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Third Year Shelf > IM > Flashcards

IM Flashcards

1
Q

Pigmented gallstones

A

Caused by chronic hemolysis such as from hereditary spherocytosis

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2
Q

Fever, severe body aches, marked fatigue, 2 days, non-productive cough, and nasal congestion. Tonsillar erythema but no exudate. Anterior cervical LN are mildly tender to palpation

Acute nasopharyngitis
Acute retroviral syndrome
Commonunity acquired pneumonia
Influenza
Streptococcal pharyngitis
A

Influenza

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3
Q

Acute nasopharyngitis

A

Common cold

Rhinitis and nasal congestion

Fever uncommon in adults

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4
Q

Acute retroviral syndrome

A

High fevers, myalgias and malasie

Pronounced and generalized non-tender lymphadenopathy

Painful mucous membrane ulcerations

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5
Q

Streptococcal pharyngitis

A

Group A strep

High fever, anterior cervical lymphadenopathy and severe pharyngitis with tonsillar exudates

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6
Q

34 y.o w/ painful finger. Throbbing. Smokes two packs a day for 15 years. Second digit on right hand is dark purple in color and 3 mm erythematous superficial ulceration at tip of second digit on right

Decreased sensation on palmar aspect. Strength and reflexes in tact. Right radial pulse diminished

A

Thromboangiitis obliterans

Digit ischemia and associated ulceration is common presenting sign

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7
Q

Livedo reticularis

A

Purple colored lace-like discoloration of the skin

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8
Q

Peripheral artery disease

Diagnose?

A

Atherosclerotic plaques

Affects lower extremities

Crampy pain w/ exertion or rest pain, diminished pulses and ulceration if long standing

ABI test

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9
Q

Polyarteritis nodosa

A

Necrotizing vasculitis

Present with systemic symptoms (WL, fatigue, fever, arthralgias) signs of multisystem involvement

Tender nodules or purpura
HTN
Renal insufficiency
Abdominal pain
Neurological dysfunction
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10
Q

Sepsis vs septic shock

A

Sepsis

  • Fever
  • Leuocytosis
  • Hypotension
  • Tachycardia

Septic shock

  • sepsis
  • elevated lactate >2 mmol
  • hypotension
  • requires vasopressor tharpy
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11
Q

Bacteremia

A

Bacteria in blood documented by positive cultures

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12
Q

Interstitial cystitis

A

Known as bladder pain syndrome

Unpleasent pain or pressure involving bladder

Suprapubic pain or spasm, urinary frequency and urgency

Symptoms worse when bladder full and relieved by voiding

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13
Q

Hypomagnesemia leads to

A

Refractory hypokalemia

Hypomagnesemia (mg < 1.6)

Leads to renal potassium wasting

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14
Q

Medication induced hypokalemia associated with

A

Insulin use

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15
Q

Third heart sound that sounds like a plop in mid-diastole

A

Left atrial myxoma

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16
Q

AA w/ chest pain, painful extremities, productive cough, bilateral conjuctival icterus

A

Sickle cell disease

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17
Q

Methylmalonic acid level is elevated in

A

Vitamin B12 deficiency

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18
Q

First step in acute urinary retention secondary to benign prostatic hyperplasia

A

Decompress the bladder

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19
Q

Eosinophilia and chronic ulcer in person from middle east

Leishmania major
Paracoccidioides lutzii
Schistosoma mansoni
Treponema pallidum pertenue
Trichinella spiralis
A

Leishmania major

Sandfly bites

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20
Q

Paracoccidioides lutzii

A

Eosinophilia and cutaneous ulcerations similar to leishmaniasis

but confined to south africa

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21
Q

Eosinophilia, Middle east, intensely purpuric, scabies like cutaneous larva migrans

A

Schistosoma mansoni

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22
Q

Africa
chronic ulcer
Normal eosinophilia

A

Treponema pallidum pertenue

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23
Q

Hunter who consumes undercooked game meat

Myalgia

Eosinophilia

A

Trichinella spiralis

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24
Q

First step in evaluation of an acute stroke

A

head CT scan w/o contrast to rule out hemorrhage

Brain MRI w/o contrast second

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25
Q

Brain aneurysm imaging

A

Brain MR angiography

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26
Q

Brain MRI w/ contrast

A

Brain lesions

Brain abscess, toxoplasmosis, and tumor

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27
Q

What decreases mortality in patients w/ COPD w/ chronic hypoxemia

A

Supplemental oxygen

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28
Q

Tx acute exacerbations of chronic COPD

A

10 days oral corticosteroid therapy

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29
Q

42 y.o male headaches, decreased vision. Baseball caps no longer fit. Coarse facial features and bitemporal hemianopia.

What hormone

Confirm diagnosis with?

A

Growth hormone

Acromegaly

Pituitary adenoma

Confirm diagnosis w/ serum insulin like growth factor I level

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30
Q

Excess aldosterone leads to

A

Hypokalemia

Hypertension

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31
Q

Pathyophysiology of BPH

A

1) Obstruction: where the enlarged prostate obstructs the lumen of the urethra and increase resistance to urine flow

Due to obstruction and increased pressure –> detrusor muscle thickening and decreased bladder compliance.

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32
Q

Patient with urinary frequency or urinary incontinence with history of stroke, MS or spinal cord injury

A

Neurogenic bladder

Diminished sphincter tone on PE

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33
Q

Symmetric scaly flaking plaque like lesions on areas on skin with sebaceous glands ( scalp, eyebrows, eyelashes, beard)

Tx

A

Seborrheic dermatitis

Selenium sulfide
(antifungal shampoo)

or ketoconazole

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34
Q

Coal tar used for

A

removal of thick plaques

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35
Q

Isotretinoin

A

systemic therapy reserved for refractory seborrheic dermatitis

Suppresses sebaceous gland activity

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36
Q

Joint pain, gradual loss of libido. Progressive aching in hands. Tanned skin. Non-tender hepatomegaly with normal sized spleen. No lymphadenopathy

Highly elevated AST
Elevated ALT
Elevated iron
Low TIBC

Tx

Risk of developing

A

Hemochromatosis

Phlebotomy

Second line: deferoxamine

Congestive heart failure
Cirrhosis
Hepatocellular carcinoma

[Siblings who die of liver or heart disease]

Order iron studies

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37
Q

Interferon alpha

A

tx for chronic hepatitis C

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38
Q

Penicillamine

A

Anticopper tx for Wilson’s disease

Liver disease
- elevaed AST/ALT
Neurologic disorder
- tremor
-dystonia
Psychiatric illness
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39
Q

2 day hx w/ gait difficulty. 2 weeks ago had dry cough and low grade fever. Developed bilateral lower extremity weakness

Tx

A

Guillain-Barre

Acute demyelinating neuropathy

Intravenous immune globulin or plasma exchange

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40
Q

Bullseye rash
Facial nerve palsy

Tx

A

Lyme disease

Oral doxycycline

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41
Q

Proximal muscle weakness
Ptosis
Diplopia
Dysphagia

Worse with repeat muscle use

Tx

A

Myasthenia gravis

Oral pyridostigmine

Acetyl cholinesterase inhibitor

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42
Q

Empiric therapy for patients with uncomplicated mild case of pyelonephritis

A

Ciprofloxacin

Fluoroquinolone

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43
Q

Tx cystitis

A

ORal nitrofurantoin

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44
Q

Patient w/ renal insuffiency who develops elevated potassium level

Tx

A

Hyperkalemia

If experiencing concerning ECG changes calcium should be administered immediately
(cardioprotective and prevents arrhythmias)

Followed by insulin and glucose

And sodium polystyrene sulfonate to normalize potassium level

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45
Q

Painful blistering lesions. Erupt easily. Epidermis easily detaches from skin. IgG and C3 deposits in the epidermis

A

Pemphigus vulgaris

Nikolsky sign : epidermis easily detached from skin

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46
Q

Bullous pemphigoid

A

Blistering disease

Subepithelial blistering and presence of IgG and C3 deposition in linear pattern along BM

Not fragile blisters

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47
Q

Chronic pruritic papulovesicular lesions and urticara on extensor surfaces

Papule or vesicle formation followed by excoriation and crusting

Group together

IgA deposits

A

Dermatitis herpetiformis

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48
Q

Erythema multiforme

A

Hypesensitivity skin rxn

Target appearance

20-40 y.o

Herpes simplex or mycoplasma pneumoniae or certain drugs (barbs, nsaids, penicillins, sulfonamides)

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49
Q

Blisters, pruritic vesicles, papules and bullae that appear on extensor surfaces

Excoriation of lesions

Linear IgA deposition along BM

A

Linear IgA dermatosis

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50
Q

Tx chronic sinusitis

A

Amoxicillin/ clavulanate or cephalosporin 21 days

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51
Q

Acute sinusitis that worsens after 5 days or persists after 10

A

S. pneumoniae
H. influenza
Moraxella catarrhalis

Tx Amoxicillin/ clavulanate or cephalosporin 10 days

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52
Q

AA w/ no signs of infection but low leukocytes and neutrophils

A

Chronic benign neutropenia

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53
Q

Paraneoplastic hypercalcemia has an increase of

A

Parathyroid hormone-related protein

[Not Serum intact parathyroid hormone will be low]

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54
Q

ACTH causes release of

A

cortisol

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55
Q

34 y.o with headaches. Using kerosene heater to stay warm. Elevated hemoglobin, Hematocrit. Erythropoietin is elevated

Appropriate next step

A

Polycythemia

Hemoglobin > 18.5 M > 16.5 F
Hematocrit > 52% M > 48% F

Carbon monoxide poisoning causes secondary polycythemia with elevated erythropoietin level

Assay for blood carboxyhemoglobin greater than 5% is diagnostic

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56
Q

Polycythemia vera

A

Myeloproliferative disorder

Low EPO

Polycythemia
Severe pruritus after shower
transient visual disturbances
Painful red pruritic palms

JAK2 mutation

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57
Q

URI followed by eye pain, redness, burning or tearing that spreads from one eye to the other

No vision changes

A

Acute conjunctivitis

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58
Q

Eye pain, blurry vision in patient with UC, Crohns, psorasis, ankylosing spondylitis, or sarcoidosis

A

Anterior uveitis

tx corticosteriods

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59
Q

Asymptomatic, increased cup to disc ratio

A

Open angle glaucoma

Tx prostaglandin analogs (latanoprost) or topical beta blockers (timolol)

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60
Q

Type of polyp to form colorectal cancer

A

Sessile villous adenoma

tubular adenomas < tubulovillous adenomas < villous adenomas

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61
Q

Elevated pulmonary arterial pressure tx

Albuterol
Heparin
Prednisone
Sildenafil
Theophylline
A

Sildenafil

Potent vasodilator

Tx for primary pulmonary htn

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62
Q

Incidental finding of 4 mm mass on right kidney. Uniform density, round, unilocular and no perceptible wall

It does not enhance after contrast

Management?

A

No intervention now; reevaluate if symptoms change

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63
Q

Methotrexate SE

A

Hepatotoxic

Myelosuppression

Pancytopenia

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64
Q

64 y.o 2 wk history gradually incrasing back pain radiates to RUQ. Stabbing. Rash appeared yesterday. Erythematous papules and bullae

Management?

A

Begin valacyclovir

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65
Q

Anti-mitochondrial antibody testing

A

Confirm primary biliary cholangitis

Present with
- cirrhosis
elevated alk phos
jaundice, fatigue, pruritius

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66
Q

Peripheral sensory neuropathy due to what deficiency
Decreased sensation in feet.
Numbness and burning

A

Vit B6

Isoniazid classic cause fo Vit B6 deficiency

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67
Q

Peripheral neuropathy w/ ataxia, increasing confusion and delirium

Weakness in stocking-gllove
Diminished reflexes
Nystagmus

A

Vitamin B1 (thiamine)

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68
Q

Peripheral neuropathy spasticity and dementia. Ataxia loss of vibration and proprioception of lower extremities

Hyperactive reflexes
Positive Babinski

A

B12 def

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69
Q

Africa, flu like, rash on stomach and back spread to arms and legs
Fever
Confusion

Clostridium perfringens
Human T cell lymphotropic virus
Rickettsia prowazekii
Salmonella typhi
Streptococcus pyogenes
  • Source
  • Diagnosis
  • Tx
A

Rickettsia prowazekii

Human louse borne (flea)

Indirect immunofluorescence and ELISA

Tx doxycycline

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70
Q

Solitary blanching pink papules on trunk, HA, cough, fever, abdominal pain, constipation or pea soup diarrhea 7-10 days

A

Salmonella typhi

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71
Q

75 y.o new onset SOB over 2 months, dry cough, takes hydrochlorothiazide, simvastin, warfarin and amiodarone. CXR diffuse bilateral infiltrates with a ground glass appearance. PFR at 70%

A

Medication toxicity w/ amiodarone

Ground glass
Foamy

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72
Q

Patietn with mulitplesmall brown cicular macules on body. Skin color papules on back.

Test to do

A

Slit lamp

Neurofibromatosis (NF)

Looking for iris hamartomas and optic gliomas

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73
Q

Cafe au lait macules
Fibrous skeletal dysplasia
precocious puberty

Test

A

McCune-Albright syndrome

Hormone studies

  • elevated testosterone (M)
  • elevated estrogen (F)
  • low levels of FSH and LH
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74
Q

HA, intolerance to light, hiking in woods in wisconsin. Targetoid plaque on arm spontaneously recovered in a week. Flexion of neck causes hip and knee to flex

What should be administered

A

Ceftriaxone

Lyme meningitis
- 28 day IV ceftriaxone

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75
Q

16 y.o with yellow firm papules on both arms from elbow to mid forearm and inferior margin of butt

Tender to palpation and non-blanching

What also do you expect to find

A

Palpable fusiform mass on Achilles tendon

Xanthomas are skin or tendon nodules of abnormal lipid deposition are characteristic of familial hypercholesterolemia

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76
Q

Risk of what cancer

17 y.o intellectual disability, refractory seizures, multiple skin hamartomas, chronic renal failure due to AD disorder

A

Renal cell carcinoma in patients with tuberous sclerosis

Also at risk for cardiac rhabdomyomas and astryocytomas in brain

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77
Q

Risk of what cancer

24 y.o w/ megaloblastic anemia, loss of proprioception and impaired gait. Elevated methylmalonic acid and positive schilling test

A

Gastric adenocarcinoma

Increased risk of gastric adenocarcinoma in patients with pernicious anemia

Autoimmune destruction of parietal cells of the stomach
- confirmed by schilling tests

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78
Q

Risk of what cancer

Previous burkitt lymphoma and chemotherapy

Peripheral smear shows dysplastic myeloblasts w/ rod-shaped cytoplasmic inclusion bodies

A

Acute myeloid leukemia

Auer rods

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79
Q

Risk of what cancer

18 y.o wrinkled and leathery skin who appears much older than age

AR defect of nucleotide excision repair

A

Cutaneous carcinomas (squamous cell carcinoma or basal cell carcinoma)

Risk increased in xeroderma pigmentosa

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80
Q

Risk of what cancer

53 y.o difficulty breathing, anti-acetylcholine receptor Ab detected

A

Malignant thymoma

Myasthenia gravis at risk for malignant thymoma

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81
Q

Risk of what cancer

Paget disease of bone

A

Fibrosarcoma of the bone

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82
Q

72 y.o with abrupt severe abdominal pain in left lower quadrant. Bloody stool. PMH DM, coronary artery disease, htn and hyperlipidemia. Leukocytosis

A

Mesenteric ischemia

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83
Q

Skip lesions

A

Crohns

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84
Q

Colon and rectum

continuous

A

UC

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85
Q

Pap smear w/ HPV testing

A

once every 5 years

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86
Q

Sigmoidoscopy

A

every 5 years

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87
Q

Herpes simplex virus type 1 vs herpes simplex virus type 2

A

Type 1: oral vesicular lesions

Type 2: genital

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88
Q

Coxsackievirus

A

children under age 5

hand, foot and mouth disease

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89
Q

Pink maculopapular rash starts on face and spreads to trunk and extremities

Febrile illness

Tender lymphadenopathy

A

Rubella

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90
Q

Adults with headaches and ring-enhanging mass on CT

A

Glioblastoma multiforme

Not surgically removable
Aggressive

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91
Q

Craniopharyngioma

A

Children

Supratentorial tumor

Vision changes (bitemporal hemianopia)
Stunted growth
Hypopituitarism

Calcification is common

Arise from Rathke’s pouch

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92
Q

Medulloblastoma

A

Children

Cerebellum involvement

Compress 4th ventricle
- HA, papilledema

Increased intracranial pressure (HA, N/V, neurologic changes)

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93
Q

24 who gave birth complicated my massive bleeding and transfusions. Drop in BP. Failure of lactation and extreme fatigue. Low prolactin, cortisol, ACTH.

Next step in management

A

Sheehan’s syndrome resulting in acute adrenal insufficiency

Pituitary necrosis caused by blood loss and hypotension

Decreased prolactin, free T4, ACTh and cortisol

IV dexamethasone (“stress dose” steroids)

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94
Q

ACTH stimulation test

A

Diagnose primary and secondary adrenal insufficiency.

Small rise in cortisol after ACTH given indicated primary.

Large rise in cortisol (3-4x normal) indicates secondary

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95
Q

Test to identify pituitary pathology

A

MRI

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96
Q

Young woman who has never smoked. Peripheral lung mass

Adenocarcinoma
Large cell carcinoma
Metastatic disease
Small cell carcinoma
Squamous cell carcinoma
A

Adenocarcinoma

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97
Q

Smoker

Peripheral lung tumor

A

Large cell carcinoma

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98
Q

Smoker
Central tumor in lung
Profound weakness or hyponatremia

A

Small cell carcinoma

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99
Q

Central tumor in lung

Hypercalcemia

A

Squamous cell carcinoma

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100
Q

Epigastric pain 2-3 hrs after meal relieved by antiacidds. Decreased libido. Diminished visual acuity in far left temporal field. Gynecomastia. Family history parathyroid adenomas

A

MEN type 1

Pituitary adenoma
Parathyroid adenomas
Zollinger Ellison syndrome (pancreatic islet tumors, gastrinomas)

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101
Q

MEN type 2a

A

medullary thyroid carcinoma
Pheochromocytoma
Parathyroid adenoma

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102
Q

MEN type 2b

A 
Medullary thyroid carcinoma
Pheochromocytoma
Mucosalneuromas
Intestinal ganglioneuromas
Marfanoid body habitus
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103
Q

Elderly older than 50.
Hip and shoulder pain and stiffness that is worsened after a period of immobility

No loss of muscle strength

Diagnose?

A

Polymyalgia rheumatica

Elevated erythrocyte sedimentation rate

Tx corticosteriods

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104
Q

Muscle disease with elevated creatine phosphokinase

A

Polymyositis, dermatomyositis

Duchenne muscular dystrophy

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105
Q

Difference in polymyalgia rheumatic and rheumatic arthritis

A

Symmetric joint pain
Stiffness

Rheumatoid arthritis will have evidence of inflammation in hands and feet

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106
Q

Anti-centromere antibody

A

CREST syndrome

Calcinosis
Raynaud phenomen
Esophageal dysmotility
Sclerodactyly
Telangiectasias
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107
Q

Anti-double stranded DNA ab

A

SLE

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108
Q

Acute swelling of right eye. Significant pain and blurry vision. Nasal congestion and fevers 3 weeks ago. PMH MS, smokes, swims and drinks

Cause?

A

Orbital cellulitis from acute sinusitis

inflammation of extraocular muscles, orbital fat and optic nerve

Anterior displacement of the globe

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109
Q

Preseptal cellulitis vs orbital cellulitis

A

both have painful eyelid edema and erythema

Preseptal cellulits: will not have ophthalmoplegia (paralysis of eye muscles), proptosis or decreased visual acuity, inflammation confined to eyelids

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110
Q

Common visual finding in MS

A

Internuclear ophthalmopelgia

Disorder of conjugate gaze caused by demyelination of the medial longitudinal fasciculus

Impairment of adduction in the affected eye and nystagmus while abducting the CL eye

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111
Q

Tobacco use is associated with increased risk of what to eyes

A

cataract formation

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112
Q

Swimming risk to eyes

A

Viral conjunctivitis

monoocular irriation with foreign body sensation

Watery discharge
Conjuntival swelling

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113
Q

Chest pain for 4 hrs, worse with deep inspiration. SOB. Recent lumpectomy and axillary LN dissection

Test?

A

PE

Initial test is CT angiography (aka spiral CT scan)

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114
Q 
Vertigo
Slurred speech
Inability to swallow
Bilateral nystagmus
Left eyelid drooping
Left pupil constricted
Loss pain and temp on left side of face and right side of body
A

Left posterior inferior cerebellar artery lesion

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115
Q

Posterior inferior cerebellar arterial lesions

A

Lateral medullary syndrome (Wallenbergs)
Vertigo
Nystagmus
Horner’s syndrome

Ipslateral face
CL body

Dysphagia
Dysarthria
Diplopia

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116
Q

Contralateral lower extremity weakness and sensory deficit

CL upper extremity weakness and sensory deficit not as significant

Personality changes

A

Anterior cerebral artery lesion

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117
Q

Contralateral upper extremity weakness and sensory deficit

Aphasia (broca’s) or wernickes if dominant side

Neglect

CL homonymous hemianopia (visual field loss on one side of vertical midline) w/ macualr sparing

A

Middle cerebral artery lesion

Eyes will deviate away from lesion

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118
Q 
Vertigo
Vertical nystagmus
Dysarthria
Dystonia
ataxia
Sensory changes in face
"Drop attack" loss of postural tone w/o loss of consciousness
A

Vertebrobasilar artery lesion

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119
Q

Vertigo
Nystagmus
Right sided horner syndrome
Loss of pain and temp on right face and left side of body

A

Right posterior inferior cerebellar

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120
Q

Acute onset flank pain, nausea, hematuria.

Crohns disease

A

Nephrolithiasis caused by hyperoxaluria

Fat malabsorption excess bowel fat binds calcium

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121
Q

Tx magnesium ammonium phosphate stones

A

Abx to tx UTI

Proteus vulgaris
- Urease producing

struvite stones

(Klebsiella and Ureaplasma)

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122
Q

Tx uric acid stones

A

Allopurinol and potassium citrate which alkalinizes the urine

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123
Q

Nephrolithiasis in childhood

pHurine < 5.5 acidic

A

Cystinuria

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124
Q

Tx acute bacterial meningitis w/ gram-negative diplococci

A

Cefotaxime

Neisseria meningitis

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125
Q

Tx Acute bacterial meningitis w/ gram positive cocci

A

Streptococcus pneumoniae

vancomycin, ceftriaxone, and dexamethasone

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126
Q

Colicky abdominal pain, n/v, brown urine, legs gave away and weak.

A

Porphyria

Colicky abd pain
Neuropathy
Seizures
Hallucinations
paranoia
Cutaneous porphyrias: accumulation porphyrin in skin= photosensitivity and blistering in sun
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127
Q

Needed in patients beginning chemotherapy to prevent tumor lysis syndrome

A

Allopurinol and IV bicarb

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128
Q

Tumor lysis syndrome

A

Sudden release of potassium, phosphorus, and uric acid from rapidly dying cancer cells

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129
Q

Tx SIADH

A

Fluid restrictiona nd demeclocycline

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130
Q

Tx hypercalcemia of malignancy

A

IV zolendronate and oral phosphorous

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131
Q

Tx Cushing syndrome by ectopic ACTH neoplasm

A

Ketoconazole and glucocorticoid replacement

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132
Q

Patient with DM with repeat htn readings place on what medication

Amlodipine
Atenolol
Furosemide
Hydralize
Hydrocholorthiazide
Lisinopril
A

Lisinopril

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133
Q

Bronchospasm in asthmatic patient is an adverse effect of

A

beta blocker therapy

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134
Q

Amlodipine AE

A

Lower extremity edema

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135
Q

Furosemside AE

A

Hypokalemia
Metabolic alkalosis
Ototoxicity
Gout

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136
Q

Pregnant lady w/ preeclampsia give

A

Hydralazine

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137
Q

Painful rash all over body 2 days after given trimethoprim-sulfamethoxazole for UTI

Itchy painful confluent erythematous desquamating rash

A

Toxic epidermal necrolysis

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138
Q

Stevens johnson syndrome

A

skin reaction

Itchy painful confluent erythematous desquamating rash

10% of body

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139
Q

Chinese woman
Painful oral and genital ulcers
Relapsing
Yellowish necrotic center

Tx

A

Behcet syndrome

Tx Colchicine
Inferior vena cava filter

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140
Q

Type 1 diabetes is caused by

A

failure of beta cells of the islets of langerhans to secrete insulin

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141
Q

Warfarin therapy causes a deficiency of what

A

Factor VII

Warfarin inhibits activation of Vit K which leads to decrease production of clotting factors II, VII, IX, X

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142
Q

Vomiting see what lab values

A

pH 7.52
pCO2 60 mmHg
Bicarb 30 mEq/L

Metabolic alkalosis

Increased pH
Increased pCO2
Increased bicarbonate

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143
Q

Kidney stones imaging

A

Non-contrast CT scan of abdomen and pelvis

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144
Q

Cerebral edema on CT scan of head

A

Hypernatremia if corrected too rapidly

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145
Q

U waves on ECG

A

Hypokalemia

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146
Q

Rheumatic fever as child. Loud S1 and high-frequency S2 followed by low pitched mid diastolic rumble

A

Mitral valve stenosis

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147
Q

Camping, rash over back, non itchying, fatigue HA, arthralgia.

A

Lyme disease

Erythema migrans

Erythematous patch with central hypopigmentation surround a hyperpigmented or indurated bite site

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148
Q

Confluent, white non scaling edematous papules coalescing into plaques

A

Urticarial wheal in urticaria (hives)

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149
Q

Erythematous patch with annular clearing and central hyperpigmentation

A

Lyme disease

Erythema migrans

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150
Q

Raised, skin-colored pearly papules with central umbilication

A

Molluscum contagiosum

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151
Q

Sharply demarcated erytematous plaque covered with silvery scale

A

Psoriasis

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152
Q

Superficial ulcer with clean base and firm, indurated margins

A

Painless ulcer of primary syphilis

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153
Q

Double layered basement membrane with subendothelial deposits

A

Membranoproliferative glomerulonephritis

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154
Q

Thickening of the glomerular BM with deposits of immunoglobulin G and C3

A

Membranous nephropathy

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155
Q

Risk factor for choleithiasis

A

obesity

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156
Q

Urine frequency. Administration of desmopression causes urine osm to double

A

Central diabetes insipidus

Large amounts dilute urine

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157
Q

51 y.o post chemotherapy for bladder cancer, hearing loss

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

C. Carboplatin

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158
Q

Severe gout attack after chemo

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

6- merocaptopurine

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159
Q

Chemo for chondrosarcoma can induce abortion

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

F. Methotrexate

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160
Q

Heart failure after chemotherapy. Diagnosed with dilated cardiomyopathy

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

E. Doxorubicin

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161
Q

Breast cancer started on adjuctive medical therapy warned could cause hot flashes and risk of endometrial carcinoma

A

Tamoxifen

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162
Q

Recently began chemo, feeling acutely ill and dark brown oliguria.

Acute renal failure, hemolysis and thrombocytopenia

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

G. Mitomycin

HUS

  • acute renal failure
  • hemolytic anemia
  • thrombocytopenia
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163
Q

Chemo can cause skin rashes and teratogen

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

I. Tretinoin

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164
Q

25 y.o AIDS and Burkitt, to Er w/ hematuria

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

Cyclophosphamide

Hemorrhagic cystitis

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165
Q

Cyclist on chemo forced to retired due to pulmonary fibrosis

A. 6-merocaptopurine
B. Bleomycin
C. Carboplatin
D. Cyclophosphamide
E. Doxorubicin
F. Methotrexate
G. Mitomycin
H. tamoxifen
I. Tretinoin
J. Vincristine
A

B. Bleomycin

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166
Q

13 y.o ALL develops glove and stocking paresthesias after chemo starts

A

J. Vincristine

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167
Q

Palpable prostate nodule, greatly elevated PSA, osteoblastic lesions on xray.

Tx

A

Metastatic prostate cancer

Tx GnRH agonists (androgen deprivation)
Leuprolide or goserelin

or GnRH antagonists (degarelix

Desensitize GnRH reeptors suppress gonadotropin secretion or Stimulation of gonadotropic-releasing hormone receptors in pituitary gland

SE gynecomastia, hot flashes

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168
Q

Tx benign prostatic hyperplasia (BPH)

A

Alpha receptors

Terazosin, doxazosin, tamsulosin

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169
Q

Inhibition of osteoclastic bone resorption

A

MOA for bisphosphonates

SE osteonecrosis of the jaw, erosive esophagitis, and hypocalcemia

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170
Q

Muscle weakness
Flattening of T wave
Increased P wave
U wave

A

Hypokalemia

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171
Q 
Dull flank pain
Hematuria
HTN
bilateral flank masses
Headaches
Father some kidney disease
A

Autosomal dominant polycystic kidney disease

Get Magnetic resonance angiography if cerebral aneurysm

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172
Q

Myelodysplastic disorder vs myeloproliferative disorder

A

Myeloproliferative disorder
- hyperproliferation of one or more myeloid cells lines

MDS
- cytopenia on CBC

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173
Q

MRI ring-enhancing lesion with surrounding cerebral edema

A

Toxoplasma gondii

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174
Q

Eosinophils rod shpaed cytoplasmic inclusion bodies

A

AML

Auer rods

All trans retinoic acid

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175
Q

Churg- Strauss

A

Asthma
Vasculitis
Eosinophilia

Collagen vascular disease

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176
Q 
Brown urine
Fever, malaise, WL
Periorbital edema
Cough productive of blood tinged sputum
Protein in urine 2 grams
Positive c-anca

-Kidney biopsy

A

Granulomatosis w/ polyangiitis

Nephritic syndrome

Subnephrotic proteinuria (0.3-3 grams)

Biopsy: no immune deposits

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177
Q

Dense subepithelial deposits on kidney biopsy

A

Post-infectious glomerulonephritis

IgG and C3 deposits

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178
Q

Diffuse mesangial IgA and C3 complement deposits

A

IgA nephropathy

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179
Q

Linear IgG on glomerular BM

A

Anti-GBM disease

Kidney and respiratory

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180
Q

Sub-endothelial and sub-epithelial deposits

A

Membranoproliferative glomerulonephritis

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181
Q

Anti-basement membranes Ab

A

Goodpasture’s syndrome

Lung and kidney

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182
Q

EGFR genetic mutations

A

Lung cancer

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183
Q

Lung cancer with low sodium

A

Small cell lung carcinoma

SIADH
Lambert Eaton syndrome

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184
Q

Squamous cell lung carcinoma extra symptom

A

Hypercalcemia

Secretion of PTH-like hormone

185
Q

Elderly patient with gradual onset of bilateral central vision loss with preservation of peripheral vision

A

Age related macular degeneration

Characterized by presence of drusen (subretinal deposits)

186
Q

Cherry red spot on the fovea

A

Central retinal artery occlusion

187
Q

Cupping of the optic disk

A

Open angle glaucoma

188
Q

Dilated nonreactive pupil

A

Closed angle glaucoma

189
Q

Relative afferent pupillary defect

A

Optic neuritis

MS

190
Q

Rheumatoid arthritis on xray

A

bony erosions

Joint space narrowing

191
Q

Cartilage calcification is seen with

A

Chondrocalcinosis

Found in pseudogout

192
Q

Punch-out erosions with overhanging bone found in

193
Q

Subcondral cysts and osteophyte

A

bone spurs

Osteoarthritis

194
Q

Multiple hypopigmented macules on the back that show up chronically

A

Tinea versicolor

Malassezia furfur

Scrapings and KOH prep
“Spaghetti and meatballs”

tx selenium sulfide shampoo

195
Q

Pityriasis rosea

A

Herald patch first
Single red or hyperpigmented plaque on trunk

Days to weeks later
“Christmas tree” trunk

Resolve on own

196
Q

Tinea corporis

A

erythematous ring-shaped lesions that scales and has central clearing

197
Q

Decreased pH
Increased PCO2
Decreased bicarb
elevated anion gap

A

Respiratory acidosis with anion gap metabolic acidosis

Acidosis
resp PCO2 >40
metabolic Bicarb <24

Alkalosis
resp PCO2 <40
metabolic Bicarb >24

Anion gap
Na- Cl- Bicarb
Normal 8-12

198
Q

Determine acidosis vs alkalosis

A

Acidosis
resp PCO2 >40
metabolic Bicarb <24

Alkalosis
resp PCO2 <40
metabolic Bicarb >24

Anion gap
Na- Cl- Bicarb
Normal 8-12

199
Q

Elevated ACTH
Dexamethasone suppression test shows pituitary adenoma

MRI confirms microadenoma

TX

A

Transsphenoidal resection of the adenoma

200
Q

Tx adrenal adenoma causing cushings

A

Unilateral adrenalectomy

201
Q

Fever
Tachycardia
Leukocytosis

A

systemic inflammatory response syndrome (SIRS)

Sepsis

202
Q

Severe sepsis

A

Sepsis with >1 sign of organ dysfunction

Hypotension
Decreased urine output
Respiratory distress
Decreased platelets
Unexplained metabolic acidosis
203
Q

Car accident

Increase in sodium

A

Impaired central release of ADH

204
Q

What distinguishes asthma from COPD

A

Carbon monoxide diffusion capacity

Is normal w/ asthma

Decreased in COPD

FEV1 decreased in both
FVC normal/ slight decreased both
FEV1/FVC decreased both
TLC increased both

205
Q

3 day history HA. Worsen with supine position. Double vision. Papilledema

A

Pseudotumor cerebri or idiopathic intracranial htn

Common in patients taking isotretinoin or vit A supplements

206
Q

Most common electrocardiography in PE

A

sinus tachycardia

207
Q

Peaked T waves

A

hyperkalemia

208
Q

Pruritus after bath
Headaches
Palpable spleen
Increased platelet and hematocrit

A

Poycythemia vera

Overproduction of RBC independent of erythropoietin leads to suppressed erythropoietin levels

JAK2 mutation

209
Q

Acute MI lab levels 60 minutes

A

Negative CK-MB
Elevated myoglobin
Negative troponin

Troponin takes 3 hrs
CK-MB takes 4 hrs

210
Q

Male with elevated lactate

Pain in inginal region

A

Incarcerated inguinal hernia

211
Q

HIV with focal areas of demyelination

A

Progressive multifocal leukoencephalopathy (PML)

Caused by JC virus

212
Q 
1 year fatigue
Feverish, WL.
Asthma exacerbations
Sinus infections
Low neutrophils
Elevated eosinophils
Elevated ESR
P-anca positive
A

Churg-Strauss syndrome

213
Q

Arm claudication
Raynaud phenomenon
Visual changes, syncope
Abd pain, n/v

Elevated ESR
Mild anemia

A

takayasu arteritis

Tx Bypass surgery

214
Q

Fungating mass in colon
Infective endocarditis

Organism?

A

Streptococcus gallolyticus

Strong association with colonic neoplasia

215
Q

Weakness, N/V. Crohns disease who had recent tx w/ corticosteriods but did not complete. Low sodium. Decreased cortisol. Hypotension

What else would you see

A

Decreased ACTH levels

Secondary adrenal insufficiency

216
Q

Diagnostic tool for PE

A

Spiral CT of the chest

217
Q

Fatigue and bone pain in lower extremities. Temperature. Conjunctival pallor. Petechiae. Bilateral lower extremities tender to palpation

Low hemoglobin
Low platelets
High leukocyte

A

Acute leukemia

218
Q

Severe episodic headaches, htn, family history of medullary thyroid cancer.

Diagnose by?

A

Phenochromocytoma

MEN 2A 2B

Urinary metanephrines

219
Q

Gram positive rods

Meningitis

A

Listeria monocytogenes

Elderly

220
Q

Gram positive cocci

Meningitis

A

Streptococcus pneumoniae

221
Q

Infant
Gram-negative coccobacilli
Meningitis

A

Haemophilius influenza

222
Q

Prophylaxis for contrast nephropathy

A

IV hydration alone

with low-weight/ non-ionic contrast

223
Q

IV drug use and new onset heart murmur waht organism

A

Staph aureus

224
Q

Dental procedure

Organism

A

Viridans streptococci

225
Q

First line tx for long term management of relapsing remitting MS

A

Interferon beta or Glatiramer acetate

226
Q

High fever, N/V change in metal status in patient with acute infection and history of noncompliance w/ tx for hyperthyroidism

A

Thyroid storm

Confirmed by decreased TSH
Elevated thyroid hormone levels

Tx: Beta blocker, propylthiouracil (PTU), hydrocortisone and stable iodine

Give iodine once patient is stabilized

227
Q

Wright-Giemsa stained bone marrow aspirate

A

used to detect leukemic myeloblasts (auer rods) for AML

228
Q

Fever, fatigue, rash, arthralgias, sore throat, N/V, diarrhea
Lymphadenopathy
Hepatosplenomegaly
Rash

A

Acute HIV infection

229
Q

Severe hip pain after fall
Bone pain
Anemia
Recurrent infections

Diagnosis

A

Multiple myeloma

Plasmacytosis on bone marrow biopsy

230
Q

Apple green birefringence

A

Amyloidosis

231
Q

Bilateral hilar adenopathy

A

Sarcoidosis

Bilateral hilar adenopathy with significant interstitial disease

SOB
AA
erythema nodosum

Biopsy of LN to confirm
- noncaseating granulomas

ACE elevated

232
Q

IgM spike on electrophoresis

A

Waldenstrom macroglobulinemia

MM has IgG spike

Will not see lytic bone lesions

233
Q

Smudge cells

A

CLL

Older patients
Lymphocytosis
Lymphadenopathy
Hepatosplenomegaly

234
Q

ACTH stimulation test

A

Distinguish between pituitary and adrenal causes of low cortisol

Dose of ACTH given, low level of cortisol afterwards indicates problem in adrenal glands

235
Q

Right handed male
Difficulty speaking suddenly while eating

Cant construct sentence
But comprehension is fine

A

Broca’s aphasia

Middle cerebral artery on dominant side

Left sided occlusion of the middle cerebral artery, superior division

236
Q

Occlusion of the inferior division of the middle cerebral artery on the left side

A

Wernicke aphasia

237
Q

Alpha 1 antitrypsin affects

A

Lungs

Liver

238
Q

Can cause siadh

A

carbamazepine

239
Q

Spontaneous nystagmus in all directions

A

Aminoglycoside toxicity

240
Q

meniere disease

A

triad vertigo
unilateral hearing loss
Unilateral tinnitus

241
Q

vestibular neuronitis

A 
vertigo
n/v
disequilibrium
flu like
Unidirectional nystagmus
242
Q

AIDS patient

Small purple papules that expand into friable nodules that bleed w/ trauma

A

Bacillary angiomatosis or Kaposi sarcoma

243
Q

Test for c. diff

A

Stool ELISA for toxins

244
Q

Fatigue, weakness, myalgia for six weeks. Purple rash around eyes and dorsal knuckles of the hands. Difficulty getting up from seated position

Diagnosis

A

Dermatomyositis

Muscle biopsy

Heliotrope rash (periorbital purple papules)
Gottron’s papules (flat papules on knuckles)
Shawl sign

245
Q

Difficulty seeing at night. Keratin accumulation in the conjunctiva

A

Vit A deficiency

Bitot spots

246
Q

Shoulder and neck weakness

Elevated ESR

A

Polymyositis

247
Q

Polymyalgia rheumatica

A

Elderly hip and shoulder muscle PAIN

Normal strength

Elevated ESR

248
Q

Reactivated Tb on X ray

A

Left apical cavitary consolidation with bilateral patchy infiltrates

249
Q

Bilateral hilar adenopathy with a single caseous focus in the right lower lung field

A

Primary tb infection

250
Q

Left apical cavitary consolidation with bilateral patchy infiltrates

A

Reactivation Tb

251
Q

Right sided pulmonary infiltrate with associated effusion

A

community acquired pneumonia

252
Q

Tx Pyelonephritis

A

Levofloxacin

Oral fluoroquinolone

  • levofloxacin
  • ciprofloxacin
253
Q

Tx PID

A

Ceftriaxone

Doxycycline

254
Q

Sudden onset dyspnea and hypoxia
Diffuse bilateral alveolar and reticular infiltration
Rales and Rhonchi

A

Acute respiratory distress syndrome

255
Q

45 y.o n/v. Now having mental status changes. Took medications, didnt eat breakfast. Tremor.

Whats causing confusion

Acute GI illness
Enalapril
Glipizide
Hctz
Metformin
A

Glipizide

Hypoglycemia

256
Q

Suspect pheochromocytoma what imaging

A

CT scan of abdomen

Lesion in in an adrenal gland

257
Q

Chronic watery diarrhea in AIDS patient

Cryptosporidium parvum
Entameoba histolytica
Giardia lamblia
Rotavirus
Shigella dysenteriae
A

Cryptosporidium parvum

[Entamoeba histolytica causes bloody diarrhea and liver abscesses; tx metronidazole]

Tx increased CD4 count
Nitazoxanide

258
Q

Giardia lamblia

A

Foul smelling diarrhea
Steatorrhea
Hiking and stream water

Elisa or stool microscopy

Double eyed trophozoite

Metronidazole

259
Q

Rapid onset tenderness in LLQ, painless hematochezia. Elevated lactic acid.

A

Large bowel ischemia

[Small bowel ischemia has pain out of proportion on PE, vomiting]

260
Q

25 y.o asain, for wellness. Hemoglobin normal/low

MCV low

A

Alpha thalassemia

Asian and African decent

Asymptomatic microcytosis

Mildly depressed hemoglobin

261
Q

Beta thalassemia

A

Mediterranean descent

Asymptomatic
Microcytosis
Mild anemia

Two copies
- chipmunk facies 
- shortened limbs
- hepatosplenomegaly
- hemolysis
Elevated hemoglobin F and A2
262
Q

Hemoglobin Barts

A

Hydrops fetalis

Defect all four alpha globin genes

Incompatible wi/ life

263
Q 
Stumbling
Crohns disease pmh
Loss of position and vibratory sense
Positive babinski
No head injury
Low Hemoglobin
High MCV
Folate and B12 low
Hypersegmented polymorphonuclear leukocytes

Test?

A

B12 deficiency

Methylmalonic acid test

264
Q

The schilling test

A

Pernicious anemia

265
Q

COPD lung values

A

Low FEV1
Low FVC
Low FEV1/fVC
High TLC

266
Q

Restrictive lung values

A

Low FEV1
Low FVC
High FEV1/FVC
Low TLC

267
Q 
Hypotension
Confusion
Diffuse abdominal tenderness
Corticosteriod therapy
Recent surgery
A

Adrenal crisis

268
Q

2 month lump in neck growing. Pruritus and fevers. 2 cm mass in left supraclavicuclar region.

Abnormal, large B cells w/ bilobed nuclei

Non-caseating granulomas in lungs

Rod-shaped cytoplasmic inclusions in blast cells

Translocation between chrom 8 and 14

Translocation between chrom 9 and 12

A

Hodkin lympoma

Cervical lymphadenopathy and B symptoms (fever, pruritus, fatigue, night sweats, WL)

Reed Sternberg cells
- large bilobed or multinucleated cells w/ owl eye appearance

269
Q

Translocation between chromosome 8 and 14

A

Burkitt lymphma

EBV, young AA w/ tumor in jaw or maxilla

Older who develops abdominal mass, “starry sky” appearance

270
Q

Translocation between chromosomes 9 and 22

A

Chronic myelogenous leukemia (CML)

Philadelphia chromosome
Bcr-abl fusion

Tx Tyrosine kinase inhibitors (imatinib)

50s/60s
Low grade fever, fatigue
Splenomegaly
Leukocytosis

271
Q

73 y.o increased difficulty reading. Normal intraocular pressure. Yellowing deposits clustered around macula in both eyes

A

Dry age-related macualr degeneration

272
Q

Night blindness
Xerophthalmia (dry eye)
Third world

A

Vit A deficiency

273
Q 
Sickle cell disease
Acute onset fever
Dyspnea
chest pain
pulmonary infiltrate
Low Hemoglobin and Hct
Elevated platelets, WBC and reticulocytes
A

Acute chest syndrome

Pulmonary fat embolism from infarct bone marrow is likely mechanism

274
Q

Fever, malaise, and rigors
Shivering
Recent travel

Diagnosis

A

Malaria

Thick and thin blood smears

275
Q 
Traveler
Febrile
Fever
Retro-orbital pain
Muscle or bone pain
Rash

Testing

A

Dengue virus

PCR for virus or serum testing for IgM ab

276
Q

Bleeding disorder uncoverered by aspirin or clopidogrel and NSAIDS

A

Von Willebrand disease

277
Q

Epistaxis
Easy bruising
Heavy bleeding after tooth extractions
Heavy menstrual bleeding

A

Von Willebrand disease

Prolonged bleeding time
Prolonged PTT

Normal platelets

278
Q

Bernard-Soulier syndrome

A

Rare

Thrombocytopenia
Giant platelets on peripheral smear
Excessive bleeding

Low platelet count

279
Q

Mucocutaneous bleeding

Clumped platelets on peripheral smear

A

Glanzmann thrombasthenia

GPIIb/IIIa

280
Q

Hemophilia A

A

Bleeding into joints
Hemorrhages

Platelet fxn not affected
Normal bleeding from small wounds
Bleeding time normal

Factor VIII

281
Q

Hemophilia B

A

Deficiency Factor IX

282
Q

Tx for GERD

A

PPI

Inhibition of parietal cell H/K/ATPase

283
Q

Spelunking in north eastern missouri

A

Histoplasmosis

284
Q 
Broad based budding yeast
Chronic PNA
Mississippi/ Great lakes
Soil/ rotten wood
Skin ulcers
A

Blastomycosis

285
Q

CA, NM, AZ, San Jauquin river valley
Erythema nodosum
Fever, myalgias, chills, HA
Erythematous nodules on her chest

A

Coccidioidomycosis

286
Q

South America
Painful lymphadenitis
Malaise, myalgia, fever

A

Paracoccidioidomycosis

287
Q

Viral meningitis

A

Lymphocyte predominance
Normal glucose
Slightly elevated protein

288
Q

Gram-negative cocci in pairs

A

Neisseria gonorrhoeae and Neisseria meningitidis

289
Q

Gram-negative rods w/ thick capsule

A

Klebsiella

290
Q

Gram-positive cocci in chains

A

Group A streptococci

  • strep throat
  • rheumatic fever
  • scarlet fever
  • TSS
291
Q

Gram-positive cocci in clusters

A

Staphylococcus aureus

292
Q

Gram-positive cocci in pairs

A

Streptococcus pneumoniae

293
Q

Gram positive rods with branching filaments

A

Actinomyces

Nocardia

294
Q

Arrhythmia characterized by increased atrial and ventricular rates 2:1

A

Atrail flutter

295
Q

Number one risk factor for stroke

A

Hypertension

296
Q

Paraneoplastic syndrome associated with squamous cell lung cancer

A

Hypercalcemia

PTH

297
Q

Tx DIC

A

treat underlying cause

If sepsis Abx

298
Q 
Pneumonia
Placed on Abx
Bleeding from central line
Large bruises on back/ butt
Elevated PT, PTT
Decreased platelets
Decreased haptoglobin
Schistocytes
299
Q

DVT tx w/ _____

MOA

A

Heparin

Increases activity of antithrombin III

300
Q

Decreased synthesis of vit K dependent factors

301
Q

Enlarged extremely tender thyroid gland 2 wks after URI.

A

Subacute thyroiditis

Cause mild hyperthyroidism

302
Q

Acute thyroiditis

A

Bacterial infection in children w/ congenital piriform sinus
(remnant of fourth pouch)

Staph/ Strep

Unilateral neck pain
Fever
Tender goiter

Thyroid tests nromal

303
Q

Diffuse nontoxic goiter

A

Caused by iodine deficiency

304
Q

Fever
Night sweats
Back pain
Africa

A

Tb of the spine (pott’s disease)

305
Q

Childhood Tdap

Wound on barb wire

A

Tetanus toxoid-containing vaccine alone

306
Q

Secondary hyperparathyroidism

A

Elevated PTH in response to Vit D deficiency

Typically due to kidney failure

Kidney lose ability to secrete phosphate, decrease phosphate intestinal absorption

307
Q

Tx community acquired pneumonia

A

Azithromycin
Clarithromycin
Erythromycin

308
Q

Cirrhosis serum- ascites album gradient

A

> 1.1 g/dL

309
Q

DEXA scan at what age

310
Q

Pneumococcal vaccination at what age

311
Q

Zoster vaccination at what age

312
Q

GERD symptoms 2x week tx

A

Lifestyle

H2RA

313
Q

Refractory GERD

A

Lifestyle

PPI

314
Q

Pap smear age

A

30-65 w/ HPV testing

Every 5 years

315
Q

Prophylaxis for HIV patients w/ CD4 less than 200

A

Trimethoprim/ sulfamethaxoazole

For pneumocystis jirovecii pneumonia

316
Q

Prophylaxis for HIV patients w/ CD4 less than 50

A

Azithromycin

Mycobacterium avium complex

317
Q

Positive TB induration in HIV patient

318
Q

Primary lesion

Marked solitary lymphadenopathy in node proximal to initial lesion

A

Cat scratch disease

Bartonella henselae

319
Q

Eczematous dermatitis in an ineterdigital web

320
Q

Pink oval macules with dust like scales

A

Tinea vesicolor

“wrinkled”

321
Q

Lung cancer screening

A

55-80

30 pack year history

322
Q

Risk of what with autosomal dominant polycystic kidney disease

A

Cerebral aneurysms

–> subarachnoid hemorrhage

Middle cerebral artery

323
Q

Schatzki ring

A

anatomic circular extension of the lower esophagus consisting of mucosa and submucosa.

Intermittent dysphagia to solids only

324
Q

9;22 translocation
Myeloblasts

Tx

A

CML

Imatinib tx
BCR-ABL

325
Q

Tx hairy cell leukemia

A

Cladribine

326
Q

T(15;17)

Tx

A

Acute promyelocytic leukemia
APL
AML-M3

Auer rods

All-trans-retinoic acid

327
Q

Red burning water eyes after URI

A

Viral conjunctivitis

Adenovirus

328
Q

Tx bacterial conjunctivitis

A

Sulfonamides

329
Q

First line tx sinusitis

A

Amoxicillin

330
Q

Muddy brown casts or heme granular casts

A

Acute tubular necrosis

331
Q

White cell casts w/ eosinophils

A

Allergic interstitial nephritis

332
Q

Sausage fingers
Nail pitting
Achilles tendinitis

A

Psoriatic arthritis

333
Q

Muscle weakness
Hypokalemia
Hypertension

Test

A

Hyperaldosteronism

Measurement of aldosterone-renin ratio

334
Q

Hemolytic anemia
Low hemoglobin
Elevated bilirubin
Lactate dehydrogenase

organism

A

Babesia microti

335
Q

Sudden fever 3-6 days
Afebrile for 2 weeks
Fever returns

Splenomegaly
Petechial bleeding

A

BOrrelia recurrentis

Spirochetes on peripheral smear
Giemsa stain

336
Q

Achalasia
Megacolon
Cardiomyopathy resulting in heart failure
South America

A

Trypanosoma cruzi

Chagas disease

337
Q

Dementia
Urinary incontinence
Gait

A

Normal pressure hydrocephalus

338
Q

Otitis externa organism

A

Pseudomonas

Staph aureus

339
Q

History otitis media develops swollen red painful mastoid process

A

Mastoiditis

S. pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

340
Q

Paranoia and acne in athlete

Fist fight

A

Anabolic steroid abuse

341
Q

Older patient
Smokes, WL, jaundice
Palpable gallbaldder

A

Pancreatic cancer

342
Q

Elevated in pancreatic cancer

343
Q

Chronic diffuse watery diarrhea
Hypokalemia
Elevated VIP levels
Tumor on abdominal CT scan

A

Vasoactive intestinal polypeptide (VIP)

344
Q

Fever chills and flank pain 12 hrs after blood transfusion

Back pain

A

Acute hemolytic transfusion rxn

Back pain

IV fluids
Mannitol or furosemide

345
Q

Delayed hemolytic reactions

A

Occurs days after a transfusion and cause extravascular hemolysis

Low grade fever

346
Q

Febrile nonhemolytic reactions

A

Occur within a few hours of a transfusion

Caused by host antibodies directed against donor leukocytes and other cytokines

Fever chills
(no back pain)

Acetaminophen and meperidine

[Centrally acting COX inhibitor]

347
Q

Transfusion related acute lung injury

A

Occurs within first 6 hrs

white blood cells aggregating and degranulating within the pulmonary vasculature

Predominance of pulmonary findings

Respiratory distress

348
Q

Ptosis
Diplopia
Down and out position
Nonreactive pupil

A

Oculomotor palsy

Aneurysm of posterior communicating artery

–> leads to subarachnoid hemorrhage

349
Q

Acute onset ptosis
Miosis
Anhidrosis

A

Acute-onset Horner syndrome

Common carotid artery dissection

Common risk factor is chiropractic manipulation

350
Q

Hemiparesis
Aphasia
Unilateral neglect

A

Middle cerebral artery aneurysm

–> subarachnoid hemorrhage

351
Q

Tender skin nodules
Non-ulcerated lesion
Arterial wall necrosis in the deep dermis without granuloma formation

A

Polyarteritis nodosa

Systemic necrotizing vasculitis

Tx corticosteroids

20% infected w/ hepatitis B or C and in the cases of plasma exchange is performed to eliminate the virus

352
Q

Tx CHF that causes hearing loss

A

Furosemide

Na-K-2CL cotransporter

353
Q

Ototoxicity

A

Aminoglycosides
Furosemide
Cisplatin
Aspirin

354
Q

Diuretic aldosterone antagonist in collecting tubules

SE

A

Spironolactone

SE: hyperkalemia, gynecomastia

355
Q

Diuretic block reabsorption of NaCl in the distal convoluted tubule

SE

A

Thiazide diuretic

Hypokalemic metabolic alkalosis

356
Q

Diuretic that increases osmotic pressure within the glomerular filtrate

357
Q

Diuretic that inhibits carbonic anhydrase at the PCT

SE

A

Acetazolamide

SE: metabolic acidosis

358
Q

Sudden SOB
Chest pain on left side
BOdy mass index 19 kg
CXR apical thin, visceral pleural line displaced form the chest wall on the left side

A

Primary spontaneous pneumothorax

Risk factors male, age 10-30, tall thin body habitus

359
Q

Protein > 0.5
Pleural fluid to serum lactate dehydrogenase ratio is greater than 0.6
Pleural fluid lactate dehydrogenase is greater than two thirds the upper limit of normal (300)

A

Exudative

Chylothorax
Malignancy
Pneumonia
Tb

360
Q

Transudative on pleural fluid analysis

A

Cirrhosis

CHF

361
Q

Household contacts of Tb induration

362
Q

5 mm positive Tb test

A

HIV positive
Immunocompromised
Household contact of TB

363
Q

10 mm positive Tb test

A

Immigrants from countries w/ high TB

High risk living conditions

High risk occupation

Children under age of 4

CKD on dialysis, DM, IV drug users

364
Q

First line pharmacologic agent for smoking cessation when bupropion is contraindicated

A

Varenicline

365
Q

HIV with red or purple papules or plaques in the oral cavity (hard palate)

A

Kaposi sarcoma

Caused by human herpesvirus-8 (HHV-8)

366
Q

Area of hypodensity in the left temporal lobe

A

Ischemic stroke

367
Q

Borrelia burgdorferi location

A

Midwest

Northeast

368
Q

Rash wrist and ankes

A

Rocky Mountain Spotted fever

369
Q

Suspect coarctation what test order

A

Echocardiogram

370
Q

Heart burn and steathorhea

A

Zollinger-Ellison syndrome

Low pH

PPI resistance

Acidic breakdown of pancreatic enzymes that digest fat

371
Q

Upper abdominal and suprapubic tenderness w/ echogenic kidneys

Hesitancy
Nocturia
Post-void residuals

Test?

A

Hydronephrosis caused by bladder obstruction

Benign prostatic hyperplasia causing this

Pelvic ultrasound examination w/ measurement of post-void residual for diagnosing BPH

372
Q

Nausea
Vomiting
Elevated liver enzymes
Chronic headaches Nsaid use

A

Acetaminophen toxicity

373
Q

Nutmeg liver

A

Congestive hepatopathy

Hepatomegaly
Elevated jugular venous pressure
Peripheral edema

374
Q

Low neutrophils
Fever
No area looking of infection

Not responding to antibiotics

Tx

A

Neutropenic fever

Tx antifungal

  • Candida most likely
  • Caspofungin or voriconazole
375
Q

Unstable gait

Small cell lung cancer

A

Paraneoplastic cerebellar degeneration

Anti-Hu antibodies (small cell lung)

Anti-Yo (breast and gynecologic)

376
Q

Anti voltage gated calcium channel antibodies

A

Lambert Eaton syndrome

Proximal muscle weakness that improves with activity

377
Q 
Bloody diarrhea
Abdominal pain
Elevated ESR
Elevated alkaline phosphatase
Elevated total bilirubin
Elevated direct bilirubin
A

Primary sclerosing cholangitis which is associated with UC

PSC leads to dilated intrahepatic and extrahepatic bile ducts

378
Q

Osteoarthritis is due to what cells

A

Chondrocytes

Degenerative disorder of the articular cartilage

379
Q

Tx Penumocystis jirovecci

A

TMP-SMX

Prednisone added if PaO2 is less than 70 mmHg

380
Q

Elevated anion gap metabolic acidosis in septic shock is caused by

A

lactic acidosis

381
Q

High pitched diastolic decrescendo murmur

Visable and palpable cardiac pulsations

A

Aortic valve regurgitation

Rapid and forceful arterial pulse with fast collapse (water hammer)

Head bobbing w/ pulsation

Visible pulsation of the uvula

Capillary pulsation with light compression of the nail bed

382
Q

Autoimmune hemolytic anemia reaction

A

Type II hypersensivity rxn

383
Q

Type II hypersensitivity rxn

A

Autoimmune hemolytic anemia rxn

Good pastures

Rheumatic fever

384
Q

Type III hypersensitivity rxn

A

Serum sickness
immune complex glomerulonephritis
SLE
Rheumatoid arthrits

385
Q

Type IV hypersensitivity rxn

A

TB skin etst
Transplant rejection
Contact dermatitis

386
Q

Fever
Sore throat
Lymphadenopathy
Rash

Given amoxicillin

Peripheral smear?

A

Infectious mononucleosis

Large, dark lymphocytes on blood smear

387
Q

Neutrophil count > 250

Cirrhosis

A

Spontaneous bacterial peritonitis

Infection of peritoneal ascitic fluid

Tx empirically w/ 3rd gen cephalosporins, cefotaxime

388
Q

What to do next for suspected giant cell arteritis

A

High dose glucocorticoid therapy

Before temporal artery biopsy

389
Q

First line tx for BPH

A

Doxazosin
Alpha 1 adrenergic antagonist

[Finasteride takes 6 months to be in effect]

390
Q

First line tx for cluster headache

A

high flow 100% oxygen

391
Q

Prophylactic therapy for migraine headache

A

Amitriptyline

392
Q

Solar lentigo

A

Liver spot

Flat oval shaped evenly pigmented macules

393
Q

Bronzing
Increased glucose
Cirrhosis

A

Hereditary hemochromomatosis

Serum iron panel

HIgh ferritin
Increased transferrin

394
Q

First trimester hyperthyroidism

A

Propylothiouracil

[Methimazole in second trimester]

395
Q

Valproic acid can cause

A

aplastic anemia

396
Q

30 y.o HTN
elevated creatinine
Elevated BUN

A

prerenal acute kidney injury

due to Fibromuscular dysplasia

397
Q

Definitive tx for achalasia

A

Surgical myotomy of lower esophageal sphincter

398
Q

Chest radiograph reveal bilateral fluffy/ alveolar infiltrates

A

Acute respiratory distress syndrome

399
Q

Psychogenic polydipsia

A

Euvolemic
Hypotonic
Hyponatremia

400
Q 
Dark lines on gums
Basophilic stippling of erythrocytes
Ringed sideroblasts
Confusion
Abdominal pain

Tx

A

Lead poisoning

Ca-EDTA
[ Succimer in children]

Can also see wrist and foot drops

401
Q

Endocarditis heart finding

A

Tricuspid regurgitation w/ vegetations

402
Q

A dual alpha beta agonist

A

Epinephrine

Anaphylactic txns

403
Q

NF-KB inhibitor

A

Corticosteriods

404
Q 
Neutropenia
Thrombocytopenia
Frequent infections
Decreased IgM
Eczema
Increased IgE
A

Wiskott Aldrick sydnrome

High risk of bleeding
High risk of malignancies (lymphoma)

Suspectible to encapsulated organisms

405
Q

Bruton’s agammaglobulinemia

A

Defective B cells

Otitis media frequently
Sinus infections

Hypogammaglobulinemia

Tx Immuneglobulin IVIG

Boys @ 6 months

406
Q

Positive straight leg test

A

Herniated disc

407
Q

Sickle cell anemia is caused by

A

Mutated hemoglobin that polymerizes under deoxygenated conditions

Causes

  • Cholelithiasis (pigmented stones)
  • painful crisis in back, legs or arms
  • chest pain
  • hip pain (avacular necrosis)
  • aplastic crisis
408
Q

Abnromalities in red blood cell surface membrane proteins

A

Hereditary spherocytosis

Younger patient
Pallor
Fatigue
Jaundice
Family hx
Splenomegaly
peripheral smear: RBC w/o any central pallor
409
Q

Abd pain
WL
Hematochezia
Change in bowel habits (pencil stool)

Location

A

Descending colon cancer

410
Q

Panacinar emphysema

A

alpha 1 antitrypsin

Loss of elastin

411
Q

Pain relieved by bending forward

A

Spinal stenosis

412
Q

Type IV hypersensitivity rxn what happens

A

Sensitized T cells contact antigens and release cytokines, activating macrophages

413
Q

Type III hypersensitivty rxn what happens

A

Antibody antigen immune complexes depositing in tissues

414
Q

Type I hypersensitivity rxn what happens

A

Antigens cross linking adjacent igE molecules leading to degranulation of mast cells

415
Q

Type II hypersensitivity rxn what happens

A

IgG binding cell surface antigens activating the complement cascade

Leading to destruction by cytotoxic T cells

416
Q

Vaso-occlusive crisis

A

Sickle cell disease

IV hydration
Oxygen
Pain control

Crew cut appearance on X ray

417
Q

SCD Tx

A

Folate supplementation

Hydroxyurea (chronic tx)
- increases fraction of fetal hemoglobin

Pencillin (give prophylactically)
-SCD patients >5

418
Q

Fatigue
Pallor
Petechiae
Malignancy

419
Q

Hemophilia A has what abnormal lab value

420
Q

Fibrinogen concentration decreased in

421
Q

Ristocetin cofactor assay

-2 lab values

A

Confirm the diagnosis of von willebrand disease

Prolonged aPTT
prolonged bleeding time

422
Q

SOB
Decreased breath sounds
Dullness to percussion

A

Pleural effusion

[Cough,fever]

Dmiminished tactile fremitus

Xray confirm

423
Q

SOB
Decreased breath sounds
Hyper-resonant to percussion
Chest pain

A

Pneumothorax

Xray

424
Q

hernia through external inguinal ring

A

Indirect inguinal hernia

425
Q

On chemotherapy
Develops fever
Decreased leukocyte count

Tx

A

Neutropenic fever

Broad spectrum antibiotics
[Monotherapy w/ cefepime, meropenem, iripenem or piperacillin-tazobactam]

Order blood and urine cultures

426
Q

Complication of chemotherapy

A

Neutropenic fever

Fever
Decreased leukocyte count

427
Q

Severe diarrhea causes

A

Non-anion gap metabolic alkalosis

Hypokalemia
Hyperchloremia
Alkalosis

428
Q

What is expected in untreated chronic kidney disease

A

Hyperphosphatemia

Bicarb low
Hypocalcemia
Low sodium

429
Q

Proximal muscle weakness
Progressive weakness
Dry mouth
Erectile dysfunction

A

Lambert Eaton syndrome

Paraneoplastic syndrome from small cell lung carcinoma

Auto-Ab to VG calcium channels

430
Q

Distal muscle weakness

A

Muscular dystrophies

431
Q

Agraphia
Acalculia
R/L confusion
Finger agnosia

A

Dominant inferior parietal lobe

Gerstman syndrome

432
Q

Bilateral visual loss

Unawre or denial of blindness

A

Anton syndrome

Posterior cerebral artery

433
Q

CL weakness of extremtiies
Ipslateral cranial nerve III palsy
Dilated pupils

A

Weber syndrome

Posterior cerebral artery

434
Q

Laxative abuse

Finding

A

Hypokalemia

Weakness
Muscle cramps

U waves of electrocardiogram

435
Q

Widening QRS

A

Hyperkalemia

436
Q

Female with family history of PE and DVT as well as spontaneous abortions, stillbirth or preeclampsia

A

Antiphospholipid syndrome

Ab against beta-2 glycoprotein I

Anti-cardiolipin ab

437
Q

Increased bleeding time
Family hx of bleeding into joint

Platelet normal
Decreased platelet aggregation
PT normal
aPTT prolonged

+ ristocetin

A

Von Willebrand disease

Bleeding involving skin and mucosal surfaces

438
Q

Dull to percussion
Decreased breathe sounds
Decreased tactile fremitus

A

Pleural effusion

439
Q

Chemotherapy
Elevated creatinine
Hyperkalemia
Hyperuricemia

Also seen?

A

Tumor lysis syndrome

Hyperphosphatemia
Hypocalcemia

440
Q

SE cyclophosphamide

A

Abundant RBC in urine

Hemorrhagic cystitis

441
Q

Methotrexate SE

A

Decreased folic acid levels

442
Q

MI

2 days later new onset blowing systolic murmur heard at apex and S4 gallop

A

Rupture of valvular papillary muscle

Acute mitral regurgitation

443
Q

Alcoholic

Vomiting bright red blood

A

Ruptured varices

Portal htn secondary to cirrhosis

444
Q

Streptococcal pharyngitis
Given penicillin

Develops erytehmatous subcutaneous nodules on lower legs

A

Erythema nodosum

Delay hypersensitivity rxn

Self limiting
Tx NSAIDS
Potassium iodine
Oral glucocorticoids

445
Q

Hematologic stem cell transplant
Rash
Elevated liver enzymes
Diarrhea

A

Graft versus host disease

Minor histocompatibility antigen mismatch

446
Q

Anti-A or Anti-B antibodies

A

Hyperacute transplant rejection

Immedicate commencement of organ destruction due to thrombi that causes diffuse ischemia of the transplanted organ

Preformed Ab

447
Q

Immunologically mediated fibrosis

A

Cause of chronic transplant rejection

Months to years

Caused by T cell and homral (antibodies/ Bcell) immunity

448
Q

T cell mediated transplant destruction

A

Acute transplant rejection

Days to weeks

Vasculitis of the transplanted tissue

Present with signs of failure of the tissue graft

Tx immunosuppressive (cyclosporine)

449
Q

SOB
Fatigue
Exercise intolerance

DVT history

Morning episodes of blood that resolve

BP drops w/ standing

Anemia
Low platelets

Hemoglobin in urine
Serum LDH elevated
Haptoglobin depressed

A

Paroxysmal nocturnal hemoglobinuria (PNH)

Deficiency of CD55 and CD 59

Normocytic hemolytic anemia

Diagnosis w/ flow cytometry

450
Q

Tx to confirm sickle cell

A

Hemoglobin electrophoresis

451
Q

Osmotic fragility test

A

Hereditary spherocytosis

Howell-Jolly bodies after spleen removed

Risk of cholelithiasis

452
Q

Thick and thin films

A

Diagnose malaria

453
Q

Radiculopathy along lateral part of leg and dorsum of foot

Weakness w/ dorsiflexion

454
Q

Weakness in plantar and toe flexion

455
Q 
24 never had period
Hirsutism
Acne
elevated K
Elevated renin
A

21-hydroxylase deficiency

Congenital adreanl hyperplasia (CAH)

diagnose w/ 17-hydroxyprogesterone serum

456
Q

Cosyntropin stimulation test

A

Diagnosis of addison disease (adrenal insuffiency)

Acutely w/ shock
Fatigue, anorexia, postural dizziness, hypotension, hyperpigmentation

457
Q

Tx frontotemporal dementia

A

Tx behavioral symtpoms w/ SSRI

paroxetine, fluoxetine, trazadone

458
Q

Large cells w/ well circumscribed nuclei, profuse quantities of cytoplasm, and areas of hyperpigmentation that are arranged around nucleus in a clock face pattern

A

Multiple myeloma

Elevated IgG

Third Year Shelf (7 decks)

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