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Certified Sommelier Exam (CMS 2) flashcards
1
Q

Cirrhotic liver

A

Shrunken and fibrotic

Not enlarged

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2
Q

Severe right leg pain after soccer match that resolved in 2 weeks.

Week later had recurrent pain and decreased ROM

Right thigh larger than left

Induration and tenderness to palpation over medial thigh

Pain with stretching, pulses normal

  • MOA
  • Name
  • PE
  • Lab
  • Xray shows
A

Heterotropic bone formation

Mositis ossificans

Formation of lamellar bone in extraskeletal tissues

Painful, firm mobile mass with local swelling

Elevated ESR

Egg shell calcification

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3
Q

Hard lump on palm of right hand. Doesnt affect function. Hard fibrous nodular band present on base of ring finger.

A

Fibrosis of palmar fascia

Dupuytren contracture

—> Decreased extension

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4
Q

Empiric antibiotics for calculus cholecystitis

A

cover aerobic and anaerobic bacteria in the enterobacteriaceae family

Piperacillin- tazobactam

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5
Q

KCN gene on chromosome 7

A

Jervell-Lange Nielsen syndrome

AR

Congenital deafness
Long QT syndrome

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6
Q

Fever, chills, general malaise

Presence of new murmur

Hx Rheumatic fever

A

Bacterial endocarditis

Get blood cultures

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7
Q

C5-C6 herniation

A

Compresses C6

Decreased sensation of thumb

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8
Q

Freyettes laws

A

First law
- Neutral mechanics
Rotation and SB are coupled in opposite directions

Second law

  • Non-neutral
  • Side bending and rotation same in non neural mechanics

Third law
- when motion is introduced into the spine in one direction, motion in the other directions is reduced

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9
Q

Pulls to stand

Crawls well

A

9 months

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10
Q

Standing momentarly without support

A

12 months

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11
Q

Low Cortisol
Low ACTh
Hypoglycemia

Tx

A

Secondary or tertiary adrenal insufficiency

Tx Glucocorticoids

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12
Q

Low Cortisol
Increased ACTH

Tx

A

Primary adrenal insufficiency

Prednisone and fludrocortisone

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13
Q

Abdominal pain in 70 y.o

Calcification of superior mesenteric artery with an occlusive thrombus

Initial treatment?

A

Heparin anticoagulation

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14
Q

When to get LEEP

A

> 24 with High grade squamous intraepithelial lesions

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15
Q

Tx Scaly hair lesion

A

Tinia capitis

Oral griseofulvin
Oral terbinafine

[Topical clotrimazole used for the other tinea infections]

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16
Q

Scoliosis

Apex on left

35 degrees

A

Levoscoliosis

< 20 mild
20-45 moderate
> 45 severe

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17
Q

Paroxysmal supraventricular tachycardia

A

AV nodal reentrant tachycardia

Narrow QRS tachycardia with P waves that overlap the T waves

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18
Q

Target lesion rash on hands and feet

Sudden onset

A

Erythema multiforme

Herpes simplex virus

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19
Q

Muscle weakness brought on by strong emotion

A

Cataplexy

Narcolepsy

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20
Q

Shortened QT interval and widened T waves

Hx Sarcoidoisis

A

Hypercalcemia

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21
Q

Loss of pain and temp in upper extremities

Bladder incontience

A

Central cord syndrome

Lateral spinothalamic fibers

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22
Q

Posterior segment of spinal cord

A

Posterior white column

Position and vibration sense of extremities

Descending motor neurons in lateral corticospinal tract

Descending autonomic tract (bladder function)

Flaccid weakness
Hyporeflexia

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23
Q

Anterior segment of spinal cord

A

Anterior horn grey matter

Lateral spinothalamic tract (pain and temperature inforamtion)

Damage to anterior horn- weakness, muscle spastic

Hyperreflexia

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24
Q

Weakness of upper and lower extremities

Urinary incontinence

Decreased pain and temperature bilaterally

Normal position and vibration sense

A

Anterior spinal artery

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25
Q

Dorsal cord syndrome

A

Posterior column of spinal cord

Affect in MS, tabes dorsalis, fredreich ataxia

Loss of prorioception and vibration

Variable affects on bladder control

Gait ataxia with weakness

Hyporeflexia

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26
Q

Multiple hyperpigmented spots on lips and oral mucosa

Hamartomatous polys

A

Peutz-Jeghers syndrome

AD

Increased risk of developing cancer

Risk: intusssception and obstruction

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27
Q

Diagnostic of ankylosing spondylitis

A

Positive human leukocyte antigen B27

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28
Q

Dapsone

A

Dermatitis herpetiformis tx

Celiac disease

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29
Q

Rash on elbows, blistering pruritic

Abdominal bloating and diarrhea often

Tx

A

Dermatitis herpetiformis

Celiac disease

Tx Dapsone

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30
Q

Blue white oral spots
Fever
Cough
Rash

What tx helps prevent death

A

Rubeola (measles)

Vit A supplementation

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31
Q

Measles can return to school

A

5 days after onset of rash

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32
Q

Ribs 1-5 axis

Ribs 6-10 axis

Ribs 11 and 12 axis

A

1-5: Transverse axis

6-10: AP axis

11&12: vertical axis

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33
Q

Tenderpoint anterior ribs

A

Flexion STRT

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34
Q

Rib cage posterior tenderpoints

A

Elevated ribs

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35
Q

Superior transverse axis

A

Both respiraotry and inherent (craniosacral ) sacral mtoion occur about the superior transverse axis of the sacrum

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36
Q

Innomianate rotation occurs

A

Inferior transverse axis

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37
Q

Tx Guillain Barre

A

Plasmapheresis or IVIG

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38
Q

Snorted cocaine what medication to tx

A

Benzodiazepine

Can cause MI if untreated

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39
Q

Tx hemochromatosis

A

Phlebotomy

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40
Q

Deferoxaine

A

Tx excess iron

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41
Q

Penicillamine

A

Promotes excretion of copper

Wilson disease

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42
Q

Calf pain
Abdominal pain brought on by eating

Unintentional weight loss
HTN

Livedo reticularis in bilateral lower extremities

Negative P-ANCA

A

Polyarteritis nodosa (PAN)

Get Hep B serology

Necrotizing arteritis of medium sized vessels

Livedo reticularis
Subcutaneous nodules
Digital gangrene
Ulcers

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43
Q

Seen with CREST

A. Asthma
B. Autoimmune hepatitis
C. Mononeuritis multiplex
D. Pulmonary HTN
E. Uveitis
A

Pulmonary HTN

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44
Q

Chapman points

  1. Surgical neck of right humerus
  2. First intercostal space
  3. Second intercostal space
  4. Third intercostal space
A
  1. Surgical neck of right humerus= eyes
  2. First intercostal space= tonsils
  3. Second intercostal space= esophagus, bronchi, thyroid, and myocardium
  4. Third intercostal space= upper lung and upper extremities
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45
Q

Cells with ringed blue dots

A

Sideroblastic anemia

Tx Pyridoxine

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46
Q

Tx parkinson disease

MOA

A

Anticholinergic drugs

Benzotropine
Trihexyphenidyl

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47
Q

Tx Neisseria meningitis

A

Vancomycin
Ceftriaxone
Steriods

Rifampin for close contacts

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48
Q

Sickle cells

Sick for a couple weeks
Anemia
Reticulocytopenia
Pancytopenia

A.Papillomarvirus
B. Paramyxovirus
C. Parvovirus
D. Picornavirus
E. Poxvirus
A

C. Parvovirus

Sickle cell + parvovirus B 19 results in aplastic crisis

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49
Q

Paramyxovirus

Picornavirus

A

Paramyxovirus

  • Mumps
  • Parainfluenza virus

Picornavirus

  • RNA viruses
  • Hep A virus
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50
Q

Osteopenia vs osteoporosis

A

Osteopenia
DEXA T score -1 to -2.5

Osteoporosis
Below -2.5

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51
Q

Infant

Bilateral hearing loss
Red reflex
Cloudy cornea

Purplish rash

A

Congenital rubella syndrome

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52
Q

Dilated tortuous submucosal vessels on colonoscopy

A

AV malformations

Angiodysplasias

Painless lower GI bleeding in people over 60

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53
Q

Chronic kidney disease

Family hx cerebral aneurysm

A

Autosomal dominant adult polycystic kidney disease

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54
Q

Rash which was one skin lesion several weeks ago

Erupted into multiple enlarging lesions all over body

Itchy not painful

Circular and oval lesions, larger ones have central clearing

What also would be expected

A

Multiple erythema migrans

Disseminated Lyme disease

Typically to have cardiac findings
- AV heart block

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55
Q

Subungual hemorrhages

A

Infective endocarditis

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56
Q

Tx Tinea

A

Topical ketoconazole

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57
Q

Tx position for R/L sacral torsion

A

Lateral recumbent with axis side down

Left lateral recumbent with face up

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58
Q

L/L sacral torsion position

A

Left lateral sims position

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59
Q

Hasnt taken medications in three days

SOB
Dyspnea
Fatigue

JVD

Rales bilaterally
S3 gallop
Edema
LV hypertrophy
Elevated creatinine level

Started on furosemide

Also give?

A

Acute decompensated heart failure

Give vasodilator, nitroglycerin

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60
Q

Dermatitis herpetiformis for rash MOA

A

Immune complex deposition

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61
Q

Tx insulinoma in nonsurgical patient

A

Diazoxide

[Octreotide if only nothing else works]

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62
Q

Tx Salicylate toxicity

A

Gastric lavage
Activated charcoal
Alkalinization of urine

Severe: dialysis

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63
Q

Lasegue test

A

Straight leg test

+ = sciatica

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64
Q

Thomas test

A

Patient supine and physican flexes hip until thigh approximates abdomen

+ test= hypertonic iliopsoas muscles

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65
Q

Patrick’s test

A

FABERE test

Flexion
Abduction
ER
Extension

Crossing supine patietns leg over the CL leg, such that ipslateral leg forms reversed L

Stabilize CL ASIS and give downward force

+ hip pathology

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66
Q

Pleural effusion by TB finding

A

Lymphocytes > 80%

Increased total protein

Adenosine deaminase >40

Glucose 30-50 (will not be lower than 30)

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67
Q

Pleural effusion

  1. 90% lymphocytes, adenosine deaminase 50 u/L
  2. Bloody appearance
  3. Extremely low pleural fluid glucose level ( <30)
  4. Lactate dehydrogenase (LDH) level of 50, ratio of total pleural fluid protein to protein in serum of 0.45, ratio of LDH in pleural fluid to serum 0.40
  5. White milky appearance
A
  1. 90% lymphocytes, adenosine deaminase 50 u/L= TB
  2. Bloody appearance= pulmonary embolism and malignancy
  3. Extremely low pleural fluid glucose level ( <30) = Rheumatoid arthritis, empyema, malignancy
  4. Lactate dehydrogenase (LDH) level of 50, ratio of total pleural fluid protein to protein in serum of 0.45, ratio of LDH in pleural fluid to serum 0.40= Transudative effusion (Congestive heart failure)
  5. White milky appearance= chylothorax with triglyceride count above 110
    - caused by lymphoma and trauma caused by thoracic surgery
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68
Q

9 y.o vomiting

Has URI infection last week

hepatomegaly

Has seizure

A

Reye syndrome

Aspirin in children

Liver failure
Increase PT
Elevated ammonia
Hypoglycemia

Increased intracranial pressure

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69
Q

Medial forearm and arm numbness

Limit wrist flexion

A

Cubital tunnel syndrome

Ulnar nerve impingement

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70
Q

Loss of sensation in first three fingers

Tinel sign at wrist is negative

A

Pronator teres compression syndrome

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71
Q

Painless ulcer on uvela that goes away

Now severe headache, muscle aches and loss of appetite.

Neck pain
Fever

Maculopapular rash on trunk, limbs, palms and soles

What else is seen

A

neurosyphilis

Personality changes

[Sensory ataxia seen with tabes dorsalis, late form of neurosyphilis with 20 year latent on average]

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72
Q

Brief episodes of neurologic dysfunction

Numbness in arm

Loss of vision in one eye

A

Transient ischemic attack

Carotid stenosis

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73
Q

Creutzfeldt jakob on biopsy

A

Neural cell loss and intraneuronal vacuolization

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74
Q
  1. Eosinophilic spongiosis
  2. Granular IgA
  3. IgA at the dermal epidermal junction
  4. Subepidermal blistering
  5. Intraepidermal vesicles
A
  1. Eosinophilic spongiosis= bullous pemphigoid
  2. Granular IgA = dermatitis herpetiformmis
  3. IgA at the dermal epidermal junction= IgA bullous dermatoses (rare autoimmune disease)
  4. Subepidermal blistering= bullous pempihigoid
  5. Intraepidermal vesicles= erytehma multiforme
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75
Q

Lab Finding with RCC (4)

A

Polycythemia
Due to production of erythropoietin

Cushing syndrome due to Cortisol production

HTN due to renin production

Hypercalcemia due to PTH like hormone secretion

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76
Q

Bone lesion child’s leg

  1. Large multinucleated cells among smaller mononuclear stromal cells
  2. Pleomorphic malignant osteoblast cells surrounded by an osteoid matrix
  3. Small round tumor cells with hyperchromatic nuclei and minimal cytoplasm
  4. Thick sclerotic bone surrounding osteoblast cells and irregular bony trabeculae
  5. Tumor cells with atypical nuclei and mitoses surrounded by a cartilage matrix
A
  1. Large multinucleated cells among smaller mononuclear stromal cells= giant cell tumors
  2. Pleomorphic malignant osteoblast cells surrounded by an osteoid matrix= osteosarcoma
  3. Small round tumor cells with hyperchromatic nuclei and minimal cytoplasm= Ewing sarcoma
  4. Thick sclerotic bone surrounding osteoblast cells and irregular bony trabeculae= osteoid osteomas
  5. Tumor cells with atypical nuclei and mitoses surrounded by a cartilage matrix= chondrosarcomas
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77
Q

21 y.o with irregular periods

Body hair

LH/FSH 3.2: 1

Tx

A

PCOS

Tx: Spironollactome
- acts as testosterone antagonist

[For fertility= clomiphene citrate]

78
Q

Transmural inflammation of distal ileum

Inital tx

A

Mild crohn’s disease

Budesonide (oral glucocorticoids)

[Prednisone for crohns that involves distal colon or entire colon, not limited to ileum]

79
Q

Chapman points

  1. Umbilicus and pubic symphysis
  2. Second intercostal space
  3. Seventh intercostal space
A
  1. Umbilicus and pubic symphysis= Bladder and urethra/ovaries
  2. Second intercostal space= Esophagus, thyroid, Bronchi and heart
  3. Seventh intercostal space= Spleen
80
Q

Incremental response on nerve conduction

A

Lambert Eaton

81
Q

Decremental response on repetitive nerve stimulation

A

Myasthenia gravis

82
Q

Wiggling poop

Tx

A

Tapeworm

Taenia solium

Tx Praziquantel

83
Q

Ivermectin tx for

A

Strongyloidiasis and onchocerciasis

84
Q

Mebendazole tx for

A

Effective against nematodes (round worms)

Ascariasis
Pinworm (enterobiasis)
hook worm

85
Q
  1. Enlarged chorionic villi with trophoblastic hyperplasia
  2. Pleomorphic glandular cells with mucin vacuoles
  3. Sheets of atypical trophoblasts, necrosis and hemorrhage
  4. Uniformly sized chorionic villi with scattered syncytiotrophoblasts
  5. Variably sized chorionic villi with scalloping and trophoblastic inclusions
A
  1. Enlarged chorionic villi with trophoblastic hyperplasia= Complete mole
  2. Pleomorphic glandular cells with mucin vacuoles= Lung cancer, adenocarcinoma
  3. Sheets of atypical trophoblasts, necrosis and hemorrhage= Choriocarcinoma
  4. Uniformly sized chorionic villi with scattered syncytiotrophoblasts= Abortion (spontaneous)
  5. Variably sized chorionic villi with scalloping and trophoblastic inclusions= Partial mole
86
Q

Seen with cardiac tamponade

A. Bowel sounds in chest
B. JVD
C. Pericardial friction rub
D. Tracheal deviation
E. Widened mediastinum
A

B. JVD

87
Q

ECG finding with acute pericarditis

A

Diffuse ST segment elevations

88
Q

Boxer fracture

A

Metacarpal neck fracture

89
Q

Seen with glucagonoma

A

Necrotizing migratory erythema

90
Q

Bloody diarrhea

Stool shows organisms with ingested erythrocytes

A

Entamoeba histolytica

91
Q

A 50 y.o patient who was recently diagnosed with pneumonia is seen in clinic for shortness of breath, cough fever and chills. Hx reveals the patient has been home in bed for 2 days only getting up to use bathroom. CXR reveals pleural effusions and thoracentesis and studies of the fluid reveal pH of 7.0 and low pleural fluid glucose level. CT revelas loculation and thickening of the pleural membranes.

A. Chylothorax
B. Pulmonary embolism
C. Cirrhosis
D. CHF
E. Empyema
A

E. Empyema

Parapneumonic effusion are pleural effusion that arise from pneumonia

Empyema: ph < 7.30, very high LDH and low glucose < 60

92
Q

Cell with two eyes

A

Owl eye= Reed Sternberg

Hodgkin lymphoma

Painless rubbery lymph nodes

93
Q

Seen with borderline personality disorder

A

Transient stress related dissociative symptoms

94
Q 
Bradycardia
Hypotension
M shaped wave
Nausea
Emesis
Headache

Also see

A

Digoxin toxicity

Altered color perception

95
Q

Bronchospasm caused by

A

Beta blocker

96
Q

Dry mouth caused by what heart drug

A

Clonidine toxicity

Centrally acting alpha agonist

97
Q

Hyperglycemia seen with what heart drug

A

CCB toxicity

98
Q

Turner most common heart finding

A

Bicuspid aortic valve

[ Coarctation is second]

99
Q

If strep left untreated develop what

A

Rheumatic fever

Mitral stenosis

100
Q

Solid testicular mass

Elevated beta HCG

Fried egg appearance

A. Seminoma
B. Embryonal carcinoma
C. Yolk sac (endodermal sinus) tumor)
D. Choriocarcinoma
E. Teratoma
A

A. Seminoma

[Yolk elevated AFP]

101
Q

Most common spot of anal fissure

A

Posterior midline of anal canal

102
Q

Only dysentery you treat

Seen on culture

Tx

A

Shigella

Negative for motility, H2S production and lactose fermentation [Only one negative for all three]

Ciprofloxacin, azithromycin, ceftraixone

103
Q

Worsening fatigue

Three bacterial infections in six months

Neutropenia
Hypochromic anemia

Deficiency of??

A

Copper

Neutropenia (recurrent infections)
Thrombocytopenia (bruising petechiae)
Microcytic hypochromic anemia

104
Q

Who to get a Low dose CT scan on check

A

Individuals 55-80 who have smoked for 30 years

Who are currently smoking or have quit in last 15 years

105
Q

Heavy sensation in chest

New murmur

Elevated troponin

No ST segment elevations

Initial test?

A. CT of chest with IV contrast
B. Exercise electrocardiograph stress test
C. Percutaneous coronary angiography
D. Radionuclide stress myocardial perfusion imaging
E. Transthoracic echocardiogram

A

C. Percutaneous coronary angiography

Followed by intervention if discrete narrowing or blockage is found

106
Q

Dark velvety patch of skin in both armpits and skin folds of groin

Elevated ALT
HTN

A

Non-alcoholic steatohepatitis (NASH)

Inflammation of the liver due to excess fat deposition that causes damage to hepatocytes

Tx Weight loss

107
Q

Tx Ventricular fibrillation

Emergent

A

Defibrillation

Unsynchronized delivery of electricity

108
Q

Direct current energy cardioversion

A

Tx new onset atrial fibrillation or atrial flutter

If unstable patient or chemical means not working

109
Q

1 y.o

Rash for two months

Ill defined patches of red thickened skin and multiple excoriation marks through out both arms

Multiple vesicles with areas of crusting and presence of clear exudate

A

Atopic dermatitis

110
Q

Beckwith Wiedemann syndrome

Features

A

Anterior linear earlobe creases

Pediatric disease

Macrosomia
Macroglossia (tongue)
Omphalocele

Wilms tumor
Neuroblastoma

111
Q

Took amoxicillin for H pylori infection ten days ago

Develops fever, joint pain, and rash

Maculopapular rash
Elevated serum creatinine

Seen w/ staining

A

Acute interstitial nephritis (AIN)

Eosinophils with Wright staining of the urine

elevated IgE
Eosinophiluria

112
Q

Chapman for pancreas

A

Between the transverse process of T7 and T8 on right

113
Q

Myasthenia gravis ab target

A

Nicotinic post synaptic acetylcholine receptors

114
Q

Broca artery

A

Middle cerebral artery

115
Q

Tx Chorea in huntington

A

Tetrabenazine

Inhibits VMAT which release dopamine

[Not Benztropine]

116
Q

Prophylaxis tx for cluster headaches

A

CCB

117
Q

Burn percentage

Anterior head
Posterior left UE
Anterior abdomen
Anterior left LE

A

27%

Anterior head 4.5%
Posterior left UE 4.5%
Anterior abdomen 9%
Anterior left LE 9%

118
Q

Patient first diagnosed with HTN

148/95

A

Stage 2 HTN
> 140

Exercise and low salt diet
Combination pharmacotherapy (CCB, ACE, Thiazide)

Stage 1 130-139

119
Q

Spontaneous bacterial peritionitis bacteria

A

Ecoli

120
Q

Epidural hematoma artery

A

Middle meningeal artery

`Branch of maxillary artery branch

121
Q

Test for aortic dissection

A

Chest radiography

122
Q

Heart chapman point

A

2nd ICS

123
Q

organisms on prosthetic heart

A

Staphylococcus epidermidis and staph aureus

[Native valve endocarditis= streptococcal viridnas]

124
Q

Positively skewed

A

Right skew

Mean is greater than median, both greater than mode

125
Q

Lab elevated in POlymyalgia rheumatica

A

ESR

126
Q

67 y.o sudden onset of weakness fell to ground

Cranial nerves intact, but unable to move any of his limbs. Sensory exam he unable to perceive pain, but able to discrimiante between two sharp pinpricks. When a cold vibrating tuning fork is placed over his extremities, he is able to perceive the vibrations, but not the coldness of the fork. Diagnosis?

A. Anterior cord
B. Central cord
C. Guillain Barre
D. Hypokalemic periodic paralysis
E. Vertebrobasilar infarction
A

A. Anterior cord syndrome

Anterior spinal artery

Corticospinal tracts (voluntary movement)

Spinothalamic tracts (temp and pain)

127
Q

5 y.o female with enlarged clitoris. Clitoromegaly, found at puberty stage 4. Hyponatremia and hyperkalemia.

Appropriate test to order?

A. serum 21-hydroxylase
B. Serum 17 hydroxyprogesterone level
C. Serum 11-hydroxyprogesterone level
D. Serum aldosterone level
E. Serum ACTH
A

B. Serum 17 hydroxyprogesterone level

CAH

21-hydroxylase deficiency

128
Q

Bilateral sacral extension somatic dysfunction inhibits sacral (blank)

A

Nutation

129
Q

Straw color discharge from right nipple

A. Ductal carcinoma in situ
B. Lobular carcinoma in situ
C. Invasive ductal carcinoma
D. Intraductal papilloma
E. Fibrocytist disease
A

D. Intraductal papilloma

130
Q

Sphenobasilar flexion you also see

A

Flexion of midline bones
ER of paired bones
Decrease in AP diameter
Extension of sacrum

131
Q

Seen with viral conjunctivitis

A. Darkening and edema of the infraorbital skin
B. Follicular appearance of the tarsal conjunctiva
C. Linear stain after application of fluorescein
D. Pain with eye movement
E. Photophobia

A

B. Follicular appearance of the tarsal conjunctiva

Papillae which are inflamed follicles are seen on the inside of the eyelids causing bumpy appearance

132
Q

Viscerosomatic levels

A 
S 5-9
L 6-9
P 5-11
S 9-11
K 10-11
B 11-2
L 11-2
Stomach/Spleen
Liver
Pancreas
Small bowel (jejunum and ileum)
Kidney
Bladder
Lower extremities (and penis)
133
Q

Asterion

Pterion

Lambda

Nasion

Bregma

A

Asterion: point where occipital, temporal and parietal bones meet

Pterion: greater wing of sphenoid, temporal, parietal bone and front bone meet. Behind zygomatic arch

Lambda: Remnant of posterior fontanelle, sagittal suture ends to lambdoidal suture

Nasion: superior aspect of nose, two nasal bone articulate with frontal bone

Bregma: anterior fontanelle, sagittal, frontal and coronal sutures meet

134
Q

To move radial head anteriorly physician must

A

Engage in arm supination

Patient must resist supination by pronating arm

135
Q

SBO what first exam to get

A

Xray

136
Q

ESRD missed dialysis see what on

Lab

EKG

A

Hyperkalemia

Peaked T waves

137
Q

Profuse watery diarrhea after antibiotic treatment

Structural finding?

A. Diverticuli
B. Pseudomembranes
C. Thickened mucosal folds
D. Transmural inflammation of the colon
E. Villous adenoma
A

B. Pseudomembranes

C. Diff

[Transmural inflammation= Crohns]

138
Q

Test for C diff

A. blood culture
B. Sigmoidoscopy
C. Stool culture
D. Stool toxin
E. Urea breath test
A

D. Stool toxin

139
Q

Craniosacral extension see what

A

Nutation of the sacral base

SBS moves inferiorly

Pair temporal and parietal bones rotate internally

AP diameter is increased

Tension of sacral base is release and moves anteriorly (nutation)

140
Q

Scaly lesion on scalp and ears that flakes

A

Seborrheic dermatitis

“dandruff”

141
Q

Graves antibody against

A

Thyrotropin (thyroid stimulating hormone) receptor

142
Q

Hashimoto antibody

A

Thyroid peroxidase TPO

143
Q

Number risk factor for osteoporosis

A

Smoking

144
Q

Tx PAD

A

Statin

145
Q

Cafe au lait

A

Hyperpigmented spots

Neurofibromatosis (intellectual disability, iris hamartomas, optic gliomas, pheochromocytomas, seizures)

Fanconi anemia (absent radii and thumbs, microcephaly, pancytopenia)

McCune Albright (unilateral, precocious puberty)

146
Q

Downs syndrome why to not do HVLA

A

Weakness of alar and transverse ligaments

147
Q

HVLA contraindicated (5)

A 
Osteomyelitis
Osteoporosis
Metastatic carcinoma
Down's syndrome
Local fractures
148
Q

35 y.o with progessive cough and greem sputum. Multiple lung infections as child. Non smoker. Hyperinflation and ill defined pulmonary nodules

  • Name
  • Dx
A

Bronchiectasis

CT chest

149
Q

Acne

A. Aerobic gram neg bacillus
B. Aerobic gram neg coccobacillus
C. Aerobic gram pos coccus
D. Anaerobic gram pos bacillus
E. Anaerobic gram pos coccus
A

Anaerobic gram positive bacillus

Acne vulgaris

Propionibacterium acnes

150
Q

New born screening tests

A

Phenylketonuria

Hypothyroidism

151
Q 
5 y.o 
Hyperpigmented spot
Short
New pubic hair growth, breast buds
Three bone fractures
Thyroid nodules
A

McCune Albright syndrome

152
Q

Sponylosis

A

Osteoarthritis of spine

153
Q

DM uncontrolled on Metformin

Add what medication

A

Sulfonylurea

- Glyburide

154
Q

When to add insulin

A

A1C > 8.5%

155
Q

Suspect Rhabdomyolysis

  • See what in labs
  • Diagnostic test
A

Hyperkalemia

Get Serum creatine kinase

[Not urine microscopy]

156
Q

1 month old

Poor feeding
Floppiness
(Progressive)

Normal ocular movement

Hypotonia
Lack of head control

A

Werdnig Hoffman disease
(Spinal muscular atrophy type 1)

AR

Diagnosed by molecular genetic testing of the SMN1 gene

Apoptosis cannot be stopped.

[Botulism has decreased eye movement]

157
Q

Uterine tumor

Smooth muscle with areas on hemorrhage and necrosis

A. Leiomyosarcoma
B. Endometrial carcinoma
C. Leiomyoma
D. Teratoma
E. Choriocarcinoma
A

A. Leiomyosarcoma

158
Q

Reoccuring painful ulcers on genitals for 5-6 years

Ulceration on mucosa

Uveitis

A

Behcet disease

Rare autoimmune disease

Can also experience mild monoarticular arthritis or arthralgias (ankle or knee)

159
Q

Tremor
Shuffling gait
Micrographia

Give what drug

A

Carbidopa-levodopa

Parkinson

160
Q

Antibodies for sclerosis

A

Anti-topoisomerase

161
Q

Anti-centromere

A

CREST

162
Q

Anti-topoisomerase

A

Sclerosis

163
Q

Rhomboid crystals

A

Calcium pyrophosphate deposition disease

pseudogout

164
Q

Large red lesion on childs face
Seizures

Also see?

A

Sturge-Weber Syndrome

Nevus flammeus= port wine stain

Intellectual disability
Hemiparesis

Angiomas in parietal or occipital lobes —> homonymous hemianopsia (loss of either left or right visual fields)

165
Q

How to CONFIRM cholecystitis

A

HIDA scan

166
Q

Diabetes
219 y.o

Give what medication

A

DM type 1

Young
Skinny

Insulin

167
Q

Hard lump in neck

Moves up and down when swallows

Firm non tender, non mobile mass left of midline

Solitary nodule with multiple regions of echogenicity

Calcitonin 5 (< 8.8 normal)

A

Papillary thyroid carcinoma

Solitary non-tender, non mobile neck mass with multiple ares of echogenicity

Cold nodule

Associated Family adenomatous polyposis

APC gene

168
Q

Tx Acute diverticulitis

A

Oral amoxicillin clavulanate

169
Q

Rubella virus family

Measles virus family

A

Rubella: Togavirus family

Measles: Paramyxovirus

170
Q

Most specific antibody for SLE

A

Anti- smith

171
Q

HUS lab finding (4)

A

Elevated LDH
Decreased haptoglobin
Anemia
Schistocytes

172
Q

Cobb angles

A

Mild 5-15
Moderate 20-45

Respiratory compromised seen when angle is over 50

Cardiovascular compromise when angle > 75

173
Q

75 y.o
Dry cough and exertional dyspnea
Worked in glass factor for 30 years

Increased FEV1/FVC

  • Name
  • CXR
A

Silicosis

Nodular opacities in the upper lobes

174
Q

85 y.o cough and exertional dyspnea. Never smoked. Worked as metal worker in machine shop.
Weight loss 20 lbs
Fever

Bilateral inspiratory crackles

  • Name
  • CXR
A

Berylliosis

Metal workers
Jewelry makers
Electronics

Bilateral hilar adenopathy

175
Q

85 y.o cough and exertional dyspnea. Never smoked. Worked as metal worker in machine shop.
Weight loss 20 lbs
Fever

Bilateral inspiratory crackles

  • Name
  • CXR
A

Berylliosis

Metal workers
Jewelry makers
Electronics

Bilateral hilar adenopathy

176
Q

Asbestosis CXR

A

Bilateral opacities with pleural plaques

177
Q

Imaging for acromegaly

A

MRI of pituitary

178
Q

Increase voltage (large peak QRS) due to

A

LV hypertrophy

HTN

179
Q

Visited Wisconsin presents with cough, fever, chest pain and severe arthralgia. Physical exam is remarkable for non-pruritic verrucous skin lesions on trunk.

A. Blastomycosis
B. Coccidioidomycosis
C. Histoplamosis
D. Cutaneous candidiasis
E. Cryptococcosis
A

A. Blastomycosis

dimorphic

Well demarcated verrucous or ulcerated skin lesions, bone lesions, CNS disease

180
Q

Seen with Acute tubular necrosis

A

Muddy brown granular casts

181
Q

Untreated syphilis at risk for

A

Nephrotic syndrome

Membranous glomerulonephritis

182
Q

16 y.o fever, sore throat myalgias. Yesterday developed a painful rash on face that spread to extremities and developing blisters. Crusting of lips and eye redness. HIV hx. Took course of TMP-SMX recently. Skin of trunk, extremities, and face is diffusely erythematous with confluent vesicles and bullae, several rupture. + Nikolsky. Erosion covering her lips and oral mucosa. Conjunctiva are injected bilateraly with purulent discharge

A. Erysipelas
B. Erythema multiforme
C. Necrotizing fasciitis
D. Staphylococcal scaled skin syndrome
E. Toxic epidermal necrolysis
A

E. Toxic epidermal necrolysis

> 30% body

  • Involves mouth, eyes and genitalia

Triggered by medication

[SJS is counterpart 10% body]

183
Q

Best to give to patient with HTN after MI

A

Beta blocker + ACE-I

184
Q

6 y.o with pheochromocytomas and clear renal cell carcinoma. Heritable disorder

A. NF1
B. NF2
C. Tuberous sclerosis
D. Von Hippel LIndau
E. Sturge-Weber syndrome
A

D. Von Hippel lindau

Multisystem cancer syndrome

Clear renal cell carcinomas
PHeochromocytomas
Hemangioblastoms

185
Q

Neurogenic shock

CO
PCWP
SVR

A

CO: Low
PCWP: Low
SVR: Low

186
Q

In septic shock kidneys are damaged due to

A

Hypoperfusion

187
Q

Posterior appendix chapman

A

TP of T 11

188
Q

Inital tx aortic dissection

A

Labetalol

Lowering BP

189
Q

Allergic contact dermatitis MOA

A

Protein haptenation

Delayed inflammatory reaction

1st step development of binding of haptens to protein carriers in skin

190
Q

Moles all over back

A

Seborrheic keratosis

191
Q

Vit B12 deficency symptoms

A

Glossitis *
Paresthesias of LE
Mental sluggishness
Fatigue

192
Q

Non surgical tx of carcinoid syndrome

A. Octreotide
B. Propanolol
C. Prazosin
D. Doxycycline
E. Open laparotomy
A

A. Octreotide

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