Internal Medicine Flashcards
1
Q
Some SLE patients with dyspnea, persistent episodes of pleuritic chest pain, a progressive decrease in lung volume, and no evidence of interstitial fibrosis or significant pleural disease on chest CT have … (dz).
A
Vanishing lung syndrome
1
Q
Causes of primary HYPER-coagulable states
A
Antithrombin III deficiency, Protein C or S deficiency, Fibrinolytic abnormalities AND Homocystinuria AND Antiphospholipid Antibody Sdr.
1
Q
Anticoagulation during pregnancy - 2 options
A
LMWH throughout the pregnancy AND AND LMWH until the 13th week, a change to warfarin until the middle of the third trimester, and then restart LMWH until delivery
1
Q
ITP definition
A
isolated thrombocytopenia AND no peripheral smear abnormalities found AND no clinically apparent conditions causing thrombocytopenia
1
Q
Acute rheumatic fever (ARF) major manifestations are: …
A
Migratory arthritis predominantly involving the large joints / Carditis and valvulitis / Central nervous system involvement (eg, Sydenham chorea) / Rash
1
Q
Anterior hip pains are …
A
true hip pains.
1
Q
Migratory polyarthritis is characteristic for … and …
A
gonococcal AND AND rheumatic fever
1
Q
The peak incidence of West Nile virus infection arises at the end of … and early… ( month).
A
August / September
1
Q
Anti-ds DNA and anti-Smith antibodies are specific for…
A
SLE
1
Q
Carpal tunel sdr in HD patients denotes
A
amyloidosis
1
Q
Erythema migratum with migratory large joints arthritis occurs in…
A
acute rheumatic fever.
1
Q
Worsening back pain with walking, but improving with back flexion or walking uphill
A
spinal stenosis
1
Q
The definitive Tx for CML is…
A
BMT (hematopoietic cell transplantation)
1
Q
… and … are the two major clinical findings in primary aldosteronism.
A
Hypertension AND AND hypokalemia
1
Q
Hypersegmented NFs are strongly sugestive of…
A
vitamin B12 or folate deficiency
1
Q
Patients with the full Wiskott-Aldrich syndrome are cured by …
A
bone marrow transplantation
1
Q
Low … is associated with increased risk for Alzheimer’s dz in elderly.
A
diastolic BP
1
Q
… vaccine is recommended for terminal complement or properdin def., asplenics and travelers to endemic areas.
A
Meningococcal
1
Q
… is the best first test for excluding or confirming pheochromocytoma (sens 99, spec 89).
A
Plasma metanephrins
1
Q
Screening with … is done in women 40-69.
A
mammography
1
Q
Endemic areas for … infections are: sub-Saharan Africa extending from Guinea in the west to Ethiopia in the east and pilgrims who make the hajj to Mecca, Saudi Arabia.
A
Meningococcal
1
Q
Neurologic symptoms after a benign respiratory or gastric infection: fine paresthesias followed by LEs weakness that may ascend is typical for…
A
Guillan-Barre sdr
1
Q
…consists of: yellow nails, lymphedema, and pleural effusion.
A
Yellow nail syndrome
1
Q
…has been commonly isolated in patients who suffered plantar puncture while wearing tennis shoes.
A
P. aeruginosa
1
When osteomyelitis arises following a puncture injury, ... is the most common pathogen in diabetic patients and ... in nondiabetics.
S. aureus AND AND P. aeruginosa
1
Three phase bone scan difference between ostemyelitis and cellulitis occurs in phase ... when only osteo results in increase uptake.
three
1
The initial Tx of spontaneous pneumothorax in a COPDer consists of…
tube placement followed by pleurodesis
1
The only useful Rx for gastroparesis is…
nutritional support
1
c-ANCA positive suggests...
Wegener granulomatosis
1
Anemia-pancytopenia, dementia, irritability, fatigue, weakness, constipation, dandruff, menstrual problems are all symptoms of …
Vitamin B12 deficiency
1
The most common cause of hemoptysis in HIV patients is…
bacterial infection
1
This sleep disorder occurs in the first third of the night and is rarely violent:
sleep walking
1
Inflammatory bowel dz, SLE, Behcet, and Reiters’ sdr. cause … in the oral cavity.
Ulcers (aftous stomatitis)
1
Erythema multiforme, …, and toxic epidermal necrolysis (TEN) are three disorders that have similar clinical features, including lesions of the skin and mucous membranes and induction by exposure to drugs or infections.
Stevens-Johnson syndrome (SJS),
1
Clinical criteria for… include fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough.
acute streptococcal pharyngitis
1
… represents 85% of brain infections in Mexico City.
Cysticercosis
1
In the perineal area, penetration of the gastrointestinal or urethral mucosa by enteric organisms can cause…, an aggressive infection
Fournier's gangrene
2
... is done in pts with unilateral tinnitus to rule out acoustic neuroma or a cerebellar-pontine angle tumor.
Gadolinium MRI
3
...therapy is given to most patients with COP (Cryptogenic organizing pneumonitis also called bronchiolitis obliterans organizing pneumonia - BOOP).
Corticosteroid
4
...is the antibiotic of choice, based upon its in vitro activity and the results of clinical trials in pertussis or "whooping cough".
Erythromycin
5
...is the second most common cause of disabling daytime sleepiness after sleep apnea.
Narcolepsy
6
The typical symptoms in... are excessive daytime sleepiness, hypnagogic, sleep paralysis, cataplexy and insomnia.
narcolepsy
7
Gamma hydroxybutyrate is especially useful in patients with severe cataplexy, but it can also improve daytime sleepiness in...
narcolepsy.
8
… arthropathy usually occurs in the 2nd and 3rd MCP joint.
Hemochromatosis
9
Abdominal pain or vaginal bleeding in a fertile woman raises concern for …
Ectopic pregnancy
10
Any new HA associated with seizure should prompt investigation with … and …
Neuroimaging / LP
11
To prevent endometrial carcinoma, women with these symptoms… should take PG with EG unless they had hysterectomy.
Hot flashes perimenopausal
12
…is a key predictor for poor outcome in patients with work-related back pain.
Low job satisfaction
13
… is very sensitive and specific for complete rotator cuff tears, less for partial.
MRI
14
… tears occur with twisting injuries (such as stopping short and turning).
Anterior cruciate ligament
15
Patients with … complain of recurrent episodes of vertigo lasting one minute or less provoked by specific types of head movements, such as looking up while standing or sitting, lying down or getting up from bed, and rolling over in bed.
Benign paroxysmal positional vertigo (BPPV)
16
... is most commonly used to palliate pain from pancreatic cancer but has also been used for relieving pain in chronic pancreatitis.
Celiac plexus neurolysis (CPN)
17
Patients with celiac disease should omit ..., ... and ... from their diet.
wheat AND rye (orz) AND barley (secara)
18
When more than one household has pruritus, Rx for ... may be appropriate even when typical burrows are absent.
scabies
19
... is the Rx of choice in head lice, with lindane and benzyl benzoate also effective.
Permethrin
20
..., an emergency, is Rx with IV acetazolamide, osmotic diuresis, topical pilocarpine and laser peripheral iridotomy.
Acute angle closure glaucoma
21
... is usually unilateral and presents with halos around objects, worsening eye pain, HA, N&V, and red eye.
Acute angle closure glaucoma
22
Fosphenytoin with ECG monitoring is an important step in the treatment of... due to ease of administration (high rate IV or IM).
status epilepticus
23
High grade gliomas are removed surgically then treated with...
external beam radiation.
24
... (location) seizures are characterized by the sudden occurrence of visual phenomena (flashing lights, hallucinations, or loss of vision).
Occipital
25
The most common manifestation of neurocysticercosis are... due to parenchymal involvement.
seizures
26
To prevent aspiration in a weak patient when emesis occurs, patient has to be placed in... position.
lateral decubitus
27
A patient with... can only move the eyes vertically and blink.
locked-in syndrome
28
One single seizure does not prompt to institution of antiepileptic meds in the absence of...
risk factors.
29
Conservative Rx with … is effective in reducing the bleeding episodes in patients with internal hemorrhoids.
Fiber supplementation
30
Diarrhea within 12 hours of ingestion of preformed bacterial toxins occurs in … and …exposure.
S. aureus / enterotoxigenic E. coli
31
Antiperistaltic agents and intraluminal adsorbents can be safely used in diarrhea without…, with the exception of enterohemorrhagic Escherichia coli infection.
slowing the clearance of pathogens
32
In patients younger then 35 YO, … or … is adequate to assess hemorrhoids unless the patient has risk factors for CA.
Anoscopy / sigmoidoscopy
33
Perianal area application of … relieves the pain, reduces the anal canal pressure and improves the anodermal blood flow in patients with anal fissures.
NTG or nifedipine
34
The positive serologic markers in acute hepatitis C are: …
HCV IgM
35
The positive serologic markers in acute hepatitis A are: …
HAV IgM
36
Disabling painful condition that occurs after a minor/major injury and is associated with vasomotor changes, skin and muscle atrophy and osteopenia is…
Reflex sympathetic dystrophy
37
Patients have an inability to localize precisely the pain and have characteristic tender points in …
Fibromyalgia
38
Anal fissures that do not occur in ... (location) are more likely to be due to a secondary cause and need investigation.
the posterior midline
39
A person with low risk for cervical CA and in a monogamous relation with many normal Pap smears, it is appropriate to screen every... .
3 years
40
HIV infection and any immunosupression state increases the speed of human papillomavirus tumor growth, so women will have to be screened for ... more often.
cervical CA
41
A recent diagnosis of ... (group of dz) is a risk factor for cervical CA.
STD
42
All these disorders cause ... HA (timing): migraine, cluster, chronic paroxysmal, OSA (Sleep apnea syndrome) and increased intracranial pressure.
morning/nocturnal
43
... (drug) is the most helpful in both labyrinthitis and Menièr’s.
Meclizine
44
Recurrent episodes of tinea versicolor is Rx with ... (drug class).
oral antifungal agents
45
... can reduce the risk of hip fracture among patients who are at risk for falls and fractures.
Hip protectors
46
… has been shown to reduce the time to hematopoietic recovery in recipients of autologous and allogeneic bone marrow transplantation.
G-CSF
47
The majority of cases have been due to … microti, (first described in 1966) and occur predominantly on the NE US coast: Massachusetts, particularly Cape Cod, Nantucket and Martha's Vineyard, Long Island, and recently also New Jersey, Block Island, off of
Babesia
48
... is the most common cancer in man and the second most common cause of CA death.
Prostate CA
49
Patients with… (location) metastases of malignant melanoma can be treated with surgery, radiation therapy, and/or stereotactic radiosurgery.
Brain
50
All abnormal PSA screening lead to ... except in very elderly and infirm men.
US guided transrectal biopsy of the prostate
51
An enlarged supraclavicular node in a patient with testicular mass suggests...
metastasized testicular CA.
52
... is the most common CA in the young man, and 95% of cases can be cured.
Testicular CA
53
Patients with ... (electrolyte imbalance) should be Rx with volume repletion and a loop diuretic to maximize renal excretion.
hypercalcemia
54
Hypokalemia is difficult to correct in the presence of ... because the latter causes renal potassium wasting through an unknown mechanism.
hypomagnesemia
55
The signs and symptoms of ... (electrolyte imbalance) include lethargy, anorexia, neuromuscular disorders (Chvostek and Trousseau’s signs) and cardiac arrhythmias, even in the absence of hypocalcemia.
hypomagnesemia
56
Most cases of traveler’s diarrhea are caused by... .
enterotoxigenic E. coli
57
Most cases of traveler’s diarrhea are responsive to Rx with ... (ABx class).
fluoroquinolones
58
... (dz) is the most common primary immune defect.
Selective IgA deficiency
59
... (complement component range) and factor D and properdin deficiency lead to increased neisserial infections.
C5-C9
60
... is the ratio between the change in anion gap and the change in plasma HCO3 and should be 1-2; when is not, in a high anion gap metabolic acidosis, a concurrent non-anion gap metabolic acidosis exists.
Delta-Delta
61
Diuretic-induced metabolic alkalosis occurs through increased... delivery to the collecting tubules where its reabsorption increases H and K secretion.
Na
62
... is the most common cause of acute renal failure due to intrinsic renal disease in hospitalized patients.
ATN (acute tubular necrosis)
63
Rx with ... as doxazosin, prazosin or tamsulosin is the most effective in BPH.
alpha-1-antagonists
64
MAOI are effective in depression but are not used b/o risk for... .
hypertensive crisis
65
... is defined as extreme mood swings, with mania plummeting into a major depressive episode.
Bipolar I disorder
66
... and … are the first line classes of drugs used for generalized anxiety disorder.
SSRIs / NRIs (norepinephrine reuptake inhibitors)
67
Symptoms of ... may include refractory hypotension, obtundation, circulatory collapse, and severe abdominal pain with nausea and vomiting.
adrenal insufficiency
68
... can be used in adrenal crisis because it does not interfere with cortisol measurements.
Dexamethasone
69
... (bacteria) meningitis is an important cause of infection in neonates, with a mortality rate of 7-27%.
Group B strep (Streptococcus agalactiae)
70
Adjunctive ... (drug) is recommended for infants/children with Hib meningitis and for children/adults with pneumococcal meningitis if initiated with or just prior to ABx.
dexamethasone
71
Infections with these 2 bugs, Clostridium septicum and Strep bovis are signaling the possible presence of a ... (dz).
GI malignancy
72
The typical rash of ... begins on the ankles and wrists and spreads both centrally and to the palms and soles. It often begins as a macular or maculopapular eruption and then usually becomes petechial.
Rocky Mountain spotted fever (RMSF)
73
Current Rx of an otherwise healthy, nonpregnant woman with uncomplicated UTI is Spectra or fluoroquinolones without a preceding ... (test).
urine Cx
74
Primary TB usually involves the ... lung zones and is associated with hilar adenopathy.
middle and lower
75
Reactivation TB commonly involves the ... and is associated with cavitation.
upper lobes
76
The clinical picture of ... (dz) is most commonly caused by Salmonella typhi, or Salmonella paratyphi A, B, or C, with some geographic variation.
typhoid fever
77
The incidence of coccidioidomycosis is increasing in older adults traveling to ... areas in the winter months.
desert
78
The causative agent in plague is... , a gram negative cocobacillus.
Yersinia pestis
79
All ... (dz group) are characterized by high fever, HA, arthralgias, myalgias, abdominal pain, conjunctivitis, pharyngitis, with petechia and purpura of mucosae.
viral hemorrhagic fevers
80
... (test) is indicated in acute or rapidly progressive glomerulonephritis and in elevated serum creatinine concentration in renal transplant recipients.
Kidney biopsy
81
These third-generation cephalosporins, cefoperazone and ceftazidime, have activity against... (bug).
P. aeruginosa
82
Multiplex polymerase chain reaction — M-PCR is a technique currently employed in research to detect the presence simultaneously of all three of the most common causes of ... in the United States.
genital ulcers
83
... remains the mainstay of therapy for genital HSV infections.
Acyclovir
84
Systemic ... has also been tried with some success for E. bieneusi infections
fumagillin
85
Any cranial nerve may be affected by Lyme disease, but ... neuropathy is most common; involvement can be bilateral, and may occur in association with meningitis or other cranial neuropathies.
facial - differentiated from patients with Bell's palsy by the presence of other clinical features of Lyme disease
86
Although ... (path finding) were exceedingly rare in syphilis the penicillin era before the onset of HIV disease, many case reports in HIV-infected persons have appeared in the last decade. Most of these have involved internal organs and seldom the skin.
gummas
87
Cardiovascular ... classically involves the ascending thoracic aorta resulting in a dilated aorta and aortic valve regurgitation. It may involve the coronary arteries, resulting in coronary thrombosis.
syphilis
88
Viral load influence the probability of developing an opportunistic infection in HIV, which, for unclear reasons, appears to be unusual with viral loads
5000
89
The ... syndrome is a form of progressive decrease renal perfusion in patients with advanced liver disease.
hepatorenal
90
Target daily protein intake should be ... to be safe (well tolerated and not leading to malnutrition) in CRF.
0.6-1 g/kg
91
... is a form of renal bone disease characterized by low bone turnover and increased osteoid levels secondary to aluminum deposition in the bone.
Osteomalacia
92
Cadaveric kidney transplant has shown to have a survival advantage over ... in patients matched for age and renal disease.
HD
93
Low dietary intake of ... is a risk factor for nephrolithiasis.
calcium
94
... (infection) in pregnancy should be treated b/o the risk for premature labor and delivery of infants who are small for gestational age.
Asymptomatic bacteriuria
95
... are needed after completion of ABx in pregnant women with asymptomatic bacteriuria.
Regular urine cultures
96
Noninfectious etiologies of ... (gyn path) include fixed drug reactions, Behcet's disease, neoplasms, and trauma.
genital ulcers
97
The ... should be suspected in any patient with hyponatremia, hypoosmolality, a urine osmolality above 100 mosmol/kg, a urine sodium concentration that is usually above 40 meq/L, normal acid-base and potassium balance, and frequently a low plasma uric aci
syndrome of inappropriate antidiuretic hormone secretion (SIADH)
98
Head and neck zoster of immunosuppressed patients should always be Rx with ...
IV acyclovir to prevent zoster ophtalmicus
99
SIADH results in ... (main electrolyte imbalance).
hyponatremia
100
High dietary intake of calcium is a protective factor for... (renal ds.).
nephrolithiasis
101
The... is a disorder in which water excretion is partially impaired because of the inability to shut off the secretion of ADH.
syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
102
... contained in chewing tobacco cause HTN and hypokalemia by inactivating cortisol.
Licorice
103
... is a granulomatous dz of medium-sized to small arterioles and venules.
Wegener granulomatosis
104
AL amyloidosis is associated with increased secretion of a ... lymphoid product.
monoclonal
105
... (food) has been shown to slow the progression of renal failure in IgA nephropathy (Berger’s dz).
Fish oil
106
Circulating anti-glomerular basement membrane antibodies confirms ... (dz).
Goodpasture’s syndrome
107
Presenting symptoms in ... (disease) most often involve the URT and include rhinorrhea, sinusitis, ulcerations, cough, SOB and hemoptysis.
Wegener granulomatosis
108
An irregular contour of the kidneys on CT helps to confirm a clinical suspicion in ... (drug class) nephropathy.
analgesic
109
Very low levels of BUN and uric acid in an euvolemic patient suggest ... (syndrome).
SIADH
110
... should be suspected in hypokalemic patients because these intracellular ions are lost together.
Hypomagnesemia
111
A serum potassium level of 3 meq/L is equivalent to ... meq potassium deficit.
200-400
112
The key features of the ... syndrome are: absence of fever, symmetric neurologic deficits, patient remains responsive with normal or slow heart rate and normal blood pressure and no sensory deficits with the exception of blurred vision.
botulism
113
A positive nitroblue tetrazolium test establishes the diagnosis of...
chronic granulomatous disease
114
Ciprofloxacin is still the most potent fluoroquinolone for... (infectious agent).
P. aeruginosa.
115
Valacyclovir is a pro-drug that gets converted to ... in the intestinal wall and liver.
acyclovir
116
Rx of sensitive Strep. viridans endocarditis on native valves is done with penicillin or ceftriaxone for... weeks.
4
117
IgA deficiency is usually ... with multiple bacterial infections.
not associated
118
Drusen deposits are localized deposits of extracellular material concentrated in the macula, some of the earlier signs in patients with...
age-related macular degeneration (ARMD).
119
Parenteral therapy in severe hypoglycemia for patients who cannot take oral glucose is...
IV D50 and IM glucagon.
120
Decreasing dietary protein to less than... improves creatinine clearance and proteinuria.
0.8g/kg weight/day
121
... BMT is used in the treatment of certain patients with leukemias, lymphomas, multiple myeloma.
Autologous
122
The only known effect of prolactin deficiency is the inability...
to lactate after pregnancy.
123
The first step in evaluating... is measurement of target gland or tissue secretion or function.
pituitary function
124
Normal levels of target gland or tissue secretion or function of hormones rules out...
abnormal pituitary function.
125
... test is the gold standard test for normal pituitary growth hormone secretion.
The insulin tolerance (hypoglycemia is a potent GH stimulant)
126
Levels of FSH and LH should be chronically elevated in...
postmenopausal women.
127
The presence of normal menstrual cycles rules out...
abnormal FSH and LH secretion.
128
A spontaneous AM level of >18micrograms/dL of cortisol signifies...
adequate ACTH secretion.
129
..., a defect in the diaphragm sella is thought to allow CSF pressure to enlarge the sella that is not entirely filled with pituitary tissue and occurs in obese women with HTN and benign increased intracranial pressure.
Primary empty sella
130
Cortisol axis depressed patients should receive... during major physical stress (Sx, infections, hTN, N&V not allowing PO steroids).
full stress doses of hydrocortisone (300mg/d IV)
131
... is hypotonic polyuria as a result of inadequate AVP (vasopressin) secretion or response to AVP.
Diabetes insipidus
132
Increase in urine osmolality... after AVP administration indicates nephrogenic diabetes insipidus.
<10%
133
HIV patients receiving antiretroviral Rx and erythropoietin level less then 500mU/mL benefit from ... administration.
erythropoietin
134
Autologous blood donation before elective surgery is helped by administering ...
erythropoietin
135
... (ABx) is preferred in bartonellosis because it also is effective against often associated Salmonella infections.
Chloramphenicol
136
Argyll Robertson pupils are small fixed pupils that do not react to strong light but do react to convergence-accomodation, typical of ...
tabes dorsalis
137
... is a disease of the posterior columns of the spinal cord and of the dorsal roots, which occurs 18 to 25 years after initial untreated infection. Typical manifestations include paresthesias, abnormal gait, and lightning (sudden severe) pains of the ext
Tabes dorsalis
138
Starting oral acyclovir in chickenpox in the first ... after the onset of rash shortens the fever duration with one day and decreases the number of lesions in children, adolescents and adults.
24 hours
139
The number of doses of doxycycline 200mg for Lyme dz suspected infection (endemic area, tick exposure duration) is...
one
140
N. meningitidis post-exposure prophylaxis is done only if the subject had contact with the patient’s ...
respiratory secretions
141
The development of reactivation tuberculosis often follows closely after... (test).
tuberculin skin test conversion.
142
Worsening of other infectious dz with antiretroviral Rx is caused by...
partial immune reconstruction
143
... after the lesion was noted is too late for any Rx in herpes labialis.
One day
144
All patients with VRE have ... with it and there is no way to eradicate it now.
intestinal colonization
145
All patients receiving linezolid (Zyvox®, VRE infections) should have a complete blood count each week b/o possible...
thrombocytopenia
146
... in addition to ABx in PCP with hypoxemia have been shown to improve the outcome.
Corticosteroids
147
... is the presence of thyroid tissue as a major cellular component in an ovarian tumor, nearly always a teratoma.
Struma ovarii
148
TSH secreting tumors should be treated by...
surgery.
149
TSH is checked after... on a stable dose of levothyroxine.
5-6 weeks
150
Persistently elevated or increasing TSH levels and hyperlipidemia are indications for... therapy.
levothyroxine
151
... can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test
Euthyroid sick syndrome
152
Most women with hypothyroidism will require an... in their levothyroxine dose during the 2nd and 3rd trimesters and a subsequent… after delivery.
increase / reduction
153
Fine needle aspiration positive for thyroid CA in a pregnant woman leads to... only when extensive local disease or rapid growth occur.
emergent surgery
154
The lab findings in... are volume contraction with hyponatremia, hyperkalemia, hypoglycemia, azotemia, non-anion-gap acidosis, anemia and eosinophilia.
adrenal insufficiency
155
Bilateral internuclear ophthalmoplegia is the classical presentation for...
MS.
156
The standard treatment for a significant acute MS exacerbation is...
high dose methylprednisolone (500-1000/d 3-5 days).
157
The genes DQA and DQB predispose to...
type Ia diabetes.
158
The two mechanisms in type 2 DM are...
decrease insulin secretion in response to glucose and peripheral resistance to insulin.
159
... is a subset of type 2 DM with early age of onset and a strong family history.
Maturity-onset type 2 DM (MODY)
160
... is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
Gestational diabetes
161
Women with gestational diabetes should undergo a 6-week postpartum...
oral glucose tolerance test.
162
Daily insulin production in healthy persons is usually... U that are secreted in the portal circulation.
24-36
163
Metformin (Glucophage) works mainly by... (action).
inhibiting hepatic gluconeogenesis
164
This oral hypoglycemic drug is contraindicated in creatinine>1.5, ETOH abuse, CHF:...
Metformin (Glucophage)
201
... (oral hypoglycemic) should be stopped 24-48 hours before contrast procedures.
Metformin (Glucophage)
202
... is indicated in patients in whom HbA1c<7 can not be maintained while on 2 oral hypoglycemic drugs combined with lifestyle modifications.
Insulin therapy
203
... is long-acting insulin with much reduced risk for hypoglycemia.
Glargine (Lantus®)
204
Acute bicarbonate replacement is usually mandatory when the pH is...
<7.0
205
Signs of complication of... (electrolyte imbalance) occur rarely: hemolysis, unexplained CHF, and rhabdomyolysis.
hypophosphatemia
206
Headache and unexplained diminished in consciousness several hours after therapy for DKA was initiated, signal...
cerebral edema.
207
Chronic hypoglycemia can lead to...
hypoglycemia unawareness.
208
A supraclavicular node of >2cm associated with systemic symptoms in a young smoker should be followed...
with CXR.
209
Surgery is not indicated in... lung carcinoma due to its systemic nature.
small-cell
210
... is a PULMONARY disease caused by the interaction between anti-granulocyte antibodies (usually of donor origin) and granulocytes (usually of recipient origin) after transfusion of blood products leading to fever, tachycardia, hypotension, and hypoxemia
The transfusion-related acute lung injury (TRALI)
211
When a patient needs platelets and has HLA alloimmunization and thus..., the platelets have to be single-donor and matched.
immune refractoriness
212
... has to be ruled out in any cancer patient with new onset back pain, and… is the test of choice.
Spinal cord compression / MRI
213
Non-small cell lung CA with one brain met should be Rx with...
excision and radiation.
214
The first priority in hypercalcemia is...
vigorous rehydration.
215
The brains of individuals with... are characterized by extracellular deposition of amyloid-beta protein, intracellular neurofibrillary tangles, and loss of neurons.
Alzheimer's disease
216
Statins Rx of hypercholesterolemia (and no other Rx) decreases the incidence of this neurological condition...
Alzheimer's disease.
217
In MDS,... (2 types cells) have abnormal function, so normal counts of either do not confer enough protection.
granulocytes and platelets
218
Rx with... is commonly used to normalize blood counts in CML
hydroxyurea or alpha-INF
219
Acquired neutropenia is most commonly caused by ...
infections and drugs.
220
Elevated red mass without secondary causes of erythrocytosis and the presence of splenomegaly or abnormal BM karyotype other then t(9;22) chromosome establish the diagnosis of...
polycythemia vera.
221
The target hematocrit in polycythemia vera is...
45%.
222
... , as opposed to essential thrombocythemia (ET), is not associated with increased incidence of thrombosis or hemorrhage, splenomegaly, or abnormal cytogenetic findings.
Secondary thrombocytosis
223
... is the most common acute leukemia in the immediate perinatal period.
AML
224
... migraine is characterized by attacks in which neurologic symptoms last for the entire headache, for several days or weeks, or in some cases leave a permanent neurological deficit.
Complicated
225
Basilar artery migraine, ophthalmoplegic migraine and hemiplegic migraine are all...
complicated migraines.
226
First line treatment of essential tremor consists of...
primidone or a nonselective beta blocker.
227
The diagnostic triad in... is: monoclonal gammopathy, lytic bone lesions, and >10% plasma cells in the BM. (manifests with bone pains, anemia, renal insufficiency, and recurrent infections)
multiple myeloma
228
The presence of Heinz bodies and characteristic bite cells make the diagnosis of... very likely.
G6PD deficiency
229
... is characterized by the following: presence of a serum monoclonal protein (
Monoclonal gammopathy of undetermined significance (MGUS)
230
Patients with febrile neutropenia should receive...
empirical ABx Rx.
231
Patients with afebrile neutropenia but signs or symptoms of infection should receive...
empirical ABx Rx.
232
Radiation for any type of CA has two major side effects...
premature CAD and secondary cancers.
233
In some patients with severe ETOH cirrhosis, RBCs accumulate large quantities of cholesterol and became small, spheroidal, and with short, spiny projections, causing a severe hemolytic anemia called...
spur cell anemia.
234
... (test) is the only blood test differentiating between iron-deficiency anemia and anemia of chronic disease.
Serum ferritin level (the gold standard is BM biopsy)
235
An extensive search for an occult malignancy in otherwise healthy patients is...
not cost-effective, due to lack of success in finding a treatable disease.
236
... is the burning pain of the hands or feet associated with erythema and warmth.
Erythromelalgia
237
Plasma exchange with... as replacement solution is the procedure of choice in TTP.
fresh frozen plasma
238
Polyneuropathy can be investigated by... when vasculitis, amyloidosis, leprosy, sarcoidosis, or tumor infiltration are suspected.
nerve biopsy
239
Glatiramer acetate works in MS by decreasing... by a mechanism called bystander suppression.
CNS inflammation
240
... usually manifests as a sudden sensorineural hearing loss and is the most common infection of the inner ear in adults.
Viral cochleitis
241
Adult dermatomyositis w/u should include... in women, and… in men.
breast and pelvic exam / prostate exam
242
If the meningioma is small and asymptomatic,... are usually appropriate.
radiological and clinical observation
243
... is recommended for symptomatic meningioma.
Surgical management
244
Teardrop cells (poikilocytes) and nucleated RBCs signal the presence of a...
myelophtisic process in the BM.
245
... which leads to excretion of iron in the urine is the drug of choice for iron overload in anemia.
Parenteral desferioxamine B
246
The most sensitive test of iron storage is the determination of the... level.
serum ferritin
247
The initial Rx for autoimmune hemolytic anemia is...
prednisone.
248
Before splenectomy, vaccination with... (3) are necessary.
pneumococcal, Hib, and meningococcal
249
Sickle cell disease is characterized by thrombosis due to enhanced sickle erythrocyte...
adhesion to the vascular endothelium.
250
Standard Rx for sickle cell disease includes consideration of..., an inducer of fetal gamma-globulin.
hydroxyurea
251
BM displays a... process when the normal elements are replaced by fibrosis, granulomatous inflammation, or neoplasm.
myelophtisic
252
Microangiopathic hemolytic anemia and thrombocytopenia with predominant renal insufficiency occurs in...
postpartum acute renal failure due to (TTP-HUS) or severe preeclampsia
253
The hallmark of acute hemolytic anemia is...
red plasma and urine.
254
The blood from close relatives has to be... (preparation) because of increased risk of GVH dz, even in immunocompetent individuals.
irradiated
255
The hallmark of transfusion-related lung injury is...
hypoxemia.
256
... is the most common malignant neoplasm of the urinary tract in children (87 percent of renal tumors) and is responsible for 8 percent of all solid tumors in this age group.
Wilms' tumor (nephroblastoma)
257
... lung CA is associated with SIADH, ectopic adrenocorticotropic hormone and Eaton-Lambert syndrome.
Small-cell
258
The most powerful prognostic factor in breast CA is the...
presence or absence of invasive dz in the biopsy specimen.
259
Squamous cell and small-cell lung CA tend to be located...
centrally.
260
All patients evaluated for dementia should have... (imaging).
brain CT or MRI
261
... (lifestyle intervention) plays a very important role in idiopathic intracranial hypertension.
Weight loss
262
Initial Rx in essential tremor consists of a...
non-selective ß-blocker (propranolol or nadolol) or with the anticonvulsant primidone.
263
... is indicated for tumors>6cm, hormone-producing tumors that are clinically apparent, and pheochromocytomas.
Adrenal surgery
264
If an adrenal mass is stable in size by CT after..., the management is stopping radiological surveillance due to very low risk for malignant transformation.
6-12 months
265
The ratio of morning aldosterone concentration to plasma renin activity test cannot be performed in patients on... (drug)
spironolactone.
266
Primary hyperaldosteronism has been recognized in as many as... % of HTN patients.
14
267
... patients have no secondary sexual characteristics, have low-set hair line, growth retardation, webbed neck and skeletal abnormalities.
Turner syndrome
268
Patients with hyperdynamic septic shock (hypotension, low SVR, and high CI) tend to have warm extremities ("warm sepsis") due to inappropriate hyperperfusion of the skin and soft tissues and should be treated with...
norepinephrine.
269
Patients receiving... are extremely sensitive to vasopressors, and require much lower doses.
monoamine oxidase inhibitors
270
... may be preferable in patients with hypodynamic sepsis (hypotension, low SVR, and low CI) which manifest hypoperfusion of the extremities ("cold sepsis").
Dopamine
271
Nonrandomized, open label case series have suggested that... may be useful in the treatment of refractory septic shock, particularly as a second pressor agent.
Vasopressin
272
The addition of... (infused at a fixed rate of 0.04 U/min) to norepinephrine was more effective in reversing late vasodilatory shock than norepinephrine alone and similar results were noted in severe septic shock.
vasopressin
273
An unprovoked and persistent hypokalemia, metabolic alkalosis in a patient with a recent diagnosis of HTN is a common lab finding in...
mineralocorticoid excess (Conn sdr).
274
In a man with lower extremity lymphedema,... should be suspected.
prostate cancer
275
A multinucleated giant cell surrounded by macrophages and T lymphocytes is called... and is characteristic of rheumatic fever.
Aschoff nodule
276
The hallmark of traditional diabetes dyslipidemia is... (2 changes).
elevated triglycerides and low HDL.
277
Obesity is defined as BMI>27 or an abdominal girth of over... (cm).
107
278
... is confirmed by an elevated lactate dehydrogenase level, reticulocytosis, and schistocytes on the peripheral blood smear.
Microangiopathic hemolytic anemia
279
... is the treatment of choice for patients with autoimmune thrombocytopenia.
Prednisone
280
In otherwise healthy young women with dysuria and pyuria without high fever or signs of pyelonephritis, a 3-day regimen of trimethoprim-sulfamethoxazole, trimethoprim alone, or a fluoroquinolone or a... regimen of nitrofurantoin may be initiated without u
7-day
281
Parenteral antibiotics (i.e. IV ceftriaxone) are recommended for treating neurologic disease, more severe cardiac disease (high grade AVB with PR>0.3sec), and complicated Lyme arthritis. Duration of therapy is usually...
4 weeks.
282
... is the single most important infection control measure.
Hand washing
283
... are an important cause of bacterial diarrhea and the most common cause of infective hemorrhagic colitis in the United States.
Enterohemorrhagic Escherichia coli
284
The most significant sequelae of enterohemorrhagic Escherichia coli infection are...
hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura.
285
The sensitivity and specificity of the urea breath test for H. pylori are greater than...
90%.
286
... , is the most common cause of acute pancreatitis.
Gallstones, including microliths (microlithiasis)
287
Smoking, diabetes mellitus, chronic pancreatitis, and exposure to industrial toxins are predisposing factors for...
pancreatic cancer.
288
For the patient with MR who is contemplating pregnancy, but is not considered a candidate for surgical mitral valve repair or replacement on the basis of usual clinical indications, prophylactic surgery should ...
not be done, because pregnancy after valve replacement may be less desirable.
289
If labor begins in a patient with PHV receiving warfarin, delivery should be ...
a cesarean section.
290
The possibility of... should be considered in any patient older than 40 years of age with unexplained anemia, renal failure, bone lesion, or recurrent infections.
myeloma
291
Cigarette smoking, postnasal drip, asthma, and gastroesophageal reflux are the most common causes of...
chronic cough.
292
... (imaging) may help to establish a diagnosis of bronchiolitis obliterans.
Expiratory high-resolution CT scan
293
A young woman with a pneumothorax and any patient with abnormal lung parenchyma on a postdrainage radiograph should undergo... to look for underlying lung disease.
high-resolution CT of the chest
294
... is a skin condition induced by heat, activity and emotional stress frequently associated with dermographism.
Cholinergic urticaria
295
Both 6-mercaptopurine and metronidazole prolonged remission and are helpful in treating fistulizing disease in patients with...
Crohn’s disease.
296
Risk factors for stress ulcers are... If these factors are absent, prophylaxis is not indicated.
mechanical ventilation and coagulopathy
297
... is a chronic inflammatory disorder of young adults presenting with interstitial keratitis (IK), vestibuloauditory dysfunction (vertigo) with sensorineural hearing loss and possibly aortitis.
Cogan's syndrome (CS)
298
... is the development of sterile pustules at the site of needle entry.
Pathergy
299
The classic triad of organ involvement in... is respiratory tract, the lungs and the kidneys.
Wegener’s granulomatosis
300
A red, warm, swollen joint presentation is... until proven otherwise.
infectious arthritis
301
Treatment with... reduces cryoglobulin levels and clinical symptoms of cryoglobulinemia.
INF-alpha
302
The number of unexplained consecutive spontaneous abortions before the 10th week of gestation to qualify for antiphospholipid antibody syndrome is at least...
three.
303
There is a possible increase in congenital CNS and limb abnormalities in fetuses with exposure to... (cholesterol drug class) during the first trimester.
lipophilic statins
304
In addition to octreotide, a new agent pegvisomat has become available for...
acromegaly (a growth hormone receptor antagonist)
305
In a symptomatic popliteal cyst that can simulate DVT, this therapy is contraindicated...
anticoagulation.
306
Serum alkaline phosphatase concentrations are physiologically significantly higher (up to two to four times normal) in the... trimester of pregnancy.
third
307
The preferred therapy for recurrent pregnancy losses in antiphospholipid antibody syndrome is...
heparin and aspirin.
308
The indications for total knee replacement in patients with OA are...
pain and limitation of function that decreases the quality of life.
309
The nasal septum ulceration causing the collapse of the nasal bridge and the characteristic saddle nose occurs in...
Wegener’s granulomatosis.
310
Phentolamine is an alpha-adrenergic blocker, the use of which is limited to the treatment of severe hypertension due to increased catecholamine activity: pheochromocytoma and tyramine ingestion in a patient being treated with...
MAOI
311
Patients with hepatitis C should receive vaccination with... unless already immune.
hepatitis A and B
312
A military recruit returning from boot camp with symptoms of URI has...
Mycoplasma.
313
The therapy for Mycoplasma is...
erythromycin.
314
Exposure to goats, cattle or swine leads to...
Q fever - widespread zoonotic infection caused by the pathogen Coxiella burnetii which has both acute and chronic manifestations
315
The CDC guidelines recommend the combination of... for the treatment of acute epididymitis most likely caused by gonococcal or chlamydial infection.
ceftriaxone (250 mg IM as a single dose) plus doxycycline (100 mg PO BID for 10 days)
316
The clinical finding of acanthosis nigricans suggests... (Metabolic derangement)
insulin resistance.
317
IM glucagon given for hypoglycemia has to be followed shortly by...
carbohydrate ingestion, due to its very low effective – minutes – half-life.
318
The diseases from this class (including Graves’ disease) remit during pregnancy...
autoimmune.
319
... is a disease characterized by vomiting leading to weight loss associated with hyperthyroidism due to elevated HCG levels.
Hyperemesis gravidarum
320
New onset hypoglycemia can occur due to... in a DM patient, especially black.
renal failure
321
The therapy for prolactin-secreting macroadenomas in patients intolerant to drugs consists of...
transsphenoidal surgery or radiation.
322
... has revolutionized the treatment options for men with impaired sperm production.
In vitro fertilization
323
“Normal” FSH and LH levels in postmenopausal women signify...
pituitary dysfunction.
324
The total body vitamin D stores are represented by the plasma concentration of...
25-hydroxyvitamin D3.
325
Androstenedione is a weak androgenic steroid hormone, the product of natural gonadal and adrenal synthesis and a precursor to...
testosterone
326
The initial therapy in a patient with DM 2 presenting with acute symptoms, pregnancy or hyperglycemic emergencies is...
insulin.
327
The prognosis of gastric carcinoma is primary related to...
the depth of local penetration through the gastric wall.
328
Symptoms of GERD more than a year duration prompt this test...
endoscopy.
329
A... is the most appropriate therapy for a patient with GERD.
PPI
330
High grade dysplasia in Barrett’s esophagus is treated with...
esophagectomy.
331
... has a typical appearance on barium esophagogram of bird’s beak.
Achalasia
332
... is a group of heterogeneous upper GI symptoms: epigastric fullness, postprandial pain and discomfort, belching, bloating, nausea and food intolerance.
Dyspepsia
333
Gastric H. pylori infection can lead to this type of lymphoma:
MALT – mucosa-associated lymphoid tissue.
334
... (drug class) should not be taken at least 2 weeks prior to a urea breath test or urea blood test for assessment of H. pylori status.
PPIs
335
... is the drug of choice for acute onset gastroparesis.
IV erythromycin
336
The severity of pancreatitis is... to the level of serum amylase or lipase.
not related
337
Symptoms of acute diarrhea that occurred after eating poorly cooked beef suggests...
enterohemorrhagic E. coli O157:H7, which can be associated with HUS.
338
Lung CA is considered an absolute contraindication to lung transplantation for at least... after curative resection.
5 years
339
As many as 30% of patients with subacute bacterial endocarditis have arthritis, particularly in the...
knees.
340
…therapy has to be instituted before anxiety treatment in hospitalized patients.
The pain control
341
The presence of cataplexy is pathognomonic for...
narcolepsy.
342
... is characterized by sudden attacks of focal or generalized muscle weakness in response to strong emotion, such as anger or laughter.
Cataplexy
343
The therapy for bronchiolitis obliterans is a...
steroid.
344
Methotrexate treated patients have to receive... as supplement.
folic acid
345
For preventing fetal loss in antiphospholipid antibody syndrome... has been advocated based on retrospective studies.
low-dose ASA
346
PET scanning in DM patients is affected by...
uncontrolled glucose levels (elevated levels cause false negative tests).
347
The empiric therapy for CAP in a non-ICU patient is...
cephalosporin plus macrolide.
348
The empiric therapy for CAP in an ICU patient is...
cephalosporin plus fluoroquinolone.
349
Risk factors for... (bug) include bronchiectasis, daily steroid therapy, recent ABx use, and malnutrition.
P. aeruginosa
350
PET scanning cannot differentiate lesions smaller than...
1 cm.
351
The test of choice in Pancoast tumor is...
MRI (local vascular and neurological structures involvement).
352
The... is reticulocytes (percent) x HCT / 90 and is normal 1, but has to increase to more than 2 to represent a normal bone marrow response to anemia.
reticulocyte production index
353
... are characterized on intestinal biopsy by villous atrophy and plasma cell infiltrate.
Both sprues (celiac and tropical sprue)
354
Before instituting this measure..., a small bowel biopsy is needed to confirm celiac sprue.
gluten-free diet
355
If an adenomatous or hyperplastic polyp is found on sigmoidoscopy, this test follows...
full colonoscopy.
356
Elevated alkaline phosphatase with normal liver imaging should be followed by the measurement of...
antimitocondrial antibodies to r/o primary biliary cirrhosis (PBC).
357
All patients with variceal bleeding due to cirrhosis should receive one week of antibiotic prophylaxis with... (class).
a fluoroquinolone
358
Acute acalculous cholecystitis is treated with...
urgent cholecystectomy.
359
The therapy of choice in patients with acetaminophen-induced fulminant hepatic failure is prompt administration of...
N-acetylcysteine.
360
... refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct.
The Mirizzi syndrome
361
... is a dilated aberrant submucosal vessel which erodes the overlying epithelium in the absence of a primary ulcer.
A Dieulafoy's lesion
362
A patient older than... with dyspepsia should undergo endoscopic evaluation.
50 years
363
Splenic vein thrombosis is a complication of both acute and chronic pancreatitis and is treated with...
splenectomy.
364
Determination of... is done to rule out carcinoid syndrome.
5-HIAA
365
Patients with porcelain gallbladder need...
removal due to the possible (20%) risk of cancer.
366
... was used as a digestive tonic and as a stimulant for milk flow in nursing mothers. It appears to supply important compounds for hepatic detoxification reactions (including drug metabolism) and to block the hepatotoxic effects of some compounds.
Milk thistle (silymarin – active ingredient)
367
Choledochal cysts are associated with increased risk of...
cancer so they need surgical excision.
368
Pulse oximetry can be falsely... if the patient being tested has an excessively high carbon monoxide concentration, because it can not distinguish between carboxyhemoglobin and oxyhemoglobin due to the same wave-length light absorption.
elevated
369
... (class drugs) are a good choice for patients with mild persistent asthma, patients taking high doses of inhaled glucocorticoids, and especially patients with aspirin-sensitive asthma.
Leukotriene receptor antagonists (Zileuton (Zyflo) is an inhibitor of 5-lipoxygenase, zafirlukast (Accolate) and montelukast (Singulair) are inhibitors of the action of LTD4 at its receptor)
370
Obstructive lung disease is present if the FEV1/FVC ratio is less than...
70%.
371
The side effects of these asthma drugs... are dose dependent and include tremor, tachycardia, SV arrhythmias and hypokalemia.
beta-agonists AND short acting = isoproterenol AND intermediate acting = albuterol, metaproterenol, levalbuterol AND long acting = salmeterol, formoterol
372
... is the only Rx that has been shown to prolong life in hypoxemic patients with emphysema.
Oxygen
373
... is the current “gold standard” test for bronchiectasis.
HRCT
374
Fluid boluses in patients with septic shock should continue until BP improves or signs of early high LV filling pressure occur...
lung crackles or drop in the pulse oximetry.
375
... is the treatment for bronchorrhea in a cholinergic crisis.
Atropine
376
The pleural fluid in... has high TG and normal protein and LDL.
chylothorax
377
... is the most effective therapy for most patients with dystonia.
Botulinum toxin
378
... refers to the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and to exercise bowel control.
Encopresis
379
... is a chronic, blistering autoimmune disease of unknown cause that most commonly affects persons 60 years of age or older. It is twice as common as pemphigus vulgaris, being the most common blistering autoimmune disease.
Bullous pemphigoid
380
The hair and nails dermatophytosis has to be treated with...
systemic antifungals.
381
Noninfectious epidermal inflammatory conditions can be treated with...
topical glucocorticoids.
382
The KOH prep showing budding yeast forms or short (pseudo-) hyphae are diagnostic of...
candidiasis.
383
... is characterized by the Ph chromosome and progression from a chronic phase to acute leukemia (blast crisis).
Chronic myelogenous leukemia (CML)
384
Approximately 50% of patients with... (disorder) have a history of pica—an unusual compulsive craving for chewy or crunchy substances, such as ice (pagophagia), clay, starch, potato chips, and even burnt match heads.
iron deficiency
385
Fulminant autoimmune hemolytic anemia after viral infections is a feature of...
paroxysmal cold hemoglobinuria.
386
Primary hypoadrenalism may include... (skin change) and features of mineralocorticoid deficiency, none of which is seen in central hypoadrenalism.
hyperpigmentation
387
Recommendations to prevent... cancer include increased dietary fiber, fruits, and vegetables, moderate alcohol consumption, and avoidance of tobacco products.
colorectal
388
The incidence of and mortality from... cancer may be decreased by long-term aspirin or NSAID use, folic acid, and calcium.
colorectal
389
Isolated liver metastases from colorectal cancer should...
be resected.
390
In patients with cirrhosis, prophylaxis with... reduces the risk of first variceal hemorrhage.
beta-blockade
391
Although primary (end-organ) gland failure is more common than secondary (central),... should be considered in any patient with symptoms of hypoadrenalism, hypothyroidism, or hypogonadism.
hypopituitarism
392
... (imaging) should be performed in all patients with central hypothyroidism, central hypoadrenalism, or central diabetes insipidus, and in most patients with central hypogonadism.
MRI of the head
393
If malignancy is the cause of hypercalcemia,... is suppressed and the tumor is usually apparent.
PTH
394
... (CV disease) can present as a musculoskeletal syndrome, with excruciating back pain, or a peripheral nonseptic arthritis.
Subacute bacterial endocarditis
395
BRCA1 abnormalities are associated with a high risk of... (2 types) cancers.
breast and ovarian
396
In immunosuppressed patients, simple exposure to a household or workplace person infected with TB leads to therapy with...
INH for 9 months.
397
... is the test of choice to confirm eradication of H. pylori infection.
Urea breath testing
398
The most specific finding in ITP is... in the BM examination without any other abnormalities.
megakaryocytosis
399
Hyperaldosteronism is also called... syndrome.
Conn’s
