial management for patients with an appendiceal abscess? IV hydration, antibiotics, and bowel rest appendectomy should not be performed right away (may return in 6-8 weeks for elective appendectomy, though this is controversial)

Answer 212

What digestive enzyme may be elevated in patients with acute mesenteric ischemia? Amylase

Answer 213

What is the next step in management of a patient with diverticulitis complicated by an abscess > 3 cm? CT-guided percutaneous drainage surgical drainage can be attempted if percutaneous drainage fails

Answer 214

What is the most common cause of small-bowel obstruction (SBO) in the U.S? Adhesions typically result from abdominal operations or inflammatory processes

Answer 215

What anatomical landmark separates the upper and lower GI tracts? ligament of Treitz thus, this is useful for separating upper GI bleeds (e.g. melena) versus lower GI bleeds (e.g. hematochezia)

Answer 216

What is the underlying cause of hemorrhagic shock in a patient with decreased breath sounds, tracheal deviation, and dullness to percussion? Hemothorax each hemithorax is capable of holding up to 50% of circulating blood volume! Pneumothorax will have hyperresonance! Hemothorax: Collection of blood in the pleural space. Will have dullness on percussion. Hemothorax must always be drained, no matter the size, because blood in the pleural cavity will clot.

Answer 217

Dumping syndrome is a common post-gastrectomy complication due to rapid emptying of hyper -tonic gastric contents into the small intestine.causes a fluid shift from intravascular space to the small intestine, resulting in hypotension, autonomic reflex stimulation, and release of intestinal vasoactive peptides

Answer 218

What is the initial step in management of dumping syndrome? Dietary modification Large amounts of carb-rich food are emptied into small intestine, causing fluid shifts and sympathetic activation.

Answer 219

What is the preferred route of intubation in a cervical spine trauma patient without significant facial trauma? Orotracheal intubation also preferred in apneic/hyponeic patients, in which nasotracheal intubation is contraindicated

Answer 220

What knee injury presents acutely with catching/locking and reduced range of motion? Meniscal tear

Answer 221

What abdominal aortic aneurysm repair complication results in progressive abdominal pain and bloody diarrhea? Bowel ischemia/infarction due to inadequate perfusion after loss of IMA during aortic graft placement

Answer 222

In amputation injuries, amputated parts should be wrapped in saline -moistened gauze, sealed in a plastic bag, placed on ice and brought to the ED with the patient.Do not allow to come in direct contact with ice!

Answer 223

What nerve is at significant risk for injury during parotid gland dissection? Facial nerve

Answer 224

What cardiac catheterization complication presents with sudden hemodynamic instability and ipsilateral flank/back pain? Retroperitoneal hematoma typically occurs within 12 hours of catheterization; treatment is supportive

Answer 225

Diagnosis of a retroperitoneal hematoma is confirmed with non-contrast CT scan of abdomen/pelvis or abdominal ultrasound.

Answer 226

Which type of skin cancer is most likely to arise from chronically wounded, scarred, or inflamed skin? Squamous cell carcinoma SCC arising in chronic wounds tends to be more aggressive

Answer 227

What is the first step in the treatment of acute upper GI bleed (e.g. variceal hemorrhage) in a patient with a normal airway/breathing? Vascular access with 2 large-bore IV catheters Airway, Breathing, Circulation

Answer 228

Which side are varicoceles more common on? Left due to drainage into the left renal vein, which is vulnerable to compression between the SMA and aorta ( nutcracker effect )

Answer 229

What testicular mass is easily transilluminated? Hydrocele Surgical excision is spontaneous resolution does not occur by 1 year (avoids risk of indirect inguinal hernia)

Answer 230

What testicular mass is a painless fluid-filled cyst at the head of the epididymis? Spermatocele

Answer 231

What does the drop arm test test for? Rotator cuff tears (particularly the supraspinatus tendon)

Answer 232

What drug classes (2) are useful for the management of anal fissures? topical anesthetics and vasodilators e.g. lidocaine and nifedipine; initial management of anal fissures should include a high-fiber diet, stool softeners, and sitz baths

Answer 233

What is the most common cause of lower extremity edema? Venous insufficiency (valvular incompetence) classically worsens throughout the day and resolves overnight

Answer 234

What nerve is responsible for flexion at the hip and extension at the knee? Femoral nerve

Answer 235

What nerve is responsible for foot inversion and plantar flexion? Tibial nerve TIPs : Tibial Inversion Plantarflexion

Answer 236

What nerve provides sensation to the medial thigh? Obturator nerve

Answer 237

Gilbert syndrome is diagnosed by elevated levels of unconjugated bilirubin on repeat testing with normal LFTs and CBC.due to reduced bilirubin glucuronidation

Answer 238

What is used to assess for intraperitoneal hemorrhage in an alert, hemodynamically stable patient with blunt abdominal trauma? Focused Assessment with Sonography for Trauma (FAST)

Answer 239

What bacteria is the most common cause of acute bacterial parotitis? Staphylococcus aureus

Answer 240

What is the preferred method for diagnosis of peripheral arterial disease in symptomatic patients? Ankle-brachial index (ABI)

Answer 241

An ABI of < 0.90 is considered diagnostic of occlusive peripheral arterial disease (PAD) in symptomatic patients.

Answer 242

What BUN:creatinine ratio is indicative of prerenal acute kidney injury? > 20:1 other characteristic symptoms include oliguria and unremarkable urine sediment

Answer 243

What imaging test can confirm the diagnosis of ischemic colitis after a CT scan has been obtained? Colonoscopy Colonoscopy is the procedure of choice in mild-moderate cases of ischemic colitisBest test in acute/chronic mesenteric ischemia is CT angio

Answer 244

What areas (2) of the colon are most commonly effected by ischemic colitis? splenic flexure and rectosigmoid junction watershed areas

Answer 245

What nerve is most commonly damaged by fracture of the medial epicondyle of the humerus? Ulnar nerve

Answer 246

CXR showing a nasogastric tube in the pulmonary cavity is diagnostic of diaphragmatic hernia .other signs include deviation of mediastinal contents to opposite side and elevation of the hemidiaphragm

Answer 247

What imaging modality is used to confirm a diagnosis of duodenal hematoma? Abdominal CT

Answer 248

A critically ill patient is found to have gallbladder wall thickening/distention and pericholecystic fluid without gallstones on imaging studies, what is likely the diagnosis? Acalculous cholecystitis

Answer 249

What is the emergency treatment of choice for acalculous cholecystitis in a critically ill patient? antibiotics and percutaneous cholecystostomy followed by cholecystectomy when the medical condition stabilizesLikely 2/2 cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms

Answer 250

What is the initial management for a tension pneumothorax in a hemodynamically unstable patient? Urgent tube thoracostomy or needle decompression

Answer 251

Persistent pneumothorax and significant air leak following chest tube placement in a patient with blunt chest trauma suggests tracheobronchial rupture::diagnosis .other findings include pneumomediastinum and subcutaneous emphysema

Answer 252

Circumferential, full-thickness burns can result in eschar formation that restricts venous/lymphatic drainage, leading to acute compartment syndrome.may warrant surgical escharotomy to relieve pressure

Answer 253

What agents (2) may be used to rapidly reverse the effects of warfarin? fresh frozen plasma (FFP) or prothrombin complex concentrate (PCC) PCC contains factors II, VI, IX, X, C, and SEg. patient in Warfarin overdose (INR 5) who is bleeding

Answer 254

What bacteria is the most frequent cause of nosocomial bloodstream infection in patients with intravascular devices? Coagulase-negative staphylococci (e.g. S. epidermidis)

Answer 255

What neurological pathology presents with pain/temperature loss and muscle weakness in the upper extremities? Syringomyelia cape-like distribution

Answer 256

The three components of the Glasgow coma scale (GCS) are eye opening , verbal response , and motor response .useful for predicting the prognosis of coma and other medical conditions (e.g. traumatic brain injury, bacterial meningitis, etc.)

Answer 257

What is the recommended treatment for symptomatic meningioma (e.g. headache, seizure, weakness, etc.)? Surgical resection stereotactic radiosurgery (focused radiation) may be considered for partially resected or unresectable meningiomas; whole brain radiation is typically used for diffuse metastatic brain disease

Answer 258

What is the most essential part of management for an uncomplicated rib fracture (e.g. no hypotension, pneumothorax, etc.)? Pain control essential to maintain deep breathing and adequate cough, which helps prevent atelectasis and pneumonia

Answer 259

What is the recommended treatment for post-surgical DVT in a patient with ESRD? Unfractionated heparin followed by warfarin LMWH and factor Xa inhibitors are not recommended in ESRD because they are metabolized by the kidney

Answer 260

What life-threatening complication may occur due to contiguous spread of a retropharyngeal abscess? Acute necrotizing mediastinitis 1. penetrating trauma to posterior pharynx, causing retropharyngeal abscess formation 2. drainage to superior mediastinum 3. extension through alar fascia into the danger space , resulting in acute necrotizing mediastinitis

Answer 261

What blunt chest trauma complication presents with a triad of hypotension, distended neck veins, and distant heart sounds? Cardiac tamponade ( Beck's triad )

Answer 262

What tissue pressure is diagnostic of compartment syndrome? > 30 mmHg

Answer 263

What musculoskeletal pathology presents with subacute pain on abduction in patients who perform repetitive arm movement above shoulder height (e.g. painter)? Rotator cuff tendinopathy typically have normal ROM with positive impingement tests (e.g. Neers)

Answer 264

What blunt chest trauma complication is characterized by unilateral decreased breath sounds and patchy, irregular alveolar infiltrate on imaging? Pulmonary contusion **the infiltrate is NOT restricted by anatomical borders; other clinical features include tachypnea, tachycardia, hypoxia, and chest wall bruising

Answer 265

What type of cholecystitis arises due to infection of the gallbladder wall with gas-forming bacteria? Emphysematous cholecystitis treatment requires emergent cholecystectomy and broad-spectrum antibiotics

Answer 266

What is the likely diagnosis for a solid, hyperechoic liver mass in a young woman on oral contraceptives? Hepatic adenoma typically seen as a well-demarcated, hyperechoic lesion

Answer 267

Are hepatic adenomas typically benign or malignant? Benign possible long-term complications include progressive growth, rupture, and malignant transformation

Answer 268

Is needle biopsy recommended for a patient with a hepatic adenoma? No (due to risk of bleeding) surgical excision is preferred

Answer 269

Which form of dysphagia, oropharyngeal or esophageal, is characterized by coughing, choking, or nasal regurgitation on swallowing? Oropharyngeal

Answer 270

What is the preferred initial study to evaluate patients with suspected oropharyngeal dysphagia? Videofluroscopic modified barium swallow evaluates swallowing mechanics, degree of dysfunction, and severity of aspirationCharacterized by difficulty initiating a swallow; underlying etiologies include stroke, NMS disorders, Zenker diverticulum

Answer 271

What IBD complication presents with colonic dilation on X-ray and fever, tachycardia, leukocytosis, and/or anemia? Toxic megacolon may also have severe bloody diarrhea; highest risk of developing toxic megacolon is early on in the disease

Answer 272

Toxic megacolon is a medical emergency that requires nasogastric decompression, antibiotics, IV fluids +/- steroids (if IBD associated).if the colitis does not resolve, emergency surgery may be required

Answer 273

What is the likely diagnosis in a patient with extensive alcohol use who presents with severe retrosternal pain and subcutaneous emphysema after vomiting? Esophageal perforation (Boerhaave syndrome) other symptoms include dyspnea, odynophagia, and signs of sepsis; it is a surgical emergency

Answer 274

What is the first test or imaging study that should be ordered to diagnose pancreatitis in a patient with acute epigastric abdominal pain that radiates to the back? Serum amylase and lipase if amylase or lipase is > 3x normal, may not need confirmatory imaging for diagnosisOrder amylase and lipase to confirm diagnosis, then do imaging to identify the etiology (i.e. gallstones)

Answer 275

What imaging modality is most useful for diagnosing acute pancreatitis if laboratory testing is unclear? Contrast-enhanced CT scan nearly 30% of patients have an ileus with bowel gas that prevents ultrasound from fully visualizing the pancreas

Answer 276

What diagnosis should be suspected in patients with multiple duodenal ulcers refractory to treatment or ulcers distal to the duodenum? Zollinger-Ellison syndrome

Answer 277

What is the underlying cause of fat malabsorption in patients with Zollinger-Ellison syndrome? pancreatic enzyme inactivation due to excess gastric acid in the small intestine

Answer 278

Which trace mineral deficiency manifests as thyroid dysfunction and cardiomyopathy? Selenium deficiency risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition

Answer 279

Which trace mineral deficiency manifests as brittle hair, neurologic dysfunction, and sideroblastic anemia? Copper deficiency risk factors for deficiency include malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition

Answer 280

What is the colonoscopy screening recommendation for patients with Lynch syndrome (HNPCC)? begin at age 20-25; repeat every 1-2 years

Answer 281

The primary inciting event of acute cholecystitis is typically a gallstone obstructing the cystic duct , with subsequent inflammation and infection.

Answer 282

What surgical procedure is preferred for biliary drainage for patients with acute cholangitis? ERCP with sphincterotomy other options include percutaneous transhepatic cholangiography and open surgical decompression

Answer 283

What procedure should be done prior to endoscopic treatment in patients with an upper GI bleed who have a depressed level of consciousness and continued hematemesis? Endotracheal intubation these patients are at high risk for aspiration and must have their airway protected before upper endoscopy

Answer 284

What hormone analog is useful for the treatment of variceal hemorrhage? Octreotide (somatostatin analog) causes splanchnic vasoconstriction and reduces portal blood flow by inhibiting release of glucagon; prophylactic antibiotics (e.g. IV ceftriaxone) should be administered as well

Answer 285

What is the likely diagnosis in an elderly patient with conjugated hyperbilirubinemia, elevated alkaline phosphatase, and painless jaundice? Malignant biliary obstruction

Answer 286

What is the likely diagnosis in a patient with melena and epigastric abdominal pain that is relieved with eating? Peptic ulcer disease (duodenal ulcer)

Answer 287

What is the likely diagnosis in a young patient with liver disease and neuropsychiatric symptoms? Wilson disease

Answer 288

Low serum ceruloplasmin with elevated urinary copper excretion suggests a diagnosis of Wilson disease .other diagnostic features include Kayser-Fleischer rings and increased copper content on liver biopsy

Answer 289

Which form of inflammatory bowel disease is characterized by mucosal inflammation and crypt abscesses on biopsy? Ulcerative colitis

Answer 290

Which form of inflammatory bowel disease is characterized by transmural inflammation and non-caseating granulomas on biopsy? Crohn disease

Answer 291

What is the recommended management for variceal hemorrhage if there is continued bleeding after endoscopic therapy? Balloon tamponade (until TIPS or shunt surgery)

Answer 292

Porcelain gallbladder is associated with an increased risk for gallbladder adenocarcinoma and usually requires cholecystectomy.often found in patients with chronic cholecystitis

Answer 293

Which form of inflammatory bowel disease is characterized by continuous colonic involvement? Ulcerative colitis

Answer 294

Dilation of the pancreatic duct and common bile duct (double duct sign) may occur with tumors of the head of the pancreas.i.e. both intra- and extra-hepatic biliary tract dilation

Answer 295

What imaging modality is used to aid in the diagnosis of toxic megacolon? Abdominal X-ray diagnosis made by radiologic evidence of colonic distention with manifestations of severe systemic toxicity

Answer 296

What is the likely diagnosis in a patient with episodes of dysphagia, regurgitation, and chest pain with radiation to the back that is precipitated by emotional stress? Diffuse esophageal spasm symptoms may be relieved by nitrates or calcium channel blockers, which relax myocytes in the esophagus

Answer 297

What test is used to establish the diagnosis of spontaneous bacterial peritonitis? Paracentesis diagnostic criteria: positive ascites fluid culture and PMN > 250/mm3; should be done before antibiotic therapy, which often results in negative ascites cultures

Answer 298

What AST:ALT ratio is indicative of heavy alcohol use? >2:1 AST:ALT

Answer 299

What is the likely diagnosis in a patient with fever, jaundice, tender hepatomegaly, and AST:ALT ratio > 2? Alcoholic hepatitis

Answer 300

What is the underlying cause of edema in patients with cirrhosis? Hypoalbuminemia (synthetic dysfunction)

Answer 301

What imaging modality is preferred for diagnosis of chronic mesenteric ischemia? CT angiography Same for acute mesenteric ichemia

Answer 302

What pharmaceutical therapy is recommended for prophylactic treatment of non-bleeding esophageal varices? Non-selective beta blockers (e.g. propanolol, nadolol) endoscopic variceal ligation can be used as an alternate primary prevention therapy in patients with contraindications to beta blockers

Answer 303

CXR findings consistent with esophageal perforation include left-sided pleural effusion, subcutaneous emphysema, and widened mediastinum.pleural effusion is typically left-sided because the esophagus is positioned on the left anatomically

Answer 304

Patients who complain of persistent abdominal pain after cholecystectomy should be evaluated for post-cholecystectomy syndrome. evaluated via abdominal imaging (e.g. ultrasound) followed by direct visualization (e.g. ERCP, MRCP) to find the causative factor

Answer 305

The absolute values of AST and ALT in alcoholic hepatitis are almost always < 500 IU/L.usually < 300 IU/L (versus other causes of hepatitis, which cause much greater elevations)

Answer 306

What is the likely diagnosis for a patient with an acute, massive increase in AST/ALT in the setting of hypotension? Ischemic hepatic injury (shock liver) often accompanied by modest elevations in total bilirubin and alkaline phosphatase

Answer 307

What is the most common source of liver metastases? Colorectal cancer in addition to tumors of the GI tract, lung and breast tumors also commonly metastasize to the liver

Answer 308

Does achalasia result in dysphagia to solids, liquids, or both? Both

Answer 309

What test is most accurate for diagnosis of achalasia? Esophageal manometry findings include high LES resting pressure and incomplete LES relaxation; barium esophagram is sometimes used as an initial test

Answer 310

What is the likely diagnosis in a patient with chronic, episodic epigastric pain that suddenly worsens (X-ray findings below)? Imaging previously showed gallstones in the gallbladder. Perforated peptic ulcer

Answer 311

What tuberculosis drug is most commonly associated with liver injury? Isoniazid idiosyncratic injury with histological features similar to those seen with viral hepatitis (e.g. hepatic cell necrosis, mononuclear infiltration)

Answer 312

What is the likely diagnosis in a patient status-post Roux-en-Y gastric bypass surgery who presents with abdominal bloating, diarrhea, and macrocytic anemia? Small intestinal bacterial overgrowth Macrocytic anemia due to vitamin B12 and folate deficienciesBacteria deconjugate bile acids and increase vitamin B12 turnover

Answer 313

Small intestinal bacterial overgrowth may be diagnosed via carbohydrate breath testing or jejunal aspirate/culture.

Answer 314

Primary biliary cholangitis is an autoimmune disease characterized by destruction of intra -hepatic bile ducts.

Answer 315

What antibody is characteristically elevated in primary biliary cholangitis? Anti-mitochondrial antibody

Answer 316

What pharmaceutical treatment is helpful for delaying the progression of primary biliary cholangitis? Ursodeoxycholic acid should be initiated as soon as the diagnosis of PBC is made; patients with advanced disease may require liver transplantation

Answer 317

What is the next step after an endoscopic biopsy is positive for gastric adenocarcinoma? CT scan of abdomen/pelvis imaging helps with disease staging, which determines prognosis and treatment options

Answer 318

What is the first-line treatment for diffuse esophageal spasm? Calcium channel blockers (e.g. diltiazem) alternatives include nitrates or TCAs

Answer 319

Patients with small intestinal mucosal disease (e.g. Celiac) will have decreased levels of urinary D-xylose.D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel

Answer 320

Patients with enzyme deficiencies (e.g. pancreatic insufficiency, lactose intolerance) will have normal levels of urinary D-xylose.D-xylose is a monosaccharide that only depends on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel

Answer 321

What is the likely diagnosis in a patient with abdominal pain and hematemesis following recent use of alcohol, aspirin, and cocaine? Acute erosive gastropathy characterized by development of severe hemorrhagic lesions after exposure to various injurious agents Hallmark is development of hemorrhagic and erosive lesions shortly after exposure of gastric mucosa to various substances or reduction in mucosal blood flow. Things like NSAIDs and alcohol (direct injury) or burns, sepsis, trauma (hypoxia of mucosa) cause loss of the protective barrier and permits acid and other substances to penetrate into the laminate propria.

Answer 322

What dietary habits decrease the risk of diverticulosis complications (e.g. hemorrhage, diverticulitis)? High fiber intake physical activity is also inversely correlated with the risk of complications

Answer 323

What imaging test is used to evaluate bright red blood per rectum in a patient > 50 years old or < 50 years old with risk factors for CRC? Colonoscopy

Answer 324

A positive urine urobilinogen assay is typically indicative of a buildup of unconjugated bilirubin.excess unconjugated bilirubin (water insoluble) undergoes regular conjugation, forming urobilinogen, which is excreted in urine and feces

Answer 325

What imaging modality is recommended to evaluate patients with suspected gallstone pancreatitis? Ultrasound (RUQ) CT is not as sensitive as US for detecting gallstones

Answer 326

What is the most significant environmental risk factor for pancreatic cancer? Smoking Alcohol can cause chronic pancreatitis, which is associated with increase risk of pancreatic cancer, but it is not as significant as association bt. smoking and pancreatic cancer

Answer 327

What is the likely diagnosis in an elderly man with dysphagia, regurgitation, halitosis, and aspiration? Zenker's diverticulum treatment is generally surgical

Answer 328

What is the test of choice for confirming the diagnosis of Zenker's diverticulum? Barium esophagram

Answer 329

What is the underlying etiology behind most MALT lymphomas of the stomach? H. pylori infection those with early-stage MALT lymphoma and confirmed H. pylori infection typically achieve complete remission with antibiotic treatment

Answer 330

What is the likely diagnosis in a patient with diverticulosis, pneumaturia, and frequent UTI? Colovesical fistula

Answer 331

What imaging study is used to confirm the diagnosis of a colovesical fistula? Abdominal CT with oral or rectal contrast (not IV)

Answer 332

What antibiotic should be started for patients with severe C. difficile colitis (WBC 15-20,000/mm3) (and what is the route of delivery)? Oral vancomycin Not IV -- C. diff is one of the rare indications for ORAL vancomycin (in C. difficile infections, however, intravenous administration is ineffective, as vancomycin is hardly excreted into the colon (the main site of infection)

Answer 333

What is the initial management for a patient with suspected GERD who has a bitter taste, substernal chest pain, dysphagia and weight loss? Endoscopy

Answer 334

Which type of esophageal cancer is associated with GERD, Barrett esophagus, and obesity? Adenocarcinoma

Answer 335

What test/imaging study is used to diagnose esophageal cancer? Endoscopy with biopsy may use CT or PET/CT for staging

Answer 336

What is the likely diagnosis in a middle-aged man with fatigue, pruritus, ulcerative colitis, and elevated alkaline phosphatase? Primary sclerosing cholangitis

Answer 337

What antibody is associated with primary sclerosing cholangitis? p-ANCA

Answer 338

What biliary disease is characterized by a beads-on-a-string appearance on imaging? Primary sclerosing cholangitis

Answer 339

What is the likely diagnosis in an elderly patient with chronic constipation, LLQ abdominal pain, fever, and leukocytosis? Acute diverticulitis

Answer 340

What test/imaging study is used for diagnosis of acute diverticulitis? Abdominal CT scan (oral and IV contrast)

Answer 341

Zenker diverticulum occurs due to posterior herniation between the fibers of the cricopharyngeal muscle.immediately above the upper esophageal sphincter

Answer 342

Are lung adenocarcinomas typically centrally or peripherally located? Peripherally

Answer 343

What is the test of choice to diagnose pulmonary embolism in clinically stable patients with a high likelihood of PE (modified Wells > 4)? CT angiography in patients with low likelihood of PE (modified Wells < 4), D-dimer testing can help rule out PE due to high negative predictive value

Answer 344

What is the next step in management for a patient with severe asthma exacerbation with an elevated PaCO2? Endotracheal intubation Patients with asthma exacerbation often have tachypnea, which should lead to low CO2 -- a normal or elevated PaCO2 suggests impending respiratory failure (inability to meet increased respiratory demands)

Answer 345

What is the best test to differentiate asthma from COPD? Spirometry before and after an inhaled bronchodilator reversal of airway obstruction suggests asthma; partial or non-reversal suggests COPD

Answer 346

What is the likely diagnosis in a young man with an anterior mediastinal mass and elevated β-hCG/AFP? Non-seminomatous germ cell tumor

Answer 347

Transudative pleural effusions are characterized by < 0.5 (low) pleural/serum protein ratio.

Answer 348

What is the recommended anticoagulation for pulmonary embolism in a patient with severe renal insufficiency (GFR < 30 mL/min/1.73m2)? Unfractionated heparin followed by warfarin LMWH and factor Xa inhibitors are not recommended in renal insufficiency because they are metabolized by the kidneyWarfarin is preferred long-term oral anticoagulant in ESRD patients, but needs to be bridged first

Answer 349

What is the initial treatment of choice in asymptomatic or mildly symptomatic patients with SIADH? Fluid restriction +/- salt tablets

Answer 350

What is the recommended treatment for patients with SIADH who have severe hyponatremia (e.g. seizures, coma)? Hypertonic (3%) saline

Answer 351

What is the likely diagnosis in a patient with significant smoking history who presents with shoulder pain, weight loss, and the imaging findings below? Pancoast (superior sulcus) tumor other common manifestations are Horner syndrome, C8-T2 neurological involvement, and SVC syndrome

Answer 352

Patients with COPD and signs of right heart failure or hematocrit > 55% should be started on long term home oxygen if PaO2 < 59 mmHg or SaO2 < 89 %.has been shown to prolong survival and improve quality of lifeResting PaO2 <55 or SaO2 <88 if no evidence of RHF or Hct <55

Answer 353

What is the likely underlying etiology in a patient with bronchiectasis predominantly in the upper lobe and sputum cultures positive for Pseudomonas aeruginosa? Cystic fibrosis

Answer 354

Is smoking cessation associated with a mortality benefit in patients with COPD? Yes decreased mortality and reduced progression of disease

Answer 355

What is the likely diagnosis in a patient with sinusitis, lung nodules/cavitations, and elevated creatinine? Granulomatosis with polyangiitis (formerly Wegener's) upper and lower respiratory tract granulomatous inflammation and glomerulonephritis

Answer 356

What autoantibody is classically elevated in granulomatosis with polyangiiitis? ANCA (typically c-ANCA/Proteinase 3-ANCA) Aids with diagnosis; definitive diagnosis made with tissue biopsy showing granulomatous inflammationFormerly Wegener's

Answer 357

What regions of the lung are most commonly involved in supine patients with aspiration pneumonia? posterior segments of upper lobe and superior segments of lower lobe

Answer 358

What is the likely diagnosis in a patient with respiratory distress, hypoxemia, and diffuse, bilateral alveolar infiltrates not due to CHF/fluid overload? Acute respiratory distress syndrome

Answer 359

How does the PaO2/FiO2 ratio change in patients with ARDS? Decreased (< 300 mmHg) PaO2 decreases and leads to an increased FiO2 requirement; lower P/F values indicate more severe ARDS

Answer 360

What is the likely diagnosis in a patient with an extensive smoking history who presents with digital clubbing and sudden-onset arthropathy of the hand/wrist? Hypertrophic osteoarthropathy often associated with lung cancer, therefore CXR is indicated to rule out malignancy or other lung pathologyMost common causes are lung malignancies, cystic fibrosis, and right-to-left cardiac shunts

Answer 361

What is the likely diagnosis in a patient on a ventilator who develops hypotension, tachycardia, and unilateral absence of breath sounds? Pneumothorax due to positive pressure ventilation; hypotension and tachycardia result from impaired right ventricular filling secondary to compression of the IVC

Answer 362

What is the likely diagnosis in a patient with COPD who presents with JVD, hepatomegaly, and pitting edema? Cor pulmonale i.e. RHF from pulmonary hypertension

Answer 363

What is the treatment of Sporothrix schenckii? Itraconazole (1st-line), potassium iodide (not used anymore)

Answer 364

Patients using asthma inhalers or oral steroids are at risk of oral Candidiasis::fungal .

Answer 365

What is the likely diagnosis in a patient with a recent URI and a persistent productive cough with blood-tinged sputum without fever or significant CXR findings? Acute bronchitis Pulmonary airway disease (chronic bronchitis bronchogenic carcinoma, bronchiectasis) is the most common cause of hemoptysis in adultsTreatment is supportive

Answer 366

What is the recommended management for symptomatic acute bronchitis? NSAIDs, bronchodilators (symptomatic treatment) Antibiotics are not recommended May see small amounts of hemoptysis due to inflammation and epithelial damage

Answer 367

How does residual volume, FRC, and total lung capacity change with obstructive lung disease (e.g. COPD)? Increase decreased elasticity of alveoli results in decreased collapsing pressure, thus alveoli retain more air (air trapping)

Answer 368

What is the likely diagnosis in an obese patient with daytime hypercapnia, hypoxemia, and respiratory acidosis? Obesity hypoventilation syndrome Defined by obesity (BMI >30), daytime hypercapnia (PaCO2 >45), and alveolar hypoventilation

Answer 369

What is the most common trigger of acute COPD exacerbation? Upper respiratory infection (URI) examination often reveals wheezes, tachypnea, prolonged expiration, and use of accessory muscles

Answer 370

What is the likely diagnosis in an immunocompromised patient with fever, chest pain, hemoptysis and pulmonary nodules with ground-glass opacities on CT scan? Invasive aspergillosis Triad of fever, CP, hemoptysis and immunocompromised

Answer 371

What is the next step in management for a solitary pulmonary nodule discovered on routine CXR? Review previous CXR

Answer 372

What is the likely diagnosis in a young patient with minimal smoking history who presents with progressive dyspnea, cough, and bilateral basilar hyperlucency on CXR? Alpha-1 antitrypsin deficiency classically presents with panacinar emphysema that results in greater destruction of the lower lobes; also is associated with liver disease

Answer 373

Pleural effusion and atelectasis result in decreased breath sounds, decreased tactile fremitus, and dullness to percussion.fluid is present outside the lung in the thoracic cavity, which insulates breath sounds and vibration (fremitus) originating within the lung

Answer 374

What is the likely diagnosis in a young male with hemoptysis and hematuria without history of sinusitis? Goodpasture's disease granulomatosis with polyangiitis can cause hemoptysis and hematuria with upper airway involvement (e.g. sinusitis, otitis media, etc.)

Answer 375

Restrictive lung disease is characterized by an FEV1/FVC ratio > 70 % of predicted.however, the individual values for both FEV1 and FVC are decreased

Answer 376

All patients with acute COPD exacerbation should receive inhaled bronchodilators and systemic corticosteroids .Supplemental O2, antibiotics, and ventilatory support should be administered when indicatedBronchodilators include anti-cholinergic (ipratropium, tiotropium) and beta-agonists

Answer 377

In mechanically ventilated patients, plateau pressure is equal to the sum of elastic pressure + PEEP .measured during an inspiratory hold maneuver; elastic pressure is a measure of tidal volume/compliance

Answer 378

Interstitial lung disease is characterized by a low DLCO.

Answer 379

What is the likely diagnosis in a patient who develops respiratory failure, hypotension, and DIC immediately post-partum? Amniotic fluid embolism

Answer 380

What CXR finding is characteristic of epiglottitis? Thumbprint sign (enlarged epiglottis)

Answer 381

Extrinsic causes of restrictive lung disease are characterized by a normal DLCO.e.g. myasthenia gravis, ALS

Answer 382

What is the likely diagnosis in a patient with sudden-onset pleuritic chest pain, hemoptysis, dyspnea, and the CT findings below? Pulmonary embolism chest CT scan showing a wedge-shaped infarction (red arrows) is virtually pathognomonic for PE (Hampton’s Hump)

Answer 383

What type of pleural effusion, transudative or exudative, is commonly seen with pneumonia (e.g. parapneumonic effusion)? Exudative

Answer 384

What is the likely diagnosis in a patient with mild hypoxemia, tachypnea, and CXR infiltrates hours after an episode of aspiration? Aspiration pneumonitis Gastric acid induces a chemical burn with a consequent inflammatory response; resolves with supportive management Treatment is supportive.

Answer 385

Which part of the mediastinum (anterior, middle, posterior) are bronchogenic cysts usually found? Middle mediastinum -bifurication of the trachea occurs in the middle mediastinum, so the bronchi are obviously located in the MM-other middle mediastinal masses include tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms of the arch 1) Anterior mediastinum: 4 T's--- Thymoma--- Thyroid neoplasm--- Teratoma--- Terrible lymphoma2) Middle mediastinum--- Bronchogenic cyst--- Tracheal tumor--- Pericardial cyst--- Lymphoma--- Lymph node enlargement--- Aortic arch aneurysm3) Posterior mediastinum--- Meningocele--- Enteric cyst--- Lymphoma--- Diaphragmatic hernia--- Esophageal tumor--- Aortic aneurysm

Answer 386

The diagnosis of asthma can be made in patients with normal or increased DLCO and a > 12 % increase in FEV1 following bronchodilator administration. patients with COPD typically have a decreased DLCO and < 12% increase in FEV1 after bronchodilators

Answer 387

Which type of lung cancer is associated with hypercalcemia (ectopic PTHrP production)? Squamous cell carcinoma

Answer 388

What is the underlying etiology in a patient with severe COPD who develops altered consciousness and seizures after administration of supplemental O2? O2-induced CO2 retention Normal respiratory drive regulated by CO2COPD patients have chronic failure so are accustomed to high CO2Thus, in COPD, reduction of O2 = trigger of respiratory driveGive COPD pt. O2 = loss of trigger = reduced RR = CO2 retention = hypercapniapatients have a decreased respiratory drive and loss of compensatory vasoconstriction

Answer 389

What is the likely cause of dyspnea in patients with ankylosing spondylitis? Limited chest and spinal mobility causes a restrictive pattern on PFTs with an normal or increased FRC (due to fixation of rib cage in an inspiratory position)

Answer 390

What is the recommended management for a patient with uremic encephalopathy? Hemodialysis

Answer 391

The indications for urgent dialysis may be remembered with the mnemonic AEIOU : A: Acidosis (pH < 7.1 refractory to medical therapy) E: {{c2::Electrolyte abnormalities (symptomatic or severe hyperkalemia) I: {{c3::Ingestion O: {{c4::Overload (refractory to diuretics) U: {{c5::Uremia (symptomatic)

Answer 392

What is the next step in management for a patient with acute renal failure and oliguria with evidence of significant urine retention? Bladder catheterization may also place a catheter if the bladder scan is inconclusive

Answer 393

What is the immediate treatment for severe hypercalcemia (> 14mg/dL or symptomatic)? Saline hydration + calcitonin hypercalcemia may induce nephrogenic diabetes insipidus leading to polyuria and fluid loss; other symptoms include weakness, GI distress, and neuropsychiatric symptoms

Answer 394

What is the treatment of choice for severe hypovolemic hypernatremia? 0.9% saline (isotonic) until euvolemic, then 5% dextrose (hypotonic) patients may also be switched to 0.45% saline instead of 5% dextrose

Answer 395

What is the likely diagnosis in a patient with elevated BUN and creatinine (< 20:1 ratio) after an episode of hypovolemic shock? Acute tubular necrosis characterized by muddy brown casts; distinguishing features from pre-renal AKI include BUN:creatinine ratio < 20:1, urine Na+ > 20 mEq/L, and FeNA > 2% Look at your fucking BUN:Cr. Do not let these fucker’s trick you— ATN can be produced by ischemia, so don’t always jump to pre-renal azotemia (BUN:Cr >20:1)

Answer 396

Nephrotic syndrome may result in a hyper -coagulable state.manifests as venous or arterial thrombosis, most commonly renal vein thrombosis; other complications include protein malnutrition, iron-resistant microcytic hypochromic anemia, increased susceptibility to infection, and vitamin D deficiency

Answer 397

What is the most common malignancy associated with painless hematuria in adults? Bladder tumors especially patients age > 35 with a smoking history

Answer 398

What is the likely cause of acute renal failure in a patient with high anion and osmolal gap metabolic acidosis and calcium oxalate crystals on urinalysis? Ethylene glycol poisoning calcium oxalate crystals are described as envelope-shaped

Answer 399

What is the likely diagnosis in a patient with colicky flank pain that radiates to the groin? Nephrolithiasis

Answer 400

What is the recommended treatment for a patient with a 4 mm kidney stone (first episode)? Hydration (> 2 L fluid intake daily) stones < 5 mm typically pass spontaneously with conservative management; supportive therapy for pain and nausea may be initiated as well

Answer 401

Treatment options for K+ removal from the body in patients with hyperkalemia include diuretics , cation exchange resins, and hemodialysis.an example of a cation exchange resin is sodium polystyrene sulfonate

Answer 402

What is the likely diagnosis in a euvolemic patient with low serum osmolality (< 275 mOsm/kg) and normal/high urine osmolality (> 100 mOsm/kg)? SIADH also typically have elevated urine sodium concentration (> 40 mEq/L)

Answer 403

What is the likely diagnosis in a patient who presents with periorbital swelling and hematuria three weeks after a skin infection? Post-streptococcal glomerulonephritis urinalysis may show hematuria with RBC casts and mild proteinuria; additionally, C3 complement levels are low

Answer 404

What is the most common cause of death in dialysis and renal transplant patients? Cardiovascular disease accounts for approximately 50% of all deaths in dialysis patients

Answer 405

What imaging modality is preferred for diagnosis of renal cell carcinoma? CT scan of the abdomen

Answer 406

What is the likely diagnosis in an adolescent with recurrent kidney stones and hexagonal crystals on urinalysis? Cyanide nitroprusside test is positive. Cystinuria due to defective transport of dibasic amino acids (cystine, lysine, arginine, and ornithine); stones are classically hard and radiopaque

Answer 407

Which type of nephrotic syndrome is associated with HIV, heroin use, and obesity? Focal segmental glomerulosclerosis (FSGS)

Answer 408

Which types of nephrotic syndrome (2) are associated with hepatitis B infection? membranous nephropathy (more common) and MPGN

Answer 409

What type of kidney stone commonly affects patients with Crohn disease or other causes of fat malabsorption? Calcium oxalate stones non-absorbed fat binds Ca2+ in the gut, preventing Ca2+ from binding oxalate (insoluble) and consequently increasing free oxalate (soluble) absorption

Answer 410

Patients with Crohn disease have increased risk for kidney stones due to increased absorption of oxalate .Ca2+ normally binds oxalate in the gut and prevents its absorption; Remember the terminal ileum is most commonly affected, which affects fat absorption -- unabsorbed fat preferentially binds Ca2+ leaving oxalate unbound and free to be absorbed

Answer 411

What is the next step in evaluation of acute kidney injury in an elderly patient with BPH who presents with rising creatinine and urinary urgency without hematuria, weight loss, or elevated PSA? Renal ultrasound helps assess for hydronephrosis and other causes of obstruction

Answer 412

What is the treatment of choice for uremic coagulopathy? Desmopressin (DDAVP) increases release of factor VIII-vWF multimers from endothelial storage sites; platelet transfusion is not indicated

Answer 413

What is the likely diagnosis in a patient with hematuria a few days after an upper respiratory infection with normal complement levels? IgA nephropathy quicker onset (within 5 days) and normal complement levels help differentiate IgA nephropathy from PSGN

Answer 414

What is the likely diagnosis in a patient who overdosed on cocaine and presents with elevated K+ and creatine phosphokinase (CPK)? Rhabdomyolysis another key clinical feature is a positive urine dipstick for blood, but no RBCs seen on microscopy (due to myoglobin in the urine)

Answer 415

The main danger associated with creatine phosphokinase (CPK) levels greater than 20,000 U/L is acute tubular necrosis due to myoglobinuria.treatment involves aggressive hydration +/- mannitol and urine alkalinization

Answer 416

Pyelonephritis in otherwise stable, non-pregnant patients may be managed with fluoroquinolones .oral (outpatient) or IV (inpatient); more severe infections may require IV broad-spectrum antibiotics (e.g. ceftriaxone)

Answer 417

What is the likely diagnosis in a female with bladder pain that is relieved with voiding, as well as dyspareunia, urinary frequency/urgency, and normal urinalysis? Interstitial cystitis (painful bladder syndrome) treatment is palliative and includes trigger avoidance, amitriptyline, and analgesics

Answer 418

What is the likely ingested agent in a patient who overdosed and presents with fever, tinnitus, and tachypnea? Aspirin causes mixed respiratory alkalosis and anion gap metabolic acidosis

Answer 419

What is the likely diagnosis in a euvolemic patient with high serum osmolality and low urine osmolality? Diabetes insipidus (central or nephrogenic) common cause of euvolemic hypernatremia

Answer 420

What type of kidney stone is characterized by needle-shaped crystals on urinalysis and radiolucency? Uric acid stones radiolucent therefore must be evaluated by abdominal CT, ultrasound, or IV pyelography (not X-ray)

Answer 421

Which type of hematuria, glomerular or non-glomerular, is associated with gross hematuria and no proteinuria? Non-glomerular hematuria

Answer 422

What is the likely cause of anion gap metabolic acidosis in a patient with a recent seizure? Postictal lactic acidosis transient and typically resolves without treatment within 90 minutes following resolution of seizure activity

Answer 423

What is the likely diagnosis in a cirrhotic patient with decreasing GFR, normal urinalysis, lack of improvement with IV fluids, and no other renal dysfunction? Hepatorenal syndrome common inciting factors include spontaneous bacterial peritonitis and GI bleeding

Answer 424

Hepatorenal syndrome occurs due to splanchnic arterial dilation, which results in decreased vascular resistance and activation of the RAAS.activation of RAAS results in renal vasoconstriction with subsequent renal hypoperfusion and decreased GFR

Answer 425

What is the most important intervention for preventing contrast-induced nephropathy? Adequate IV hydration with isotonic bicarbonate or normal saline; acetylcysteine administration may reduce risk as well

Answer 426

What is the likely diagnosis in a patient who develops a spike in creatinine a day after having a CT with IV contrast? Contrast-induced nephropathy transient increase that normalizes within 5-7 days; higher risk in patients with elevated baseline creatinine and diabetes

Answer 427

Which type of nephrotic syndrome is most commonly associated with renal vein thrombosis? Membranous nephropathy may present acutely with abdominal pain, fever, and hematuria or gradually as worsening renal function and proteinuria in an asymptomatic patient (more common)Also, patients with SLE can get membranous nephropathy, making them even more hypercoagulable

Answer 428

What is the initial treatment for prerenal acute kidney injury? IV normal saline need to restore renal perfusion and prevent development of acute tubular necrosis

Answer 429

What side effect may thiazide diuretics have on serum Na+ levels? Hyponatremia

Answer 430

What is the likely diagnosis in a patient with a recent seizure who has a large amount of blood on urinalysis with few RBCs on microscopy? Myoglobinuria (secondary to rhabdomyolysis) urinalysis cannot detect the difference between hemoglobin and myoglobin but microscopic exam for RBCs can add clarity

Answer 431

What is the likely diagnosis in a hepatitis C patient with palpable purpura, hematuria, proteinuria, and low serum complement? Mixed cryoglobulinemia other symptoms include arthralgias, hepatosplenomegaly, peripheral neuropathy, and non-specific systemic symptomsArthalgias d/t cryoglobulinemia

Answer 432

What is the most common type of kidney stone? Calcium oxalate

Answer 433

In addition to IV hydration and a low-purine diet, uric acid kidney stones may be treated with potassium citrate .potassium citrate alkalinizes the urine making uric acid stones more soluble

Answer 434

What is the recommended treatment for patients with a CHA2DS2-VASc score > 2? Oral anticoagulants e.g. warfarin or non-vitamin K antagonist oral anticoagulants (e.g. apixaban, dabigatran, rivaroxaban, edoxaban)

Answer 435

What is the likely diagnosis in a patient with pitting edema and leg pain that is worse in the evening accompanied by varicose veins and skin ulceration? Chronic venous insufficiency (CVI) skin ulceration is classically on the medial aspect of the lower leg; some risk factors for CVI include advancing age, obesity, family history, and sedentary lifestyle

Answer 436

What is the treatment of choice for Dressler's syndrome? NSAIDs anticoagulation should be avoided to prevent development of hemorrhagic pericardial effusion

Answer 437

What is the likely diagnosis in a young patient with abrupt onset tachycardia and palpitations? Paroxysmal supraventricular tachycardia (PSVT) typically due to an atrioventricular nodal re-entrant tachycardia

Answer 438

What is the initial treatment of choice for a patient with persistent tachyarrhythmia with associated hemodynamic instability? Immediate synchronized cardioversion energy delivered is synchronized to the QRS complex to minimize the likelihood of the shock occuring during repolarization, which can precipitate ventricular fibrillation

Answer 439

What is the likely diagnosis in a COPD patient with JVD, hepatomegaly, and pitting edema? Cor pulmonale

Answer 440

What is the initial management of choice (besides pain control) for patients with type B aortic dissection? IV beta blockers (e.g. labetalol, esmolol, propanolol) results in decreased HR, BP, and LV contractility (less aortic wall stress)

Answer 441

What is the most common causes of constrictive pericarditis in the United States? Viral or idiopathic (>40%) other common causes include radiation therapy (30%), cardiac surgery (10%), uremia, and connective tissue disordersTuberculosis common in developing countries

Answer 442

What electrolyte abnormality may potentiate the effects of digoxin? Hypokalemia

Answer 443

What is the recommended treatment to reduce risk of stent thrombosis following drug-eluting stent placement? Dual antiplatelet therapy for at least 12 months i.e. aspirin and a P2y12 receptor blocker (e.g. clopidogrel, prasugrel, ticagrelor)

Answer 444

What is the likely diagnosis in a patient with a history of peripheral arterial disease that presents with pain, pallor, paresthesias, and pulselessness in one limb? Acute limb ischemia e.g. due to arterial thrombosis

Answer 445

What is the most common location of ectopic foci that cause atrial fibrillation? Pulmonary veins Three steps perpetuate a vicious cycle in AF:AF is initiated by one or both of mechanisms:1. Burst of activity from foci near pulmonary veins or in diseased fibrosed atrial tissue2. Pre-excitation of atria as result of aberrant pathways (WPW)AF is sustained by reentry rhtyhms or rapid focal ectopic firingAtrial remodeling which further predisposes the patient to AF

Answer 446

Atrial flutter is most commonly caused by a re-entrant circuit around the tricuspid annulus .

Answer 447

What is the likely diagnosis in a patient with hypotension, distended neck veins, and muffled heart sounds? Cardiac tamponade this is classically known as Beck's triad ; symptoms are due to an exaggerated shift of the interventricular septum toward the left ventricular cavity (decreases LV preload, SV, and CO)

Answer 448

What is the likely diagnosis in a patient with Marfan syndrome that presents with sudden-onset tearing chest pain? Aortic dissection

Answer 449

What CXR finding is often found in patients with coarctation of the aorta? Notching of the ribs also may have a 3 sign due to indentation of the aorta with pre- and post-stenotic dilation

Answer 450

What is the likely diagnosis in a patient with sharp, localized chest pain that is worsened with inspiration and tender to palpation? Costochondritis most common cause of musculoskeletal chest pain

Answer 451

What is the most important predisposing risk factor associated with aortic dissection? Hypertension other risk factors include Marfan syndrome and cocaine use

Answer 452

Which of the following is most likely to occur in a patient with intermittent claudication secondary to peripheral arterial disease? 1. Abdominal aortic aneurysm rupture2. Leg amputation (above- or below-knee)3. Myocardial infarction Myocardial infarction patients with PAD and intermittent claudication have an estimated 20% 5-year risk of non-fatal MI and stoke and a 15-30% risk of death due to cardiovascular causes

Answer 453

What valvular defect is a possible complication of aortic dissection? Aortic regurgitation may result in sudden onset worsening chest pain, hypotension, and pulmonary edemaCardiac tamponade can occur as a complication as well, but those patients with clear lung fields

Answer 454

What is the likely diagnosis in a male smoker with chest discomfort and the CXR findings below? Thoracic aortic aneurysm Suggestive findings include a widened mediastinum, increased aortic knob, and tracheal deviationInitial test: CXRBest confirmatory test: CT with contrast

Answer 455

What is the likely diagnosis in a patient with a recent URI that presents with CHF and dilated ventricles with diffuse hypokinesia on echocardiogram? Dilated cardiomyopathy often seen following viral myocarditis, particularly after a Coxsackievirus B infection; treatment is supportive

Answer 456

What age range of diabetic patients should be started on statin therapy? 40 - 75 years old high-intensity if 10-year ASCVD risk > 7.5%; moderate intensity if < 7.5%

Answer 457

What is the first-line therapy for conscious and stable patients with torsades de pointes? IV magnesium if patient is hemodynamically unstable, immediate defibrillation is indicated

Answer 458

What is the preferred diagnostic study for patients with renal insufficiency or hemodynamic instability with suspected aortic dissection? Transesophageal echocardiography

Answer 459

What is the preferred diagnostic study for hemodynamically stable patients with normal renal function and suspected aortic dissection? CT angiography CT angiography (and MR angiography) should be avoided in patients with moderate to severe kidney disease

Answer 460

What phenomenon is illustrated in the image below? Pulsus paradoxus (cardiac tamponade, asthma, COPD) fall in systolic pressure > 10 mmHg during inspiration

Answer 461

What is the likely diagnosis in a patient with a wide pulse pressure and pounding heart sensation, especially in the left lateral decubitus position? Aortic regurgitation the left lateral decubitus position brings the enlarged LV closer to the chest wall, increasing awareness of the heartbeat

Answer 462

What is the likely diagnosis in an elderly patient with syncope, dyspnea, and a slow-rising/delayed pulse? Aortic stenosis pulse is known as pulsus parvus et tardus ; isolated AS is usually caused by age-dependent sclerocalcific changes

Answer 463

What laboratory finding has a high sensitivity for the diagnosis of congestive heart failure? Elevated brain natriuretic peptide (BNP) levels BNP is released from ventricular myocytes in patients with CHF due to high ventricular filling pressures

Answer 464

What is the recommended diagnostic test for patients with chest pain that have low-risk for CAD? No further testing a positive stress test in low-risk patients is likely to be a false positive

Answer 465

What is the most common cause of sudden cardiac arrest in the immediate post-infarction period in patients with acute MI? Re-entrant ventricular arrhythmias (e.g. ventricular fibrillation)

Answer 466

What imaging study is used for the definitive diagnosis of cardiac tamponade? Echocardiography management includes immediate percutaneous or surgical drainage of pericardial fluid

Answer 467

What is the likely underlying cause of muscle pain in a patient taking metoprolol, lisinopril, aspirin, and simvastatin? Statin-induced myopathy possible due to decreased coenzyme Q10 synthesis, which is involved in muscle cell energy production

Answer 468

What is the likely underlying cause of resistant hypertension in a patient with diffuse atherosclerosis and >30% creatinine elevation after starting ACE inhibitors? Renovascular disease (e.g. renal artery stenosis due to atherosclerosis) other suggestive findings of renovascular disease include asymmetric kidney size and recurrent flash pulmonary edema

Answer 469

What is the likely diagnosis in a patient with a short systolic murmur (cardiac apex) that disappears with squatting? Mitral valve prolapse squatting increases preload and LV volume, decreasing the intensity of the murmur

Answer 470

What is the likely diagnosis in a patient with previous Hodgkin lymphoma status-post chemoradiation therapy that presents with dyspnea, JVD, ascites, and hepatomegaly? A mid-diastolic sound is heard. Constrictive pericarditis -Constrictive pericarditis is a potential late complication of radiation therapy-Other common findings include Kussmaul's sign, a pericardial knock (mid-diastolic sound), and pericardial calcifications

Answer 471

What is the recommended pharmaceutical therapy to reduce overall cardiovascular mortality in patients with peripheral arterial disease? antiplatelet agent (e.g. aspirin) and a statin Statin recommended in all patients with ASCVD (atherosclerotic vascular disease)

Answer 472

What is the likely diagnosis in a patient with fever, weight loss, an early diastolic murmur, and a left atrial mass on echocardiography? Cardiac myxoma may also have complications of systemic embolization (e.g. TIA, stroke) or cardiovascular symptoms simulating mitral valve disease (e.g. dyspnea, pulmonary edema, orthopnea); treatment involves prompt surgical resection

Answer 473

What is the imaging modality of choice for diagnosis and follow-up of abdominal aortic aneurysms? Abdominal ultrasound cheap and does not require contrast (vs. CT and MRI)

Answer 474

What is the likely underlying cause of syncope in an elderly patient that stood up after a period of bed rest? Orthostatic hypotension there is often prodromal dizziness and/or blurred vision

Answer 475

What is the likely diagnosis in a patient on post-MI day 3 that presents with sudden-onset pulmonary edema, hypotension, and a systolic murmur (cardiac apex)? Papillary muscle rupture

Answer 476

What is the likely diagnosis in a young woman with significant hypertension, amaurosis fugax, and a carotid bruit? Fibromuscular dysplasia non-inflammatory and non-atherosclerotic condition that commonly involves the renal, carotid, and vertebral arteries