Medicine

Question 1

PE vs. Shunt

Answer 1

PE = air, no blood
Shunt = blood, no air

Question 2

Tx and PPx of secondary amyloidosis

Answer 2

colchicine

Question 3

Light’s Criteria:

Answer 3

Exudate if any of the following:

1. Fluid/Serum LDH > 0.6, or
2. Fluid/Serum protein > 0.5, or
3. Fluid LDH > 2/3 ULN

Question 4

Leukocyte alk phos is low in…

Leukocyte alk phos is high in…

Answer 4

CML (leukocytes are inactive)

P. vera

Question 5

These crystals are rectangular (envelope-shaped)

Answer 5

Calcium oxalate crystals from ethylene glycol

Question 6

HFpEF = …

Answer 6

diastolic dysfunction

Question 7

Adults with suspected bacterial meningitis get …, which helps …

Answer 7

dexamethasone x4 days,

prevents complications from S. pneumo

Question 8

PPx of PCP and toxo for HIV pts

Answer 8

TMP-SMX

Question 9

Pulmonary HTN =

Answer 9

> 25 mmHg at rest,

>30 mmHg with exercise

Question 10

GERD predisposes to Barrett’s and esophageal stricture, which shows …

Answer 10

symmetric lower esophageal narrowing

Question 11

Lobar hemorrhage in brain =

Answer 11

amyloid angiopathy

Question 12

Best non-pharm Tx for HTN

Answer 12

Weight loss via DASH diet

Question 13

Weakness in upper > lower extremities, w/ or w/o loss of pain sensation

Answer 13

Central cord syndrome from hyperextension in pts with spondylosis

Question 14

Tx of dermatitis herpetiformis

Answer 14

Dapsone

Question 15

Is arthritis a/w SLE deforming or non-deforming?

Answer 15

Non-deforming

Question 16

Sign of Beta-blocker toxicity,

Tx of Beta-blocker toxicity

Answer 16

Wheezing,

Glucagon

Question 17

Best way to dec. UTI occurrence in pts with neurogenic bladder?

Answer 17

Intermittent catheterization c.f. indwelling

Question 18

USPSTF osteoporosis screening guidelines

Answer 18

1 DEXA in F >= 65 yrs old

Question 19

Alcoholics are commonly deficient in this vitamin

Answer 19

B9 (folate)

Question 20

Does a negative FOBT r/o GI bleeding in pts with dec. Fe++?

Answer 20

No.

Question 21

NNT =

Answer 21

1/ARR

Question 22

Possible adverse effect of acyclovir

Answer 22

Nephrotoxicity (prevent with IVF)

Question 23

Is tactile fremitus inc. or dec. in pneumonia?

Answer 23

Tactile fremitus inc. in solid c.f. air, so inc. in pneumonia > effusion

Question 24

Mixed cryoglobulinemia Sx:

Answer 24

• palpable purpura
• proteinuria, hematuria
• dec. complement
• hepatosplenomegaly
• HCV infections –> Aby

Question 25

Is empyema exudative or transudative?

Answer 25

Exudative w/ dec. glucose

Question 26

Tx for hyperkalemia w/o EKG changes

Answer 26

Furosemide + normal saline

Question 27

Osler-Weber-Rendu

Answer 27

• AD
• Telangiectasia
• Epistaxis
• AV malformations
• Reactive polycythemia
• Pulmonary AVMs –> fatal hemoptysis
• Digital clubbing from chronic hypoxia

Question 28

ASA toxicity acid-base disturbance

Answer 28

Respiratory alkalosis –> non-anion gap metabolic acidosis; extremely low PaCO2

Question 29

ASA toxicity Tx

Answer 29

Alkalynization or dialysis

Question 30

ASA toxicity Sx

Answer 30

Fever, tinnitus, and tachypnea

Question 31

HMG CoA reductase MOA

Answer 31

intracellular biosynthesis of HMG CoA –> mevalonate, which inc. LDL receptors

Question 32

MOA for statin-induced myopathy

Answer 32

Statins dec. synthesis of coenzyme Q10

Question 33

Anticoagulation for DVT –> PE

Answer 33

Goal INR for idiopathic DVT: 2-3
Tx for 3 mos in cases w/ reversible risk factors
Tx for 6-12 months in cases of idiopathic DVT

Question 34

First-line Tx of obesity hypoventilation syndrome

Answer 34

Weight loss and non-invasive positive pressure ventilation

Question 35

Dx of obesity hypoventilation syndrome

Answer 35

BMI >30, daytime hypercapnea (PaCO2 > 45); these effects are due to noctural hypoventilation

Question 36

Non-hereditary (idiopathic) chronic pancreatitis is associated with …

Answer 36

pancreatic Cx; 60% of tumors present in head of pancreas with weight loss, jaundice, epigastric pain, steatorrhea

Question 37

Preferred abdominal imaging techniques in pts with and w/o jaundice

Answer 37

W/ jaundice: U/S to find biliary obstruction

W/o jaundice: CT scan looking for cancer

Question 38

75 yo male s/p surgery for advanced prostate cancer 6 mos ago presening with 3 days of worsening lumbar back pain, with imbalance. VS stable. PE shows mild LE spasticity, 3+/5 DTR, diminished rectal tone, point tenderness midline L5/S1 –> next step?

Answer 38

Glucocorticoids –> dec. vasogenic edema (caused by obstructed epidural venous plexus); have been shown to restore neurologic function

MRI is needed to look for bony mets

Question 39

Best way to inc. quality of care during transition of care?

Answer 39

Interventions that target pharmacy personnel and high-risk patients

Question 40

Cocaine and immobilization can cause …

Answer 40

rhabdomyolysis (20% of cocaine ODs complicated by rhabdo)

Question 41

Rhabdo damages kidneys by causing …

Answer 41

ATN

Question 42

Tx of rhabdo =

Answer 42

excessive IVF; mannitol and urine alkalynization may help

Question 43

Sx of methanol OD

Answer 43

AG metabolic acidosis, HA, N/V, epigastric pain, vision loss, loss; optic disk hyperemia on PE

Question 44

How to differentiate b/w methanol and ethylene glycol toxicity

Answer 44

Methanol –> affects eyes

Ethylene glycol –> affects kidneys

Question 45

Lumbar spinal stenosis is worsened by … and relieved by …

Answer 45

extension, flexion (shopping cart)

Question 46

Causes of lumbar spinal stenosis

Answer 46

• Degenerative spondylosis
• Degenerative joint disease
• Thickening of ligamentum flavum

Question 47

This imaging is used prior to parathyroidectomy to localize pathology

Answer 47

3-D sestamibi scintigraphy and U/S

Question 48

MOA of anticholinergic-induced urinary retention

Answer 48

Failure of detrusor contraction

Question 49

Detrusor activity is controlled by …

Answer 49

parasympathetic input from pelvic splanchnic nerves

Question 50

Tx of legionella pneumonia =

Answer 50

macrolides or FQs (the latter are favored if severe enough for admission)

Question 51

Avoid these drugs during right-sided MIs (3)

Answer 51

Nitrates, diuretics, opioids

Question 52

USPSTF recommendations for mammography

Answer 52

women 50-74 yo q2yrs

individualized >75 yo

Question 53

USPSTF recommendations for HLD

Answer 53

men 35+ yo lipid panel q5yrs

Question 54

USPSTF recommendations for HIV

Answer 54

15-65 yo Aby screen 1 time

Question 55

USPSTF recommendations for colon Ca

Answer 55

50-75 yo FOBT yearly or colonoscopy q10yrs

Question 56

USPSTF recommendations for cervical Ca

Answer 56

women 21-65 pap smear q3yrs

Question 57

Pt w/ h/o of wheezing following NSAID, rhinitis, postnasal drainage, Dx =

Answer 57

ASA Exacerbated Respiratory Disease (AERD); commonly presents with nasal polyps

Question 58

Dx of ASA Exacerbated Respiratory Disease

Answer 58

asthma, chronic rhinosinusitis w/ nasal polyposis, bronchospasm induced by NSAIDs/ASA

Question 59

Hypotension, tachycardia, JVD, pulsus paradoxus in pt w/ severe tearing chest pain w/ pain radiating to back

Answer 59

aortic dissection w/ rupture and cardiac tamponade

Question 60

Most common mets of colon Ca?

Answer 60

liver

Question 61

Hepatic hydrothorax 2/2 cirrhosis usually occurs on which side of the body?

Answer 61

right

Question 62

Imaging used for suspected colon Ca with mets

Answer 62

CT Abd w/ contrast

Question 63

Acute bronchitis Sx, etiology, Tx

Answer 63

1) afebrile, hemoptysis w/ no other signs concerning for PNA or Ca
2) viral
3) observation and close f/u

Question 64

Heart murmur most specific for IVDU with IBE

Answer 64

Tricuspid regurg that inc. w/ inspiration

Question 65

Hashimoto thyroiditis inc. risk for …

Answer 65

lymphoma of the thyroid

Question 66

Vaccinations for splenectomy pt recommendations:

Answer 66

should be >=14 day prior or s/p splenectomy;

give PCV13 followed by PPSV23 >= 8 weeks later, with revaccination at 5 years and again at age 65 yo

Question 67

Histo endemic areas

Answer 67

Mississippi and Ohio River Valleys, Central America

Question 68

Non-healing isolated ulcer in vermillion zone of lower lip w/ sun exposure =

Answer 68

squamous cell carcinoma

Question 69

For vent settings, inc. … prior to …

Answer 69

PEEP, FiO2 > 70% (2/2 oxygen toxicity)

Question 70

Dipyradimole and adenosine MOA

Answer 70

coronary vasodilators

Question 71

Tx of anticholinergic OD =

Answer 71

physostigmine, a cholinesterase inhibitor

Question 72

If scleroderma involves trunk, then more likely …, which is more likely to present with … lung disease

Answer 72

systemic c.f. CREST (limited), ILD c.f. PAH

Question 73

Next step in pt with lower GI bleeding that cannot be seen on colonoscopy?

Answer 73

Tech-99-labeled erythrocyte scintigraphy

Question 74

Tx of warfarin toxicity?

Answer 74

Vitamin K + PCC (prothrombin-complex concentrate) > FFP

Question 75

Imaging sign of invasive aspergillosis

Answer 75

Halo sign or air crescent on CT chest

Question 76

… in mandatory in all new-onset SLE w/ renal disease, even if Dx is slam-dunk

Answer 76

renal biopsy

Question 77

Postconcussive symptoms can last …

Answer 77

> = 6 mos

Question 78

Most specific arrythmia for digoxin toxicity

Answer 78

Atrial tachycardia with AV block

Question 79

This drug can inc. levels of digoxin, causing toxicity

Answer 79

amiodarone

Question 80

Acute digoxin toxicity Sx

Answer 80

GI (anorexia, N/V, abd pain)

Question 81

Chronic digoxin toxicity Sx

Answer 81

Less GI, more neuro (scotomas, color changes, blindness)

Question 82

Histology seen on Bx of CD and UC? How are they differentiated?

Answer 82

Neutrophilic cystitis; CD is transmural, UC is superficial mucosa

Question 83

Alternative name for Paget disease of bone

Answer 83

osteitis deformans

Question 84

Lab values for Paget disease of bone

Answer 84

Normal Ca, PO4
Inc. Alk Phos
Inc. urinary markers of bone degredation (hydroxyproline, deoxypyridinoline, N- and C-telopeptide

Question 85

Alcoholic smoker who presents w/ palpable LN, Dx and best initial test?

Answer 85

Squamous cell carcinoma of mucosa (head and neck),

Panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

Question 86

Common cause of acute limb ischemia s/p MI

Answer 86

LV thrombus

Question 87

Test to screen for LV thrombus s/p MI

Answer 87

TTE w/ contrast

Question 88

Which is more sensitive for acute pancreatitis, lipase or amylase?

Answer 88

Lipase (rises sooner, remains elevated longer)

Question 89

HIV PPx against MAC?

Answer 89

Azithromycin

Question 90

Fundoscopic exam of pt with optic neuritis shows?

Answer 90

Swollen disc

Question 91

When should HAART be started in pt with cryptococcal meningitis?

Answer 91

Defer HAART until 2 weeks after antifungal Tx is started

Question 92

Purulent arthritis in sexually active pt is … until proven otherwise

Answer 92

Gonococcal arthritis

Question 93

Tx of disseminated gonococcal infection =

Answer 93

• IV ceftriaxone 1 g/day for 7-14 days, switch to PO (cefixime) when clinically better
• Joint drainage
• Empiric azithromycin (single 1 g dose) or doxycycline for 7 days for simultaneous chlamydial infection
• Tx sexual partner

Question 94

This drug can cause an idiosyncratic liver injury with histologic features of viral hepatitis

Answer 94

Isoniazid

Question 95

Treatment of uremic pericarditis?

Answer 95

Hemodialysis

Question 96

Treatment of MALT w/o mets?

Answer 96

Eradication of H. pylori w/ triple therapy (PPI, clarithromycin, amoxicillin); chemo (CHOP or CHOP + bleomycin) if MALT doesn’t recede with Abx

Question 97

Heart murmur a/w rheumatic fever

Answer 97

Mitral stenosis

Question 98

Sequelae of mitral stenosis

Answer 98

Left atrial dilation –> atrial fibrillation –> cardiac emboli
Dyspnea, cough, hemoptysis (hemoptysis is sensitive for mitral stenosis)

Question 99

Tx of PCP

Answer 99

TMP-SMX (IV if severe)

Question 100

When treating PCP, what can happen to breathing? How is this avoided?

Answer 100

Breathing worsens when beginning treatment due to dead organisms in lungs; this is avoided by giving steroids to PaO2 35 when starting Abx

Question 101

Tx of immune TCP

Answer 101

Systemic steroids for pts w/ severe TCP (

Question 102

Manometry shows inc. amplitude peristaltic contractions w/ normal LES tone, Dx?

Answer 102

Diffuse esophageal spasm

Question 103

Corkscrew appearance on esophagram

Answer 103

Diffuse esophageal spasm

Question 104

Tx of diffuse esophageal spasm

Answer 104

Antispasmodics, dietary modification, psychiatric counseling

Question 105

Things that inc. risk of warfarin bleeding

Answer 105

• Acetaminophen, NSAIDs
• Metronidazole, antifungals
• Amiodarone
• Cimetidine
• Cranberry juice, Ginkgo biloba, Vit E
• Omeprazole
• Levothyroxine
• SSRIs

Question 106

Things that dec. risk of warfarin bleeding

Answer 106

• Carbamazepine
• Ginseng
• Green vegetables
• OCPs
• Phenobarbital
• Rifampin
• St. John’s Wort

Question 107

How long does it take for Vit K deficiency to occur?

Answer 107

Usually 30 days, but can be 7-10 days if underlying liver disease

Question 108

What is the Tx for Vit K deficiency

Answer 108

Vit K + FFP for first 8 hours (if bleeding)

Question 109

Panacinar emphysema + cirrhosis

Answer 109

Alpha-1-anti-trypsin deficiency

Question 110

Tx of alpha-1-anti-trypsin deficiency

Answer 110

Purified human A1AT; lung or liver tplant

Question 111

15% of pts with myesthenia gravis have this …

Answer 111

thymoma (Dx via CT chest)

Question 112

These tumors produce Beta-hcg and AFP

Answer 112

Nonseminomatous germ cell tumors

Question 113

Sx of GVHD

Answer 113

• Maculopapular rash of palms, soles, face
• Bloody diarrhea
• Inc. LFTs and jaundice

Question 114

Pathophys of GVHD

Answer 114

Recognition of host HLA-antigens by donor T cells –> cell-mediated immune response

Question 115

Lynch syndrome II is a/w extracolonic cancers, most common of which is …

Answer 115

endometrial cancer

Question 116

HIV+ w/ subacute fevers, HA, and signs of inc. ICP, Dx?

Answer 116

Most likely cryptococcal meningitis (CD4

Question 117

How to Dx cryptococcal meningitis

Answer 117

• Antigen in CSF
• India ink
• Subourand agar

Question 118

Meningococcal vaccination recommendations:

Answer 118

• Primary vaccination, everyone age 11-12

- Booster vaccination, 16-21 if received primary 21 if at high risk –> travel

Question 119

Primary amyloidosis shorthand

Secondary amyloidosis shorthand

Answer 119

AL

AA

Question 120

Causes of secondary amyloidosis

Answer 120

RA, IBD, chronic infections

Question 121

Sx of amyloidosis:

Answer 121

• CHF
• Proteinuria
• Waxy skin or bruising
• Macroglossia
• Hepatomegaly
• Peripheral (carpal tunnel syndrome) or autonomic neuropathies (orthostatic hypotension)

Question 122

EKG/ Echo changes a/w amyloidosis

Answer 122

Low voltage EKG, inc. wall thickness with nl LV cavity

Question 123

Dx of amyloidosis

Answer 123

Tissue Bx –> abdominal fat pad

Question 124

Prolonged use of omeprazole inc. risk of … (3)

Answer 124

• C dif infections
• dec. Ca++ absorption –> osteoporosis
• pneumonia

Question 125

Hypovolemic shock damages the kidneys, causing …

Answer 125

ATN (FENa > 3%)

Question 126

Muddy brown casts =

Answer 126

ATN

Question 127

WBC casts =

Answer 127

interstitial nephritis or pyelonephritis

Question 128

Fatty casts =

Answer 128

nephrotic syndrome

Question 129

Broad/ waxy casts =

Answer 129

chronic renal failure

Question 130

Young healthy pt develops CHF, what should you suspect?

Answer 130

Myocarditis –> viral (esp. Coxsackie B) is most common

Question 131

Risk factor for infective endocarditis 2/2 Eikenella corrodens

Answer 131

Periodontal infections, dental procedures

Question 132

Skin lesions a/w meningococcal meningitis

Answer 132

Petechiae or purpura

Question 133

… are more commonly seen with meningococcal meningitis c.f. viral meningitis

Answer 133

Myalgias

Question 134

Acid-base disturbance a/w Conn’s syndrome

Answer 134

Metabolic alkalosis

Question 135

Normal pH of pleural fluid

Answer 135

7.60

Question 136

pH of transudative pleural fluid

Answer 136

7.40-7.55

Question 137

pH of exudative pleural fluid

Answer 137

7.30-7.45

Question 138

How to Dx lead poisoning

Answer 138

• Blood lead levels
• CBC w/ smear
• X-ray fluorescence to measure bone lead concentration

Question 139

Tx of lead toxicity

Answer 139

Chelation therapy

Question 140

Another name for FSGS

Answer 140

HIV-related neuropathy

Question 141

Dx of Dubin-Johnson syndrome

Answer 141

Conjugated hyperbilirubinemia with >= 50% direct bilirubin, in the presence of normal LFTs
Confirmatory testing on urine coproporphyrin looking for unusually high levels of coproporphyrin I (c.f. III)

Question 142

Seborrheic dermatitis is a/w these two diseases

Answer 142

Parkinson disease and HIV

Question 143

TSH-secreting pituitary adenoma lab values

Answer 143

Inc. thyroid hormone production with elevated or normal TSH (should be low)

Question 144

TSH-secreting pituitary adenomas classically present with signs of …

Answer 144

mass effect (HA, visual field defects, disruption of normal pituitary function), as these are macroadenomas upon presentation

Question 145

Pulsus paradoxus definition

Answer 145

Exaggerated decline in systemic blood pressure (>10 mmHg) during inspiration

Question 146

Pulsus paradoxus is a/w …

Answer 146

cardiac tamponade, severe asthma, and COPD

Question 147

Lateral medullary infarct (Wallenburg syndrome) is from occlusion of …

Answer 147

PICA or vertebral artery

Question 148

Pts suffering from ankylosing spondylitis for >20 years are at inc. risk of … due to …

Answer 148

vertebral fracture, rigidity and dec. bone mineral density

Question 149

Aortic stenosis radiates to the … and is a/w …

Answer 149

carotids and apex, pulsus parvus et tardus (pulse that rises gradually and has a delayed peak)

Question 150

Pain from epidural spinal cord compression c.f. degenerative joint disease

Answer 150

ESCC is worse when lying down due to distension of the epidural venous plexus when lying down, as opposed to DJD which is better with recumbency

Question 151

Suspect atheroembolism when s/p …

Answer 151

cardiac catheterization (can be immediate or delayed >30 days)

Question 152

Sx of atheroembolism

Answer 152

cutaneous (“blue toe syndrome,” livedo reticularis), cerebral or intestinal ischemia, acute kidney injury, and Hollenhorst plaques

Question 153

Tx of atheroembolism

Answer 153

Supportive, including statin therapy for risk factor reduction and prevention of recurrent embolism

Question 154

Livedo reticularis

Answer 154

Reticular, lacy skin discoloration/erythema that blanches on pressure; a/w atheroembolism

Question 155

Hollenhorst plaques

Answer 155

Bright, yellow, refractile plaques in the retinal artery which indicate a proximal source such as the internal carotid a.; a/w atheroembolism

Question 156

Pt stepped on a nail, now has osteomyelitis. Most likely organism and Tx?

Answer 156

Pseudomonas; oral or IV FQs w/ aggressive surgical debridement

Question 157

What heart sound is auscultated during acute MI?

Answer 157

S4, due to ischemia-induced myocardial dysfunction

Question 158

What conditions are S4 heart sounds heard?

Answer 158

During dec. LV compliance = acute MI, hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy

Question 159

Pathophys of dermatofibroma

Answer 159

Inc. fibroblast production

Question 160

Presentation of dermatofibroma

Answer 160

Most common on lower extremity, dimpling in center when pinched

Question 161

Tx of dermatofibroma

Answer 161

Cryosurgery or shave excision

Question 162

How is molluscum contagiosum transmitted?

Answer 162

Skin-to-skin contact

Question 163

Pts w/ molluscum contagiosum and a prolonged course, wide distribution, lesions involving face, numerous or large lesions should be tested for …

Answer 163

HIV –> dec. cellular immunity

Question 164

Tx for influenza w/i 48 hours?

Answer 164

Neuraminidase inhibitors (oseltamavir, zanamivir)

Question 165

Tx of fibromyalgia?

Answer 165

Patient education, regular aerobic exercise, good sleep hygiene

Question 166

Presentation of fibromyalgia

Answer 166

Point tenderness in mid trapezius, lateral epicondyle, costochondral junction, or greater trochanter

Question 167

Tx of frostbite

Answer 167

Rapid re-warming w/ warm water (40-44C)

Question 168

These complications occur 5-14 days s/p transmural MI

Answer 168

Ventricular free wall or septum rupture

Question 169

PEA after recent first MI w/o signs of CHF

Answer 169

Ventricular free wall rupture

Question 170

Major cause of chronic diarrhea in HIV pts w/ CD4

Answer 170

Cryptosporidium parvum

Question 171

Dacrocystitis

Answer 171

Infection of lacrimal sac

Question 172

Sudden onset pain/ redness in medial canthal region

Answer 172

Dacrocystitis

Question 173

Organisms that cause dacrocystitis

Answer 173

S. aureus or Beta-hemolytic strep

Question 174

Side effect of indinavir

Answer 174

Crystal-induced nephropathy

Question 175

Side effect of didanosine

Answer 175

Pancreatitis

Question 176

Side effect of abacavir

Answer 176

Hypersensitivity syndrome

Question 177

Side effect of many NRTIs

Answer 177

Lactic acidosis

Question 178

Side effect of many NNRTIs

Answer 178

Stevens-Johnson syndrome

Question 179

Side effect of nevirapine

Answer 179

Liver failure

Question 180

Test that differentiates b/w psychogenic and organic erectile dysfunction

Answer 180

Nocturnal penile tumescence

Question 181

Acute back pain + point tenderness after strenuous exercise, Dx?

Answer 181

Vertebral compression fracture

Question 182

Risk factors for vertebral compression fracture

Answer 182

Osteoporosis, osteomalacia, osteomyelitis, malignancy w/ bone mets, hyperparathyroidism

Question 183

Tx of trigeminal neuralgia

Answer 183

Carbamazepine

Question 184

Inc. serum protein w/ normal albumin suggests … (4)

Answer 184

MM, WM, MGUS, amyloidosis

Question 185

MGUS pts usually have … M proteins on SPEP and … plasma cells in bone marrow

Question 186

MM pts usually have … M proteins on SPEP and … plasma cells in bone marrow

Answer 186

> 3 g/dL, >10%

Question 187

MGUS pts need …

Answer 187

bone scan to exclude lytic lesions

Question 188

Nontraumatic SAH most likely caused by …

Answer 188

ruptured saccular/ berry aneurysm

Question 189

Inc. risk of globe penetration and intraocular foreign body w/ …

Answer 189

high-velocity injury (drilling, grinding, etc.)

Question 190

Suspected intraocular foreign body Dx

Answer 190

Fluorescein application following slit-lamp

Question 191

How does thyrotoxicosis cause hyperdynamic cardiovascular status?

Answer 191

Inc. chronotropy and inotropy of heart

Question 192

The tighter the confidence interval, the … the results

Answer 192

more precise

Question 193

Increasing the sample size of a study … the precision

Answer 193

increases

Question 194

Radioiodine therapy is most likely to cause hypothyroidism in …

Answer 194

Graves’ disease c.f. multinodular goiter or toxic adenoma

Question 195

Tx of Lyme disease in pregnant or breast-feeding

Answer 195

Amoxacillin (not ceftriaxone)

Question 196

Objective assessment (echocardiography) needed to r/o hydrostatic pulmonary edema in pts w/o …

Answer 196

ARDS risk factors

Question 197

Alarm Sx that prompt EGD in pt with GERD

Answer 197

• dysphagia
• odynophagia
• weight loss
• anemia
• GI bleeding
• recurrent vomiting
• age > 50 years w/ chronic ( >5 years) Sx
• cancer risk factors

Question 198

Randomization dec. … (2)

Answer 198

confounding, selection bias

Question 199

Alkalosis causes hyper- or hypocalcemia?

Answer 199

Hypocalcemia (inc. pH causes H+ to dissociate from albumin, allowing Ca++ to bind, which dec. free Ca++)

Question 200

Pts with PE can get hypocalcemic, how?

Answer 200

Tachypnea causes respiratory alkalosis, which causes hypocalcemia by inc. Ca++ binding to albumin

Question 201

New mom was holding infant with thumb outstretched (abducted/extended), Dx?

Answer 201

De Quervain tenosynovitis

Question 202

Tenderness to palpation at radial wrist, base of hand, Dx?

Answer 202

De Quervain tenosynovitis

Question 203

Pain with Finkelstein test

Answer 203

De Quervain tenosynovitis

Question 204

Muscles implicated it De Quervain tenosynovitis

Answer 204

Abductor pollicus longus, extensor pollicis brevis

Question 205

Acid-base disturbance a/w repeated vomiting

Answer 205

Hypokalemic, hypochloremic metabolic alkalosis

Question 206

History of travel to Mexico + dysentery + RUQ pain + single cyst in right lobe of liver, Dx?

Answer 206

Amebic liver abscess

Question 207

Tx of amebic liver abscess?

Answer 207

Metronidazole

Question 208

Dx of amebic liver abscess?

Answer 208

Examination of trophozoites, serology, liver imaging

Question 209

Causes of pyogenic liver cyst?

Answer 209

Surgery, GI infection, acute appendicitis

Question 210

Organism implicated in hydatid cyst?

Answer 210

Echinococcus granulosus

Question 211

Vignette a/w Echinococcus granulosus

Answer 211

Intimate contact with dogs (definitive host) or sheep (intermediate host)

Question 212

Nephrotic syndrome inc. risk of

Answer 212

accelerated atherosclerosis via causing abnormal lipid panel (dec. HDL, inc. LDL)

Question 213

How does PCP cause hypoxia?

Answer 213

Alveolar and interstitial inflammation –> V/Q mismatch –> inc. A-a gradient

Question 214

DDx asthma from COPD

Answer 214

Asthma shows significant reversal (>12%) in FEV1 after bronchodilator

Question 215

Large contributor to medical errors and adverse pt outcomes?

Answer 215

Communication failures between physicians

Question 216

How to prevent communication failures during pt handoff?

Answer 216

Checklists

Question 217

Tx of mild persistent asthma (2nd level; after intermittent)

Answer 217

SABA + ICS

Question 218

What triggers pseudogout attacks?

Answer 218

Trauma, surgery, illness

Question 219

Radiographic evidence of pseudogout?

Answer 219

Chondrocalcinosis (calcified articular cartilage)

Question 220

Pseudogout crystal appearance

Answer 220

Rhomboid, + birefringent

Question 221

Gout crystal appearance

Answer 221

Needle-shaped, - birefringent

Question 222

Most common drug cause of priapism?

Answer 222

Prazosin

Question 223

Common causes of priapism (4)

Answer 223

1. SCD and leukemia –> children and adolescents
2. Perineal/ genital trauma –> laceration of cavernous a.
3. Neurologic lesions –> SCI, cauda equina syndrome
4. Meds –> prazosin, trazadone

Question 224

Risk factors for diverticular disease

Answer 224

Chronic constipation; low fiber, high fat diet

Question 225

Best test for Dx of acute diverticulitis?

Answer 225

Abd CT with oral and IV contrast

Question 226

Management of acute diverticulitis?

Answer 226

Bowel rest, Abx (cipro/ flagyl)

Question 227

What is contraindicated during acute diverticulitis?

Answer 227

Sigmoidoscopy and colonoscopy 2/2 inc. risk of perforation

Question 228

Recommendations for DMT2 screening:

Answer 228

• BP >= 135/80 mmHg
• maybe all pts >= 45
• those with additional RFs

Question 229

How to Dx Parkinson disease

Answer 229

Clinically

Question 230

Episodic painless GI bleeding with recent negative colonoscopy, Dx?

Answer 230

Angiodysplasia

Question 231

Where is angiodysplasia most common in body?

Answer 231

Rt colon

Question 232

Angiodysplasia is a/w which diseases?

Answer 232

Advanced renal disease, von Willebrand disease, aortic stenosis

Question 233

How to Dx angiodysplasia?

Answer 233

Endoscopy; however, can be missed 2/2 bad bowel prep or location behind haustral fold

Question 234

Tx of angiodysplasia?

Answer 234

Asymptomatic: none

Symptomatic (Fe deficiency, bleeding): endoscopically, with cautery

Question 235

Tx of shingles (VZV):

Answer 235

Acyclovir/ valacyclovir –> dec. duration of disease and incidence of post-herpetic neuralgia

Question 236

What medications trigger bullous pemphigoid?

Answer 236

Furosemide, NSAIDs, captopril, penicillamine, many ABx

Question 237

Presentation of bullous pemphigoid?

Answer 237

Tense bullae w/ urticarial plaques, pruritis; spares mucous membranes

Question 238

Pathophys of bullous pemphigoid?

Answer 238

IgG autoantibodies target hemidesmosomes and basement membrane zone

Question 239

How to Dx bullous pemphoid?

Answer 239

Skin Bx

• Histo: subepidermal bulla with eosinophils
• DIF: IgG and C3 depositis linearly along basement membrane zone (dermal/ epidermal junction)

Question 240

Loss of peristalsis in distal esophagus and lack of relaxation of LES during swallowing?

Answer 240

Achalasia

Question 241

Dysphagia for solids and liquids, heartburn, regurgitation of food, weight loss

Answer 241

Achalasia

Question 242

Dx of achalasia?

Answer 242

• Barium swallow with bird-beak narrowing (“smooth tapering of distal esophagus)
• Confirmed with manometry

Question 243

What must be ruled out before starting achalasia Tx

Answer 243

Esophageal malignancy, via endoscopy

Question 244

Malignant otitis externa vs otitis externa

Answer 244

Severity of pain, presence of granulation tissue, inc. ESR

Question 245

Pt population who get malignant otitis externa

Answer 245

Elderly w/ poorly controlled DMT2 or immunocompromised

Question 246

Tx of malignant otitis externa

Answer 246

Empiric IV ciprofloxacin

Question 247

Complications of malignant otitis externa

Answer 247

Osteomyelitis of skull base and TMJ; cranial nerve involvement

Question 248

Patient with malignant otitis externa allergic to FQs, Tx?

Answer 248

piperacillin, ceftazidime

Question 249

Spontaneous retrosternal pain precipitated by emotional stress, hot/ cold food; nitrates help relieve pain

Answer 249

Diffuse esophageal spasm

Question 250

Dx of diffuse esophageal spasm

Answer 250

Esophageal manometry (shows repetitive, non-peristaltic, high amplitude contractions spontaneously or after ergonovine stimulation)

Question 251

Tx of choice for Lyme disease in non-pregnant, >=8yo

Answer 251

PO doxycycline

Question 252

Tx of choice for Lyme disease in pregnant,

Answer 252

Amoxicillin

Question 253

Tx of choice for early disseminated or late Lyme disease

Answer 253

IV ceftriaxone

Question 254

First line medications for mild-moderate dementia

Answer 254

Cholinesterase inhibitors (donepezil, galantamine, rivastigmine)

Question 255

Pernicous anemia causes a chronic atrophic gastritis that inc. risk for …

Answer 255

intestinal-type gastric Cx and gastric carcinoid tumors (by 2-3x)

Question 256

Depolarizing neuromuscular blocker used in rapid sequence intubation

Answer 256

Succinylcholine

Question 257

Onset and offset of succinylcholine

Answer 257

Onset 45-60 seconds

Offest 6-10 minutes

Question 258

Succinylcholine is contraindicated in which pts?

Answer 258

Hyperkalemia:

• Crash/burn victims > 8 hours (inc. risk of rhabdo)
• Pts with demyelinating disease (GBS)
• Tumor lysis syndrome

Question 259

What to give pts who are contraindicated to succinylcholine?

Answer 259

Non-depolarizing NM blocker (vecuronium, rocuronium)

Question 260

Heterophile Ab are commonly … in early infectious mononucleosis

Answer 260

negative; need to be repeated

Question 261

Most critical factor in determining pt survival in sudden cardiac death?

Answer 261

Elapsed time to effective resuscitation (effective bystander CPR, prompt rhythm analysis, early defibrillation in pts w/ V-fib)

Question 262

Pharmacologic Tx for restless leg syndrome

Answer 262

DA agonists (pramipexole) or alpha-2-delta calcium channel ligands (gabapentin)

Question 263

Non-pharmacologic Tx for restless leg syndrome

Answer 263

Leg massage, heating pads, regular exercise, avoidance of sleep deprivation; Fe supplementation if ferretin

Question 264

Bloody diarrhea in absence of travel history

Answer 264

E. coli, Shigella, Campylobacter

Question 265

Most common cause of bloody diarrhea in absence of fever

Answer 265

E. coli

Question 266

Dx of EHEC?

Answer 266

Assay for shiga-toxin in stool, stool culture

Question 267

Tx of EHEC?

Answer 267

-Supportive

NOT ABX!! (inc. risk for HUS)

Question 268

First line Tx for fibromyalgia

Answer 268

Amitriptyline, followed by pregabalin, duloxetine, milnacipran

Question 269

HIV pts with odynophagia and visible oral thrush management

Answer 269

1-2 weeks of empiric oral fluconazole

Question 270

HIV pts with persistent odynophagia following empiric fluconazole, next step?

Answer 270

Endoscopy with Bx

Question 271

HIV pts with persistent odynophagia, Bx shows large linear ulcers w/ intranuclear and intracytoplasmic inclusions

Answer 271

CMV esophagitis –> Tx with gancyclovir

Question 272

HIV pts with persistent odynophagia, Bx shows small, well-circumscribed round/ ovioid ulcers with intranuclear inclusions

Answer 272

Herpes simplex esophagitis –> Tx with acyclovir

Question 273

Post-MI pericarditis (Dressler’s syndrome) occurs how long after MI

Answer 273

1-6 weeks s/p MI

Question 274

Prolonged recumbency inc. risk of …

Answer 274

orthostatic hypotension

Question 275

HHS/DKA pts have dec. total body K+ despite normal/ elevated levels –> BOLO for…

Answer 275

severe hypokalemia caused by aggressive insulin therapy

Question 276

OTC pain medications + EtOH can cause …

Answer 276

acute liver failure

Question 277

Lung disease seen with ankylosing spondylitis

Answer 277

Restrictive lung disease 2/2 dec. chest wall/ spinal mobility

Question 278

Rheumatoid arthritis causes inc. risk of …

Answer 278

osteoporosis

Question 279

Herpetic whitlow =

Answer 279

HSV 1 or 2 of hand

Question 280

Which population is at inc. risk of herpetic whitlow?

Answer 280

Health-care workers

Question 281

Tx of choice for Dressler’s syndrome?

Answer 281

NSAIDs

Question 282

Dry/ rough skin with horny plates over extensor surfaces, Dx?

Answer 282

ichthyosis vulgaris (‘lizard skin’)

Question 283

Anaphylaxis 2/2 blood transfusion, what happened?

Answer 283

Pt had IgA deficiency, anaphylaxis 2/2 presence of anti-IgA antibodies

Question 284

Pts with IgA deficiency should get which products?

Answer 284

IgA-deficient plasma and washed red cell products

Question 285

Greatest risk factor for variant (Prinzmetal’s) angina?

Answer 285

Smoking

Question 286

Other Sx of hypercalcemia?

Answer 286

• constipation –> altered intestinal Sm M tone
• polyuria –> nephrogenic DI
• acute pancreatitis

Question 287

Dec. air flow during inspiration and expiration, Dx?

Answer 287

Fixed-upper airway obstruction

Question 288

How does fixed-upper airway obstruction appear on flow-volume loop?

Answer 288

Flattened top and bottom loops

Question 289

BOLO for hypercalcemia questions in pts w/ back pain, elevated ESR, anemia, renal failure

Answer 289

MM pts

Question 290

What do you need to monitor in pts taking amiodarone?

Answer 290

Periodic thyroid and hepatic testing (can cause hypo- or hyperthyroidism or hepatocellular injury)

Question 291

Adverse effects of amiodarone? (5)

Answer 291

1. Hypo/erthyroidism
2. Hepatotoxicity
3. Bradycardia/ heart block
4. Pneumonitis
5. Neurologic/ visual disturbances

Question 292

Infectious ascitic fluid collection w/o obvious intraabdominal surgical etiology

Answer 292

Spontaneous bacterial peritonitis

Question 293

When should you suspect spontaneous bacterial peritonitis?

Answer 293

Any cirrhotic pt w/ temp >100F warrants an investigation

Question 294

Dx of spontaneous bacterial peritonitis

Answer 294

PMN count > 250/microL; positive fluid Cx

Question 295

Tx of spontaneous bacterial peritonitis

Answer 295

3rd gen cephalosporin (cefotaxime)

Question 296

Tx of PVCs on EKG

Answer 296

Asymptomatic –> observation

Symptomatic –> Beta blocker

Question 297

How to DDx b/w OSA and obesity hypoventilation syndrome?

Answer 297

Acid-base disturbance corrects with OSA when awake, while pt maintains respiratory acidosis with obesity hypoventilation syndrome during daytime

Question 298

How does body respond to respiratory acidosis?

Answer 298

Kidneys compensate via inc. retention of bicarb and dec. chloride reabsorption

Question 299

3 most common causes of cough?

Answer 299

1. Upper-airway nasal discharge (postnasal drip)
2. Asthma
3. GERD

Question 300

Dx of postnasal drip?

Answer 300

Elimination of nasal d/c and cough with H1 histamine receptor antagonists

Question 301

What is cutaneous larva migrans?

Answer 301

Cutaneous eruption caused by Ancylostoma braziliense (dog and cat hookworm)

Question 302

Pruritic, elevated, serpiginous lesions s/p sandbox

Answer 302

Cutaneous larva migrans

Question 303

Anelgesic nephropathy causes which kidney diseases?

Answer 303

• tubulointerstitial nephritis

- hematuria via papillary necrosis

Question 304

IV acyclovir causes what type of kidney disease?

Answer 304

Crystal-induced AKI

Question 305

Dx of CLL?

Answer 305

Flow cytometry

Question 306

If pt is bitten by high risk animal (raccoon, bat, skunk), how to manage risk of rabies?

Answer 306

Pt should get PEP, which may get d/c if animal can be observed. If animal is unavailable, then pt continues PEP

Question 307

If pt is bitten by healthy dog, how to manage risk of rabies?

Answer 307

Observe dog for 10 days prior to starting PEP

Question 308

What does rabies PEP consist of?

Answer 308

Active (rabies vaccine) and passive (human rabies Ig) immunizations

Question 309

Lambert-Eaton syndrome cancer?

Answer 309

Small cell lung carcinoma

Question 310

Pathophys of Lambert-Eaton syndrome?

Answer 310

Autoantibodies against presynaptic VG-Ca++ channels

Question 311

Tx of Lambert-Eaton syndrome?

Answer 311

Plasmapharesis and immunosuppressive drug therapy

Question 312

What is ‘fight bite?’

Answer 312

Clenched fist injury from person striking teeth of opponent

Question 313

How to Tx clenched fist injury?

Answer 313

Amoxacillin-clavulanate (PPx and Tx of choice for polymicrobial infections from human and dog mouth)

Question 314

What physical exam maneuver is 99% specific for renovascular disease?

Answer 314

Continuous abdominal bruit

Question 315

In which pts should you suspect renovascular disease?

Answer 315

Resistent HTN +…

• diffuse atherosclerosis
• asymmetric kidney size
• recurrent flash pulmonary edema
• inc. Cr >30% after starting ACEi/ARB

Question 316

Hemineglect ignores the … side and involves the … parietal lobe

Answer 316

left; right (non-dominant)

Question 317

Most common cause of mucormycosis?

Answer 317

Rhizopus spp.

Question 318

What do pts with dec. Vit D complain of?

Answer 318

Bone pain and muscle weakness; pts have dec. bone density and pseudofractures (Looser zones)

Question 319

What can identify 80% of superior vena cava syndromes?

Answer 319

Chest X-ray

Question 320

Lymph node diameter > … is a/w greater risk of malignancy or granulomatous disease

Answer 320

2.0 cm

Question 321

How do chronic glucocorticoids cause adrenal insufficiency?

Answer 321

HPA axis suppression –> dec. cortisol, dec. ACTH, nl. aldosterone

Question 322

Risk factors for osteomyelitis (3)

Answer 322

IVDU, sickle cell anemia, immunocompromised

Question 323

Physical exam maneuver most sensitive for osteomyelitis of spine?

Answer 323

Tenderness to gentle percussion over spinous process, pain not relieved by rest

Question 324

Syncope + crescendo-decrescendo murmur in lower left sternal border

Answer 324

HOCM

Question 325

Where are bronchogenic cysts located?

Answer 325

Middle mediastinum

Question 326

Where are thymomas located?

Answer 326

Anterior mediastinum

Question 327

Where are neurogenic tumors located?

Answer 327

Posterior mediastinum

Question 328

What should be performed after placing a central venous catheter?

Answer 328

CXR to confirm proper placement of catheter tip and absence of complications prior to administering medications

Question 329

Tx of pt w/ pheochromocytomas

Answer 329

NEED to give alpha-blocker prior to beta-blockers (otherwise will get a very dangerous inc. in BP)

Question 330

Tight glycemic control dec. risk of … complications

Answer 330

Microvascular (retinopathy, neuropathy)

Question 331

MC pathogen cause pneumonia in nursing home patient if pneumonia is in right lower lobe

Answer 331

Strep pneumo

Question 332

Interferon use in hepatitis B

Answer 332

IFN is a short-term Tx; cannot be used in decompensated cirrhosis

Question 333

Preferred Tx for hepatitis B

Answer 333

Entecovir or tenofovir

Question 334

Tx of hepatitis C

Answer 334

Pegylated IFN + ribavirin

Question 335

Chronic malabsorption/ diarrhea, weight loss, migratory non-deforming arthritis, LAD and fevers

Answer 335

Presenting Sx of Whipple disease

Question 336

… mode of mechanical ventilation that delivers predetermined tidal volume; inspiration can be initiated by the patient

Answer 336

Assist control

Question 337

Ideal tidal volume?

Answer 337

6mL/kg of ideal body weight

Question 338

What is the next step of management for mechanically ventilated patient with respiratory alkalosis and appropriate TV?

Answer 338

Dec. respiratory rate

Question 339

D-xylose absorption is … in pts with small intestinal mucosal disease and … in pts with malabsorption 2/2 enzyme deficiencies

Answer 339

impaired; normal

Question 340

Painless hard mass in testicle + suggestive U/S of cancer, next step?

Answer 340

Radical orchiectomy via high inguinal orchiectomy

Question 341

What is contraindicated in pts with suspected testicular tumors?

Answer 341

FNAC(ytology) or transscrotal Bx (due to potential seeding)

Question 342

ASx pt w/ Paget disease of bone in non-weight bearing bone, Tx?

Answer 342

None

Question 343

Sx pt w/ Paget disease of bone, Tx?

Answer 343

PO or IV aminobisphosphonates

Question 344

Thyroid labs in pt with liver disease?

Answer 344

Dec. total T3/T4, with normal TSH (liver disease causes dec. production of thyroid-binding proteins)

Question 345

Drugs with … effects, like …, can cause urinary retention by …

Answer 345

anticholinergic; amitriptyline; preventing detrusor muscle contraction and urinary sphincter relaxation

Question 346

Tx of anticholinergic urinary retention?

Answer 346

Catheterization (>50 mL confirms Dx)

Question 347

Most common cause of death in dialysis pts?

Answer 347

CV disease

Question 348

Most common cause of death in renal transplant pts?

Answer 348

CV disease

Question 349

Definition of nephrotic syndrome? (4)

Answer 349

1. Proteinuria >3.0-3.5 g/day
2. Hypoalbuminemia
3. Edema
4. Hyperlipidemia/ lipiduria

Question 350

Most frequent manifestation of hypercoagulability of nephrotic syndrome?

Answer 350

Renal vein thrombosis

Question 351

Side effects of loop diuretics?

Answer 351

Hypokalemic metabolic alkalosis, prerenal kidney injury

Question 352

Panlobular emphysematous changes in lower lobes

Answer 352

Alpha-1-antitrypsin deficiency

Question 353

Dx of alpha-1-antitrypsin deficiency?

Answer 353

Measure serum levels of alpha-1-antitrypsin

Question 354

Only abnormal lab is inc. alk phos (GGT is normal), disease?

Answer 354

Paget disease of bone

Question 355

This disease is considered a ‘pseudoallergic reation’ (not IgE-mediated)?

Answer 355

Aspirin-exacerbated respiratory disease

Question 356

Easily induced hypokalemia after starting a thiazide suggests …

Answer 356

primary hyperaldosteronism

Question 357

Inc. T4 with low TSH, low RAIU uptake, two possibilities are … and …, and they are distinguished by …

Answer 357

release of preformed toxin, exogenous thyroid hormone intake; thyroglobulin levels (high in the former, low in the latter)

Question 358

Tx of mild hypothermia

Answer 358

Passive re-warming, warmed crystalloids (42C) for hypotension

Question 359

Hypokalemia inc. renal production of …

Answer 359

ammonia

Question 360

Besides fixing electrolyte problems, other Tx for hepatic encephalopathy

Answer 360

lactulose, rifaximin

Question 361

Persistent, nonbloody, watery diarrhea for >= two weeks s/p trip to E. Europe?

Answer 361

Cryptosporidium parvum

Question 362

Traveler’s diarrhea lasting >= 2 weeks suggests … etiology

Answer 362

parasitic (Cyrptosporidium, Cystoisospora, Giardia, microsporidia spp)

Question 363

Hazard ratio 1 indicates…

Answer 363

Tx group had a lower event rate, Tx group had a higher event rate

Question 364

Drug of choice for hairy cell leukemia

Answer 364

Cladribine

Question 365

Most common cause of death in acromegaly

Answer 365

Cardiovascular

Question 366

IN addition to giving meds that inc. survival in CHF pts (ASA, B-blocker, ACEi, statins), clopidogrel should be given if …

Answer 366

pt w/ UA/NSTEMI for >=12 months

pt s/p PCI (30 days for BMS, 1yr for DES)

Question 367

Inc. Ca++ + inc. PTH can be caused by … or …

Answer 367

Primary hyperparathyroidism, familial hypocalciuric hypercalcemia

Question 368

How to differentiate b/w PHP and FHH?

Answer 368

Urinary Ca++/Cr clearance (0.02 in PHP)

Question 369

Compression of brachial plexus by superior sulcus tumor

Answer 369

Pancoast syndrome

Question 370

… is a common cause of false-positive VDRL

Answer 370

Antiphospholipid antibody syndrome

Question 371

Tx of antiphospholipid antibody syndrome in pregnant female to PPx SA

Answer 371

LMWH

Question 372

1% of actinic keratoses convert to …

Answer 372

squamous cell carcinoma of the skin

Question 373

Pts who receive many blood transfusions can get …, which …

Answer 373

inc. citrate; chelates Ca++ and Mg++, causing paresthesias

Question 374

Initial stabilization in STEMI

Answer 374

• O2
• full-dose ASA
• clopidogrel
• nitro +/- morphine for pain
• Beta-blocker
• heparin

Question 375

Indications for primary PCI w/ STEMI:

Answer 375

• w/i 12 hrs of Sx onset AND
• w/i 90 min from first medical contact to device time OR
• w/i 120 min from first medical contact to device time at a non-PCI capable facility

Question 376

Indications for fibrinolysis if PCI is not an option

Answer 376

-w/i 12 hrs of Sx onset

Question 377

Subacromial bursitis cause

Answer 377

result of repeitive overhead motions

Question 378

Subacromial bursitis presentation

Answer 378

pain w/ AROM, passive internal rot and shoulder flexion

Question 379

All pts w/ DMT2 receive …

Answer 379

statin

Question 380

Pt w/ parkinsonism + orthostatic hypotension, impotence, incontinence, or other autonomic dysfunction

Answer 380

Multiple system atrophy

Question 381

Tx of primary syphilis

Answer 381

single dose IM benzathine PCN G

Question 382

Tx of primary syphilis in non-pregnant w/ PCN allergy

Answer 382

14 day doxycycline

Question 383

Tx of primary syphilis in pregnant w/ PCN allergy

Answer 383

desensitization therapy, then PCN G

Question 384

How long should pts with infectious mononucleosis abstain from sports?

Answer 384

> = 3 weeks

Question 385

Which medicines are withheld prior to a stress-test if unknown CAD?

Answer 385

B-blockers, CCB, nitrates

Question 386

Are B-blockers, CCB, and nitrates stopped prior to a stress-test if pt has known CAD?

Answer 386

No, those meds are continued to assess efficacy of anti-anginal therapy

Question 387

How does SLE cause pancytopenia?

Answer 387

Immune-mediated peripheral destruction of all 3 cell lines

Question 388

N-acetylcysteine is used for … (3)

Answer 388

1. Nephropathy from contrast
2. Acetaminophen overdose
3. Cystic fibrosis

Question 389

What does a normal DLCO indicate?

Answer 389

Intact alveolar and capillary structures (non-emphysematous)

Question 390

COPD w/ predominant emphysema, what is DLCO?

Answer 390

decreased

Question 391

COPD w/ predominant bronchitis, what is DLCO?

Answer 391

normal

Question 392

Most common site of hypertensive hemorrhages

Answer 392

Putamen

Question 393

Hypothyroid Sx with inc. T3/T4 and nl TSH

Answer 393

Generalized resistance to thyroid hormone

Question 394

Most common cause of nephrotic syndrome in pts w/ solid malignancy?

Answer 394

Membranous nephropathy

Question 395

Most common cause of nephrotic syndrome in pts w/ Hodgkin lymphoma?

Answer 395

Minimal change disease

Question 396

Well-known causes of non-traumatic avascular (aseptic) necrosis are … (3)

Answer 396

• Chronic corticosteroid use
• Alcoholism
• Hemoglobinopathies

Question 397

Presentation of avascular necrosis of hip

Answer 397

Progressive hip pain w/ nl ROM and nl radiographs in early stage

Question 398

Dx of avascular necrosis of hip

Answer 398

MRI and scintigraphy

Question 399

Which drugs cause drug-induced interstitial nephritis?

Answer 399

Cephs, PCN, sulfonamides, NSAIDs, rifampin, phenytoin, allopurinol

Question 400

Pt present w/ arthralgias, rash, renal failure; UA shows eosinophiliuria

Answer 400

Drug-induced interstitial nephritis

Question 401

Kaposi sarcoma caused by … and cutaneous form looks like …

Answer 401

HHV-8, multiple violaceous papules

Question 402

Tx of cataracts w/ lens extraction and artificial lens implantation indicated when …

Answer 402

loss of vision impairs ADLs

Question 403

Ring-shaped scaly patches w/ central clearing, Dx?

Answer 403

Tinea corporis

Question 404

Tinea corporis is caused by which organism?

Answer 404

Trichophyton rubrum

Question 405

Dx of tinea corporis?

Answer 405

KOH –> shows hyphae

Question 406

Tx of tinea corporis?

Answer 406

Topical antifungals (turbinafine) or systemic (griseofulvin)

Question 407

Pain + bullae formation + skin necrosis weeks after starting oral anticoagulant

Answer 407

Warfarin-induced skin necrosis

Question 408

Warfarin-induced skin necrosis most commonly affects which body parts?

Answer 408

Breast, thigh, abdomen, buttocks

Question 409

Pathologic causes of sinus bradycardia?

Answer 409

• sick sinus syndrome
• MI
• OSA
• hypothyroidism
• inc. ICP
• medications

Question 410

Tx of symptomatic sick sinus syndrome?

Answer 410

IV atropine, then epi, DA or transcutaneous pacing in pts w/ inadequate response to atropine

Question 411

… is a RF for TTP

Answer 411

HIV

Question 412

Persistent A-fib with RVR in WPW pt can progress to …

Answer 412

V-fib

Question 413

Tx of persistent A-fib with RVR in WPW pt

Answer 413

Unstable: cardioversion
Stable: Anti-arrhythmics (IV ibutilide or procainamide)

Question 414

Which medications should you avoid in pts with WPW?

Answer 414

AV blockers (B-blockers, CCB, digoxin, adenosine)

Question 415

Which anticoagulants cannot be used in pts with renal failure?

Answer 415

LMWH (enoxaparin), fondaparinux, or rivaroxaban

Question 416

These studies involve randomization to different interventions w/ additional study of 2 or more variables?

Answer 416

Factorial design studies

Question 417

Hypomagnesemia is very common in …

Answer 417

alcoholics

Question 418

Hypomagnesemia can cause hypocalcemia by …

Answer 418

inducing resistance to PTH and/or dec. PTH secretion

Question 419

Hypocalcemia 2/2 hypomagnesemia is usually refractory to Tx until …

Answer 419

Mg++ is replaced

Question 420

Intense itching, hyperemia, tearing, and edema of the conjunctiva and eyelids bilaterally

Answer 420

Allergic conjunctivitis

Question 421

Pathophys of vitiligo

Answer 421

Autoimmune destruction of melanocytes

Question 422

Defect on stress test when stressed, which med should be started?

Answer 422

Anti-platelet (ASA)

Question 423

Renal failure that does not respond to volume in pt w/ ESLD?

Answer 423

Hepatorenal syndrome

Question 424

Tx of hepatorenal syndrome?

Answer 424

Liver tplant

Question 425

Tumors that most commonly cause tumor lysis syndrome?

Answer 425

Burkitt’s lymphoma, ALL, AML

Question 426

Electrolyte changes in tumor lysis syndrome?

Answer 426

Inc. K+, phos, uric acid

Dec. Ca++

Question 427

This medication dec. risk of acute urate nephropathy from tumor lysis syndrome

Answer 427

Allopurinol

Question 428

New-onset ascites requires … to determine cause

Answer 428

Paracentesis

Question 429

Serotonin is made from …, which is also used for production of … and …

Answer 429

tryptophan; niacin and nicotinic acid

Question 430

Tryptophan and niacin deficiency seen w/ … can lead to …

Answer 430

carcinoid syndrome; pellagra

Question 431

Sx of pellagra

Answer 431

Diarrhea, dermatitis, dementia, glossitis, angular stomatitis

Question 432

Physical exam of pt with lung consolidation

Answer 432

Dullness to percurssion, bronchial breaths (louder with expiration), egophany

Question 433

Uremic toxins can cause platelet dysfunction, which presents as …

Answer 433

nl PT, PTT, and plt count; inc. BT

Question 434

Tx of uremia-induced platelet dysfunction

Answer 434

DDAVP

Question 435

These meds are used to dec. the frequency of exacerbations in pts with relapsing-remitting or secondary progressive MS

Answer 435

Beta-interferon or glatiramer

Question 436

Tx of renal artery stenosis

Answer 436

ACEi or ARB

Question 437

Definition of chronic bronchitis

Answer 437

Chronic production of cough for 3 mos in 2 successive years

Question 438

Hyperparathyroidism can cause …

Answer 438

secondary HTN (in lieu of MEN2, which can also cause secondary HTN and must be r/o in pts with hyperparathyroidism)

Question 439

Dx of babesiosis?

Answer 439

Giemsa stain

Question 440

Tx of babesiosis?

Answer 440

quinine-clindamycin or atovaquone-azithromycin

Question 441

Which Sx suggest babesiosis c.f. ehrlichiosis?

Answer 441

Hemolysis and jaundice

Question 442

Theophylline is … cleared and has a … therapeutic index

Answer 442

hepatically; narrow (can become toxic via dec. hepatic function or DDI)

Question 443

Sx of theophylline toxicity?

Answer 443

CNS (HA, insomnia, seizure)
GI (N/V)
CV (arrhythmia)

Question 444

Most common cause of macrocytic anemia in pt with SCD?

Answer 444

Folate deficiency

Question 445

Basic w/u for essential HTN?

Answer 445

UA, chem panel, lipid profile, baseline EKG

Question 446

mono-like illness with large, basophilic lymphocytes w/ vacuolated appearance; us. presents without pharyngitis or LAD

Answer 446

CMV

Question 447

Bright red, firm, friable exophytic nodules in HIV pt

Answer 447

Bacillary angiomatosis

Question 448

Tx of bartonella?

Answer 448

PO erythromycin

Question 449

S4 heart sound indicates …

Answer 449

stiff left ventricle (restrictive CM, LVH from HTN, diastolic HF)

Question 450

HIV pt w/ severe odynophagia w/o dysphagia or thrust

Answer 450

Viral esophagitis

Question 451

… has opening snap after S2 at apex

Answer 451

Mitral stenosis

Question 452

… is described as low-pitched diastolic rumble heart best at apex

Answer 452

Mitral stenosis

Question 453

Elevated left main bronchus

Answer 453

Left atrial enlargement

Question 454

Insensate hypopigmented skin patches

Answer 454

Leprosy

Question 455

Dx of M. leprae

Answer 455

skin Bx w/ acid-fast bacilli

Question 456

These Sx of cirrhosis are caused by hyperestrogenism

Answer 456

Gynecomastia, palmar erythema, spider angiomas, testicular atrophy, dec. body hair

Question 457

Situation syncope is a thing; can be related to … or …

Answer 457

micturition (commonly seen in pt with BPH); man who loses consciousness during coughing fits

Question 458

Tx of cervical actinomycosis

Answer 458

high-dose PCN for prolonged period (12 weeks)

Question 459

Change in behavior b/c of awareness that one is being studied

Answer 459

Hawthorn effect

Question 460

Postoperative endophthalmitis occurs w/i … weeks of surgery

Answer 460

6

Question 461

Tx of postoperative endophthalmitis?

Answer 461

Intravitreal Abx injection or vitrectomy

Question 462

Most common form of endophthalmitis?

Answer 462

Postoperative endophthalmitis

Question 463

Dx of abdominal angina (chronic mesenteric ischemia)

Answer 463

Angiography or Doppler U/S

Question 464

Triad of polyarthralgia, tenosynovitis, painless vesiculopapular skin lesions

Answer 464

Disseminated gonococcal infection

Question 465

Euthyroid sick syndrome (= “low T3 syndrome”)

Answer 465

Occurs in any pt w/ acute severe illness

Question 466

Large amount of blood on UA w/o RBC on urine microscopy suggests …

Answer 466

myoglobinuria (from rhabdomyolysis)

Question 467

Test of choice for PE

Answer 467

CT angiography

Question 468

Test of choice for PE in pt w/ CxIx to contrast (allergy or RF)

Answer 468

V/Q scan

Question 469

Mismatch perfusion defect on V/Q scan is present in only … of cases

Answer 469

50%

Question 470

1st line medication for chemotherapy-induced nausea or vomiting?

Answer 470

Serotonin (5HT3) antagonist (ondansetron)

Question 471

Pt had stab wound to thigh, now has heart failure, Dx?

Answer 471

Symptomatic AVF of popliteal or iliac a.

Question 472

Pathophys of symptomatic AVF

Answer 472

Lots of blood shunted from arterial to venous circulation –> inc. preload –> high output heart failure over long period of time

Question 473

Dx of symptomatic AVF

Answer 473

Doppler U/S

Question 474

Tx of symptomatic AVF

Answer 474

Surgery

Question 475

Most common cause of sudden cardiac arrest in post-MI period

Answer 475

Reentrant ventricular arrhythmias (esp. V-fib)

Question 476

Most common cause of mitral regurg in developed countries

Answer 476

Mitral valve prolapse

Question 477

Pathophys of mitral valve prolapse

Answer 477

Myxomatous degeneration of MV leaflets and chordae

Question 478

Murmur a/w mitral valve prolapse

Answer 478

Mid-systolic click w/ mid-to-late systolic murmur that progresses to holosystolic murmur w/o click

Question 479

Displaced apical pulse, holosystolic murmur, third heart sound (2/2 LV overload)

Answer 479

Mitral regurg

Question 480

Criteria for PPx for Lyme (need all 5)

Answer 480

1. Attached tick is Ixodes
2. Attached >= 36 hours or engorged
3. PPx started w/I 72 hours of tick removal
4. Local Borrelia burgdorferi infection rate >20% (New England area)
5. No CxIx to doxycycline (pregnant,

Question 481

Development of clubbing and sudden-onset joint arthropathy (commonly of wrists and hands) in chronic smoker; what is the Dx and next management step?

Answer 481

Hypertrophic osteoarthropathy

CXR (a/w lung Cx, TB, bronchiectasis, or emphysema)

Question 482

Acute monoarthritis and fever w/ underlying RA suggests …

Answer 482

septic arthritis

Question 483

Progressive dyspnea over months, digital clubbing, bibasilar-end-inspiratory crackles, Dx?

Answer 483

Asbestosis

Question 484

CXR findings of asbestosis

Answer 484

Interstitial abnormalities at lung base, pleural plaques

Question 485

PFTs in asbestosis

Answer 485

Restrictive pattern (nl FEV1/FVC, dec. DLCO)

Question 486

75-90% of kidney stones are …

Answer 486

Calcium oxalate

Question 487

Calcium oxalate crystals appear … and stones are radio…

Answer 487

envelope-shaped, opaque

Question 488

Risk factors for calcium oxalate stones

Answer 488

Small bowel disease, surgical resection, chronic diarrhea

Question 489

Sharp wave complexes on EEG, inc. 14-3-3 proteins in CSF

Answer 489

Creutzfeldt-Jakob disease

Question 490

Progressive destruction of intrahepatic bile ducts (a type of ductopenia)

Answer 490

Vanishing bile duct syndrome

Question 491

Causes of ductopenia

Answer 491

• PBC
• failing liver tplant
• Hodgkin’s lymphoma
• GVHD
• sarcoid
• CMV infection
• HIV
• medications

Question 492

Pathophys of Baker cyst

Answer 492

Develop from extra fluid production from inflamed synovium, as seen w/ RA, OA, and cartilage tears

Question 493

Fever w/ no obvious focus in neutropenic pt

Answer 493

Febrile neutropenia

Question 494

Definition of neutropenia and severe neutropenia

Answer 494

ANC

Question 495

Tx of febrile neutropenia

Answer 495

Initial blood and urine Cx, then immediate IV broad-spec Abx, including anti-pseudomonal coverage (cefepime, meropenem, piperacillin-tazobactam)

Question 496

Caustic ingestion does not affect …

Answer 496

cognition

Question 497

Presentation of caustic ingestion

Answer 497

Dysphagia, white tongue, heavy salivation, mouth burns, complicated by stomach perforation causing peritonitis or mediastinitis

Question 498

Chronic epigastric pain that suddenly worsens and becomes diffuse w/ pneumoperitoneum is likely …

Answer 498

perforated PUD

Question 499

+ Prussian blue stain in urine indicates …

Answer 499

hemosiderin, which means hemolysis is occurring.

Question 500

NPH pathophys

Answer 500

dec. CSF absorption that causes permanent ventricular enlargement w/o inc. ICP

Question 501

What monitoring should be performed in pt with compensated cirrhosis?

Answer 501

Esophageal endoscopy to evaluate for varices

U/S surveillance for HCC +/- AFP every 6 months

Question 502

Tx for primary prevention of variceal hemorrhage

Answer 502

Non-selective Beta-blocker

Question 503

pts w/ HTN have …-fold increase in stroke c.f. pts w/o HTN

Answer 503

four

Question 504

Nec fasc has crepitis in … of cases

Answer 504

50%

Question 505

Most frequently recovered pathogen from nec fasc?

Answer 505

GAS

Question 506

Endemic areas of chikungunya fever?

Answer 506

Central/S America, tropical Africa, S Asia, Caribbean

Question 507

Vector of chikungunya virus?

Answer 507

Aedes mosquito (same as Dengue fever)

Question 508

Sx of chikungunya fever

Answer 508

Flu + polyarthralgias, lymphopenia, TCP, rash, cervical LAD

Question 509

Tx of severe non-allergic rhinitis

Answer 509

Intranasal antihistamine + glucocorticoid

Question 510

Criteria for home O2 in COPD pt

Answer 510

PaO2

Question 511

Sx of digoxin toxicity

Answer 511

Diarrhea, nausea, fatigue, visual sx (scotoma, blindness)

Question 512

RF for digoxin toxicity

Answer 512

Hypokalemia, diuretic use, viral illness

Question 513

Clearance of digoxin

Answer 513

Renal; narrow TI

Question 514

Graves eye disease may … upon starting radioiodine therapy

Answer 514

worsen

Question 515

Side effects of CCB

Answer 515

edema, HA, flusing, dizziness

Question 516

How to prevent CCB-induced edema

Answer 516

adding ACEi/ARB

Question 517

… is present in all cases of rotator cuff tendonitis

Answer 517

Impingement

Question 518

Pain + guarding during Neer test (passive ROM arm above head)

Answer 518

Rotator cuff tendonitis

Question 519

Pain relief w/ lidocaine injection

Answer 519

tendonitis (c.f. rotator cuff tear)

Question 520

Proteinuria, dysmorphic RBCs, or RBC casts indicate …

Answer 520

glomerular hematuria

Question 521

IgA nephropathy occurs w/i … days of URI

Answer 521

5

Question 522

Sx of central retinal vein occlusion

Answer 522

painless loss of vision, acute, unilateral; ‘blood and thunder,’ optic disc swelling, retinal hemorrhages, dilated veins, cotton wool spots

Question 523

Gastric ulcers + hypercalcemia/ kidney stones in pt with family history of same

Answer 523

MEN1

Question 524

Allergic contact dermatitis is what type of hypersensitivity?

Answer 524

Type IV HSN

Question 525

PEs cause which type of effusion?

Answer 525

Trick question; they cause both transudative and exudative

Question 526

Which anti-epileptic drugs can cause megaloblastic anemia (2/2 impaired folate absorption from small intestine)?

Answer 526

phenytoin, primidone, phenobarbital

Question 527

What is the rescue Tx for methotrexate-induced folate deficiency?

Answer 527

Leucovorin

Question 528

HA + FND + solitary, ring-enhancing lesion on CT + fluid collection in ethmoid sinus suggests …

Answer 528

brain abscess 2/2 anaerobes (Strep viridans)

Question 529

Tx of confirmed brain abscess

Answer 529

4-8 weeks of Abx + aspiration/ drainage of abscess whenever possible

Question 530

Source of 90% of PEs

Answer 530

Proximal vein thrombosis (above knee) c.f. calf DVTs

Question 531

‘Female athlete triad’

Answer 531

Amenorrhea, dec. caloric intake, osteoporosis; inc. risk for stress fracture

Question 532

Sharp, localized pain over bony surface

Answer 532

Stress fracture of foot

Question 533

Acute tplant rejection Tx

Answer 533

anti-rejection, including high-dose IV steroids

Question 534

Acute onset polyarticular/ symmetric arthritis resolving w/i 2 months

Answer 534

Viral arthritis

Question 535

Best measure to slow end-organ damage in pt w/ DMT2

Answer 535

ACEi (nephropathy)

Question 536

‘Aversion to smoking’ is a/w which disease?

Answer 536

Hep A

Question 537

People in close contact to Hep A pt should get …

Answer 537

immune globulins

Question 538

Which pts should be given Hep A PPx?

Answer 538

Endemic travel, chronic liver disease, MSM

Question 539

In pts w/ really low testosterone, … and … should be elevated, not normal

Answer 539

FSH, LH

Question 540

Next management step when suspecting central (secondary) hypogonadism?

Answer 540

serum prolactin (inc. prolactin causes dec. GNRH release)

Question 541

This drug requires regular testing of lungs and thyroid.

Answer 541

Amiodarone

Question 542

Amiodarone causes what pulm toxicity?

Answer 542

Most commonly chronic interstitial pneumonitis, but can cause ARDS

Question 543

Colonoscopy guidelines for pt with IBD

Answer 543

Start 8 years s/p Dx, q 1-2 yrs

Question 544

Colonoscopy guidelines for pt with FAP

Answer 544

Start 10-12 years old, q year

Question 545

Colonoscopy guidelines for pt with Lynch syndrome

Answer 545

Start 20-25, q 1-2 yrs

Question 546

Side effects of recombinant EPO

Answer 546

Worsening HTN, HA, flu-like Sx, red cell aplasia (rare)

Question 547

Recombinant EPO can be given in which type of pt?

Answer 547

ESRD with Hgb

Question 548

First step in vent management

Answer 548

Dec FiO2 to non-toxic levels, less than 60%

Question 549

Pt w/ non-bleeding varices: what is first line PPx, what is physiology behind it, and what is second line?

Answer 549

Nonselective Beta-blocker; causes unopposed alpha-mediated vasoconstriction and dec. portal venous flow; endoscopic ligation in people with CxIx to Beta-blockers

Question 550

Pathophys of Goodpasture’s syndrome

Answer 550

Antibody to alpha3 chain of type IV collagen

Question 551

How to Dx Goodpasture’s syndrome

Answer 551

Renal Bx showing linear IgG deposition along GBM on IF

Question 552

Most common medications causing diabetes insipidus

Answer 552

Lithium, democlocycline, foscarnet, cidofovir, amphotericin

Question 553

Tx of lithium-induced DI

Answer 553

d/c lithium, salt restriction

Question 554

Hidradenitis supprativa (AKA acne inversa) presentation

Answer 554

Painful tender masses w/ inflammation, scarring, and sinus tract formation; most commonly in axilla, groin, inner thighs, perineum

Question 555

+ urine bilirubin =

Answer 555

conjugated bilirubinemia

Question 556

+ urine urobilinogen =

Answer 556

unconjugated bilirubinemia

Question 557

Pts w/ MM are at inc. risk of …

Answer 557

infections, 2/2 dec. in functional antibodies

Question 558

Paraprotein gap

Answer 558

Total protein - albumin; indicates extra proteins in blood (normal = 3-4)

Question 559

Extracolonic manifestations of UC

Answer 559

• Erythema nodosum
• Pyoderma gangrenosum
• Episcleritis
• Arthritis
• Cholangitis

Question 560

Hyperthermia can cause …

Answer 560

rhabdomyolysis, acute renal failure, DIC

Question 561

Preferred Tx of exertional heat stroke:

Answer 561

Ice water immersion

Question 562

Carpal tunnel syndrome occurs in 30% of pts with …

Answer 562

hypothyroidism

Question 563

Pathophys of carpal tunnel syndrome in pts with hypothyroidism

Answer 563

Deposition of mucopolysaccharide protein complexes in perineurium/ endoneurium of median n., tendons, synovial sheath, which causes pressure on median n.

Question 564

Most common causes of constrictive pericarditis in 1) developing countries, and 2) United States

Answer 564

1) tuberculosis

2) idiopathic, viral, radiation, cards surg, CTD

Question 565

Indications for cystoscopy:

Answer 565

• Unexplained gross or microscopic hematuria
• Recurrent UTIs
• Obstructive Sx

Question 566

In pt w/ BPH and unexplained hematuria w/ cancer risk, need …

Answer 566

cystoscopy.

Question 567

For pts w/ suspected postnasal drip, first line Tx =

Answer 567

oral first-generation anti-histamine or combined antihistamine-decongestant

Question 568

Hypotension, JVD, new RBBB in postoperative pt, suspect …

Answer 568

Massive PE

Question 569

Initial Tx of hepatic hydrothorax =

Answer 569

salt restriction and diuretic

Question 570

Tx of refractory hepatic hydrothorax =

Answer 570

TIPS

Question 571

Best markers for following DKA management

Answer 571

Anion gap and direct assay of Beta-hydroxybutyrate

Question 572

Stepwise Tx of ascites =

Answer 572

1. Na+/ H2O restriction
2. Spironolactone
3. Loops diuretic (

Question 573

Skin condition a/w Mycoplasma pneumoniae

Answer 573

Erythema multiforme

Question 574

Tx of exercise-induced bronchoconstriction if 1) exercise daily, or 2) exercise

Answer 574

1) ICS or antileukotriene agent

2) SABA 10-20 min before workout

Question 575

Tachycardia-induced cardiomyopathy is a thing; what is the Tx?

Answer 575

Aggressive rate control, restoration of normal sinus rhythm

Question 576

Pathophys of empyema

Answer 576

Bacterial seeding of parapneumonic effusion after untreated pneumonia

Question 577

Complications of PEEP

Answer 577

Alveolar damage, tension pneumothorax, hypotension

Question 578

Replenishing folate before B12 fixes …, but leads to a rapid progression of …

Answer 578

megaloblastosis; neurologic Sx

Question 579

Lab abnormalities in pt with hypothyroidism

Answer 579

Inc. lipids (inc. LDL and TG)
Dec. Na+
Inc. CK
Inc. LFTs

Question 580

Statins inc. risk for … in pt w/ poorly controlled hypothyroidism

Answer 580

myopathy

Question 581

… and … mutations are more severe than missense or silent mutations

Answer 581

Nonsense, frameshift

Question 582

Chronic neck pain, limited neck ROM, sensory deficit 2/2 osteophyte-induced radiculopathy; Dx?

Answer 582

Cervical spondylosis

Question 583

Most common findings on cervical Xray for pt with cervical spondylosis

Answer 583

Osteophytes/ bone spurs

Question 584

Gouty arthritis cannot be distinguished from … or … based on H&P; therefore, need …

Answer 584

pseudogout, septic arthritis; synovial fluid analysis

Question 585

Vast majority of head and neck cancers are …

Answer 585

squamous cell carcinoma

Question 586

Tinea versicolor is most commonly caused by which pathogen?

Answer 586

Malassezia globosa

Question 587

Presentation of tinea versicolor?

Answer 587

Salmon colored, hyper- or hypopigmented macules sometimes covered by fine scales that do not tan

Question 588

Dx of tinea versicolor?

Answer 588

KOH of scrapings show large, blunt hyphae w/ thick-walled budding spores (spaghetti and meatballs)

Question 589

Tx of tinea versicolor?

Answer 589

Selenium sulfide or ketoconazole

Question 590

Tx of herpes zoster

Answer 590

Valacyclovir > acyclovir

Question 591

PPx/Tx of postherpetic neuralgia

Answer 591

TCAs w/ acute antiviral Tx

Question 592

MOA of Factor V Leiden

Answer 592

Factor V becomes resistant to inactivation from protein C

Question 593

Pathophys of S3 heart sound

Answer 593

Tensing of papillary chordal apparatus w/ rapid influx of blood into ventricle during early diastole

Question 594

S3 heart sound is a/w …

Answer 594

CHF and inc. ventricular filling pressures

Question 595

Potentially life-threatening complication of IBD

Answer 595

Toxic megacolon

Question 596

Dx of toxic megacolon

Answer 596

Radiographic evidence of distension;

+ 3 of the following: fever > 38C, HR > 120bpm, neutrophilic leukocytosis > 10,500, anemia;

+1 of the following: volume depletion, AMS, electrolyte disturbance, or hypotension

Question 597

Conservative management of toxic megacolon

Answer 597

Bowel rest, NG tube placement, steroids or Abx

Question 598

Severe cases of toxic megacolon that do not respond to conservative Tx require …

Answer 598

emergent surgery w/ subtotal colectomy and end-ileostomy

Question 599

Raising cutoff points of screening tests … sensitivity and … specificity

Answer 599

dec.; inc.

Question 600

Avoid … in pts with acute glaucoma

Answer 600

mydriatic agents (atropine)

Question 601

Tx of acute glaucoma

Answer 601

Mannitol, acetazolamide, pilocarpine, timolol

Question 602

Culture-negative urethritis =

Answer 602

chlamydial urethritis

Question 603

Most common cause of urethritis in men

Answer 603

Chlamydia

Question 604

Dx of chlamydial urethritis

Answer 604

NAAT on first-catch urine w/o pre-cleaning

Question 605

Tx of chlamydia

Answer 605

Doxycycline or azithromycin

Question 606

Subjunctival hemorrhage is completely …

Answer 606

benign

Question 607

Ethical guidelines on accepting gifts from pharmaceutical companies:

Answer 607

non-monetary, small monetary value, benefit pt care

Question 608

Vertical nystagmus + violent behavior, severe HTN, hyperthermia

Answer 608

Phencyclidine intoxication

Question 609

Intense postoperative wound pain, dec. sensitivity at wound edges, cloud gray discharge, +/- crepitis =

Answer 609

Necrotizing surgical infection

Question 610

Tx of necrotizing surgical infection

Answer 610

Early surgical exploration is essential

Question 611

Risk factors for AAA expansion

Answer 611

Large diameter, rate of expansion, current cigarette smoking

Question 612

Indications for operative or endovascular repair of AAA

Answer 612

> 5.5cm

Question 613

Glucocorticoid deficiency + hypothyroidism + hypogonadism

Answer 613

Panhypopituitarism

Question 614

Postictal lactic acidosis causes an anion gap metabolic acidosis that typically resolves … min following resolution of seizure activity

Answer 614

60-90

Question 615

Need … on all pts w/ syncope related to …

Answer 615

echocardiogram; suspected structural heart disease

Question 616

Hypomotility (dec. peristalsis) and incompetence of LES =

Answer 616

Systemic sclerosis

Question 617

Pathophys of systemic sclerosis

Answer 617

Sm M atrophy and fibrosis of Sm M in lower esophagus

Question 618

Which HPV serotypes are a/w SCC of anus, genitals, and throat?

Answer 618

16 and 18

Question 619

Arrange these transplants in order from preferred to least preferred: living, non-related donor; cadaver; living, related donor

Answer 619

Living, related donor > living, non-related donor > cadaver

Question 620

CxIx of radioactive iodine Tx

Answer 620

Pregnancy, very severe ophthalmopathy

Question 621

Recurrent bacterial infection suggests …

Answer 621

humoral immunity defect

Question 622

Dx of humoral immunity defect

Answer 622

Quantitative measurement of serum Ig levels

Question 623

Fever, tender LAD, blanching erythematous maculopapular rash that erupts on face and spreads to trunk/extremities sparing palms/soles

Answer 623

Rubella (German measles)

Question 624

These vaccinations are generally CxIx in HIV pts

Answer 624

Live attenuated vaccinations

Question 625

Location and pathophys of Zenker diverticulum

Answer 625

Develops immediately above UES 2/2 posterior herniation b/w fibers of cricopharyngeal muscle from sphincter dysfunction and dysmotility

Question 626

Sx of Zenker diverticulum

Answer 626

Dysphagia, regurgitation, aspiration, halitosis

Question 627

Dx of Zenker diverticulum

Answer 627

Barium esophagram

Question 628

Most common extra-articular manifestation of ankylosing spondylitis

Answer 628

Anterior uveitis

Question 629

… can cause inhibition of body’s shivering mechanism and/or autonomic regulation of temperature, causing hypothermia

Answer 629

Fluphenazine (and other typical anti-psychotics)

Question 630

Fatigue, dyspnea following URI Tx w/ amoxicillin w/ splenomegaly, anemia w/ retics; Dx?

Answer 630

AIHA

Question 631

Fever + leukocytosis + LUQ pain

Answer 631

Splenic abscess

Question 632

Most common pathogens causing splenic abscess

Answer 632

Staph, Strep, Salmonella

Question 633

Tx of splenic abscess

Answer 633

Splenectomy + Abx; percutaneous drainage if poor surgical candidate

Question 634

… is thought to be the cause of 10-20% of splenic abscesses

Answer 634

Infective endocarditis

Question 635

Lab finding highly correlated to lupus anticoagulant?

Answer 635

Inc. PTT

Question 636

Dx of lupus anticoagulant

Answer 636

Diluted Russell viper venom test, kaolin clotting time

Question 637

Tx of hypovolemia in non-ketotic hyperglycemic coma

Answer 637

NS transitioned to 1/2NS

Question 638

Recommended Abx for COPD exacerbations

Answer 638

Macrolides, FQs, penicillins + Beta-lactamase inhibitors for 3-7 days

Question 639

RA commonly affects the … spine, causing … and …

Answer 639

cervical; spinal subluxation, spinal cord compression

Question 640

TCA started for DMT2 polyneuropathy, and pt gets worsening urinary Sx or orthostatic hypotension; next step in management?

Answer 640

Gabapentin

Question 641

Pt with GI bleed commonly have inc … or …, 2/2 … or …

Answer 641

BUN; BUN:Cr

inc. urea production from intestinal breakdown of hemoglobin; inc. urea reabsorption from hypovolemia

Question 642

Carpal tunnel syndrome can also be a sign of …

Answer 642

acromegaly

Question 643

Positive straight leg raise suggests …

Answer 643

disk herniation

Question 644

Conservative approach for acute mechanical back pain w/o neurologic deficits

Answer 644

Early mobilization, NSAIDs, muscle relaxants

Question 645

Over 90% of pts with duodenal ulcers have …

Answer 645

H. pylori infection

Question 646

Tx of H. pylori

Answer 646

Amoxicillin + clarithromycin + PPI

Question 647

3D’s of pellagra?

Answer 647

Dermatitis, Diarrhea, Dementia

Question 648

Cause of pellagra

Answer 648

Niacin (Vitamin B3) deficiency

Question 649

Congenital disorder of tryptophan absorption

Answer 649

Hartnup disease

Question 650

Inflammation and pain at sites where tendons and ligaments attach to bone

Answer 650

Enthesitis

Question 651

Enthesitis is a/w

Answer 651

HLA-B27 arthropathies, esp. AS

Question 652

1 SD = …%, 2 SD = …%, 3 SD = …%

Answer 652

68, 95, 99.7

Question 653

Reasons to d/c metformin

Answer 653

Acute renal failure, liver failure, or sepsis

Question 654

Pain in anteromedial part of tibial plateau just below the joint line of knee

Answer 654

Anserine bursitis

Question 655

Steppage gait is most commonly 2/2 …

Answer 655

L5 radiculopathy or common peroneal neuropathy

Question 656

How to differentiate L5 radiculopathy vs. common peroneal neuropathy?

Answer 656

L5 radiculopathy –> back pain radiating to foot, weakness of foot inversion and plantar flexion

Common peroneal neuropathy –> sensory loss of dorsum of foot, normal inversion and plantar flexion

Question 657

Untreated hyperthyroidism can cause …, which presents w/ …

Answer 657

acute thyrotoxic myopathy; proximal muscle weakness w/ or w/o atrophy

Question 658

Best screening tests for virilizing neoplasm, and how to interpret tests

Answer 658

Serum testosterone and DHEAS levels
Inc. test, nl DHEAS = ovarian source
Inc. DHEAS, nl test = adrenals

Question 659

… is secreted from adrenals and ovaries, while … is secreted from adrenals only

Answer 659

DHEA, DHEAS

Question 660

Tx for pts w/ DMT2 + acute pyelonephritis

Answer 660

IV Abx for 48-72 hours transitioned to orals for total of 10-14 days

Question 661

Nodular glomerulosclerosis w/ Kimmelsteil-Wilson nodules, Dx?

Answer 661

Diabetic nephropathy

Question 662

Tx of severe symptomatic hypercalcemia

Answer 662

NS hydration + calcitonin; bisphosphonates for long-term Tx

Question 663

White granular plaque over buccal mucosa in pt w/ h/o EtOH or tobacco use, Dx?

Answer 663

Oral leukoplakia

Question 664

What is oral leukoplakia?

Answer 664

Precancerous hyperplasia of the squamous epithelium; 1-20% progress to SCC in 10 years

Question 665

Management of oral leukoplakia

Answer 665

Most resolve w/ tobacco cessation; if areas of induration/ ulceration are present, prompt Bx to r/o malignancy

Question 666

… is indicated for + genetic testing of MEN type 2

Answer 666

Total thyroidectomy

Question 667

Prior to performing procedures on recently deceased patients, what must be done?

Answer 667

Permission must be obtained from family

Question 668

Severe CO poisoning Sx

Answer 668

Seizures, coma, syncope, heart failure, arrhythmias

Question 669

… (3) can reduce incidence of contrast-induced nephropathy.

Answer 669

Adequate hydration, N-acetylcysteine, non-ionic contrast agent

Question 670

… is an indicator of CHF severity, and it is caused by …

Answer 670

Hyponatremia; inc. renin, norepi, and ADH release

Question 671

Heavy EtOH use can cause … and could be reason for poor response to medications

Answer 671

HTN

Question 672

Features that suggest esophageal c.f. cardiac chest pain

Answer 672

> 1 hr, postprandial Sx, heatburn or dysphagia, relief w/ PPI

Question 673

Granulomatosis with polyangiitis nasophargyneal and cutaneous manifestations

Answer 673

Nasopharygneal: epistaxis, purulent rhinorrhea, otitis, sinusitis, saddle-nose deformity
Cutaneous: painful subcutaneous nodules, palpable purpura, pyoderma gangrenosum-like lesions (non-healing ulcers)

Question 674

What is sympathetic ophthalmia?

Answer 674

Damage to one eye after penetrating injury to the other

Question 675

Pathophys behind sympathetic ophthalmia

Answer 675

Immunologic response to uncovering of ‘hidden’ antigens

Question 676

Bath salts, AKA …, are … analogs

Answer 676

synthetic cathinones; amphetamine

Question 677

Sx of bath salt intoxication

Answer 677

Inc. BP, inc. HR, agitation, combativeness, psychosis, delirium, myoclonus, seizures

Question 678

How to distinguish b/w bath salts and other intoxicants?

Answer 678

Bath salts have a prolonged duration of effect (many days to weeks), while others do not

Question 679

Do routine tox screens test for bath salts?

Answer 679

No.

Question 680

Changes in metabolism and electrolytes a/w thiazide diuretics

Answer 680

Inc. uric acid, Ca++, LDL, TG, blood glucose

Dec. Na+, K+

Question 681

Inc. leukocyte alkaline phosphatase =

Answer 681

Leukemoid reaction (infection)

Question 682

Dec. leukocyte alkaline phosphatase =

Answer 682

Chronic myeloid leukemia

Question 683

Pt w/ suspected gallstone pancreatitis w/ non-diagnostic U/S; next step?

Answer 683

ERCP

Question 684

HIV pt w/ AMS, EBV DNA in CSF and a solitary, weakly ring-enhancing paraventricular mass on MRI; Dx?

Answer 684

Primary CNS lymphoma

Question 685

HIV pts have a high risk of …

Answer 685

reactivation tuberculosis

Question 686

How to differentiate aspiration pneumonia vs. TB pt

Answer 686

Aspiration pneumonia pts are much sicker

Question 687

In pt w/ symptomatic hyperthyroidism, … is the treatment of choice for symptomatic relief until underlying cause is identified and definitively treated

Answer 687

Propranolol

Question 688

Periorbital swelling, hematuria, oliguria 10-20 days s/p skin or throat infection

Answer 688

Post-streptococcal glomerulonephritis (has dec. serum C3 levels)

Question 689

Hypersensitivity pneumonitis to aerosolized bird droppings

Answer 689

Bird Fancier’s lung

Question 690

What can develop with repeated exposure to hypersensitivity pneumonitis

Answer 690

Fibrosis, causing restrictive lung disease pattern on spirometry

Question 691

Radiographic findings of hypersensitivity pneumonitis

Answer 691

Ground-glass opacity or ‘haziness’ of lower lung fields

Question 692

Tx of hypersensitivity pneumonitis

Answer 692

Avoidance of antigen exposure

Question 693

Tx of thyroid storm

Answer 693

Propranolol, PTU, iodine (given >= 1hr s/p PTU), steroids

Question 694

Pts w/ somatic Sx d/o benefit from …

Answer 694

regularly scheduled visits with physician to reduce underlying psychological stress

Question 695

Pathophys of paroxysmal nocturnal hemoglobinuria

Answer 695

Lack GPI that anchors CD55/59, resulting in complement fixation, MAC, and hemolysis

Question 696

Sx of PNH

Answer 696

Hemolysis –> hemoglobinuria
Cytopenias –> fatigue, dyspnea from anemia
Hypercoagulable –> portal vein thrombosis

Question 697

Dx of PNH

Answer 697

Flow cytometry demonstrating absence of CD55/59

Question 698

Sx of cerebellar dysfunction

Answer 698

Gait instability, truncal ataxia, poor rapid-alternating movements, hypotonia, intention tremor

Question 699

Abdominal succussion splash maneuver

Answer 699

Stethoscope placed on upper abdomen, and patient is rocked back and forth at hips

Question 700

What does positive abdominal succussion splash indicate?

Answer 700

Possible gastric outlet obstruction (GOO)

Question 701

Risk factors for esophageal adenocarcinoma

Answer 701

Barrett’s esophagus, obesity, inc. caloric or fat intake, GERD, smoking

Question 702

Risk factors for esophageal SCC

Answer 702

Smoking, EtOH, dec. Beta-carotene, Vit B1, zinc, selenium, viral infections, toxin-producing fungi, hot food/beverages, pickled veggies, foods rich in N-nitroso compounds

Question 703

Fever + polyarthraglia + pustular rash in pt w/ high-risk sexual behaviors

Answer 703

Disseminated gonococcal infection

Question 704

For normal upright individuals, where is greatest ventilation and perfusion?

Answer 704

Lung bases&raquo_space; apices

Question 705

Causes of ascending aortic aneurysm

Answer 705

Cystic medial necrosis, CTD

Question 706

Causes of descending aortic aneurysm

Answer 706

Atherosclerosis, HTN, hypercholesterolemia, smoking

Question 707

Dx of aortic aneurysm

Answer 707

CT w/ contrast to differentiate from tortuous aorta

Question 708

First-line Tx of idiopathic intracranial hypertension

Answer 708

Acetazolamide +/- furosemide

Question 709

How does acetazolamide help Tx IIH

Answer 709

Inhibits choroid plexus carbonic anhydrase, dec. production of CSF

Question 710

For refractory IIH, what is the next step

Answer 710

Surgery w/ optic nerve sheath decompression or lumbroperitoneal shunting

Question 711

When are LP and steroids used in IIH?

Answer 711

For short-term bridges to surgery; not for long-term use

Question 712

Cross-sectional study is AKA …, and measures …

Answer 712

prevalence study; exposure and outcome simultaneously

Question 713

Inflammatory symmetric arthritis that resolves w/i 2 months =

Answer 713

viral arthritis

Question 714

Common causes of viral arthritis

Answer 714

Parvovirus, hepatitis, HIV, mumps, rubella

Question 715

Dx of adhesive capsulitis

Answer 715

> 50% reduction in passive and active ROM

Question 716

Flank pain + hematuria + palpable abdominal mass =

Answer 716

RCC (only present in 10% of cases however)

Question 717

RCC can also present with …

Answer 717

scrotal varicoceles that do not drain with recumbency

Question 718

Megacolon/ megaesophagus + cardiac disease

Answer 718

Chaga’s disease

Question 719

Initial hematuria indicates damage to what structure?

Answer 719

Urethra

Question 720

Terminal hematuria indicates damage to which structures?

Answer 720

Bladder or prostate

Question 721

Total hematuria indicates damage to which structures?

Answer 721

Kidney or ureter

Question 722

Afebrile w/ irritative urinary Sx; expressed prostatic secretions show nl leukocyte count and culture-negative

Answer 722

Non-inflammatory chronic prostatitis

Question 723

TMP can cause …

Answer 723

hyperkalemia, 2/2 blockade of epithelial Na+ channels in collecting tubule

Question 724

TMP can also cause artificial inc. in Cr w/o dec. GFR 2/2 …

Answer 724

competitively inhibiting renal Cr secretion

Question 725

… prevents decubitus ulcers

Answer 725

Patient repositioning q2hrs

Question 726

… % of Hep B pts recover, a minority get chronic Hep B, and 0.1-0.5% develop …

Answer 726

90; fulminant hepatic failure

Question 727

Definition of fulminant hepatic failure

Answer 727

Hepatic encephalopathy that develops w/i 8 weeks onset of acute liver failure

Question 728

Tx of fulminant hepatic failure

Answer 728

Orthotopic liver transplant

Question 729

Contraindications to liver transplant

Answer 729

Irreversible cardiopulmonary disease causing prohibitive risk; incurable or recent (

Question 730

Tx of pt w/ active variceal bleed

Answer 730

IVF, Abx (ceftriaxone), somatostatin analogues (splanchnic vasoconstriction), endoscopy

Question 731

Pts w/ uncontrollable variceal bleeding get …

Answer 731

balloon therapy for short-term, TIPS or shunt for long-term

Question 732

Pts w/ new onset asthma should also be questioned about Sx of…

Answer 732

GERD

Question 733

Sx of GERD-induced asthma

Answer 733

Worsens in adulthood, worse after meals, worse with recumbency (nocturnal)

Question 734

Type 1 HIT

Answer 734

Non-immune effect of heparin on plts; presents at 2 days

Question 735

Type 2 HIT

Answer 735

Immune-mediated disorder 2/2 Ab to plt factor 4, which leads to plt aggregation, TCP, and thrombosis; plt dec. by >50%, nadir at 30-60,000; presents at 5-10 days

Question 736

Tx of malignant otitis externa

Answer 736

Systemic ciprofloxacin

Question 737

Sudden painless vision loss w/ subtle retinal whitening and cherry spots

Answer 737

Central retinal artery occlusion

Question 738

CRAO commonly a/w … before occlusion

Answer 738

amaurosis fugax

Question 739

Immediate Tx of CRAO

Answer 739

Ocular massage +/- anterior chamber paracentesis to dec. pressure; hyperbaric O2 if given early

Question 740

Anti-mitochondrial Ab =

Answer 740

Primary biliary cirrhosis

Question 741

Anti-Sm M Ab =

Answer 741

Auto-immune hepatitis

Question 742

Indications for carotid endarterectomy

Answer 742

Sx of carotid stenosis and 70-99% stenosis

ASx men at 60-99% stenosis

Question 743

All pts w/ cerebrovascular attack should start … and optimize RF

Answer 743

anti-plt Tx

Question 744

This fungal infection occurs in midwest and upper midwest, disseminated disease can occur in immunocompetent pts

Answer 744

Blastomycosis

Question 745

This fungal infection occurs in the Mississippi and Ohio River valleys, less likely to occur in immunocompetent pts

Answer 745

Histoplasma

Question 746

Describe the pain of acute appendicitis

Answer 746

Visceral peri-umbilical pain –> somatic RLQ pain involving peritoneum

Question 747

Effects of angiotensin II

Answer 747

Preferential vasoconstriction of efferent renal arterioles to maintain GFR
Dec. Na+ delivery to distal tubule

Question 748

Systemic blasto presents with …

Answer 748

characteristic ulcerated skin lesions + lytic bone lesions

Question 749

Tx of systemic blasto

Answer 749

Itraconazole or Amphotericin B

Question 750

Slowly progressive anterior hip pain w/ limited ROM on chronic steroids

Answer 750

Steroid-induced osteonecrosis of bone

Question 751

Sudden vision loss and onset of floaters w/ difficult to visualize fundus

Answer 751

Vitreous hemorrhage

Question 752

Most common cause of vitreous hemorrhage

Answer 752

Diabetic retinopathy

Question 753

Xray shows expansile and eccentric lytic area (‘soap-bubble’ appearance) in epiphysis of distal femur in young adult +/- pathologic fracture

Answer 753

Giant cell tumor of bone

Question 754

… pneumonitis seen 45 days s/p tplant, c.f. immediate post-tplant period of …

Answer 754

CMV; PCP

Question 755

Xray of CMV pneumonitis

Answer 755

Multifocal diffuse patchy infiltrates

Question 756

Dx of CMV pneumonitis

Answer 756

Bronchiolar lavage

Question 757

Other Sx of CMV pneumonitis that are not seen with PCP after tplant

Answer 757

GI Sx, arthralgias, myalgias, esophagitis

Question 758

BPPV 2/2 …

Answer 758

crystalline canaliths in semicircular canal disruption normal flow; Dx aided by Dix-Hallpike maneuver

Question 759

Tx of hypernatremia w/ volume depletion

Answer 759

Restore volume w/ 0.9% saline

Switch to 5% dextrose > 0.45% saline for free H2O supplementation

Question 760

Rate of correction for hypernatremia

Answer 760

0.5 mEQ/dL/hr w/o exceeding 12 mEQ/dL/day

Question 761

Glucocorticoids cause neutrophilia by …

Answer 761

mobilizing the marginated neutrophil pool

Question 762

Two indications for placement of thoracostomy tube for parapneumonic effusion

Answer 762

1. pH

Question 763

Pathophys of ARDS

Answer 763

Impaired gas exchange, dec. lung compliance, inc. pulmonary arterial pressure

Question 764

This indicates the degree of severity of ARDS

Answer 764

PaO2/FiO2 is decreased (

Question 765

All pts with chronic liver disease should be immunized against …

Answer 765

Hep A and Hep B

Question 766

Inc. MCHC, hemolytic anemia, jaundice, splenomegaly, cholecystitis, Dx?

Answer 766

Hereditary spherocytosis

Question 767

Tx of hereditary spherocytosis

Answer 767

Folate supplementation, splenectomy to minimize hemolysis

Question 768

Same abd pain after cholecystectomy, with inc. alk phos, mildly inc. LFTs, dilated CBD on U/S; Dx and next step

Answer 768

Postcholecystectomy syndrome; endoscopic U/S, ERCP, or MRCP

Question 769

Chronic diarrhea in pt w/ travel history

Answer 769

Tropical sprue

Question 770

Tropic sprue small intestine mucosal Bx

Answer 770

Villus blunting and infiltration w/ chronic inflammatory cells (lymphocytes, eosinophils, plasma cells)

Question 771

Acute severe retroorbital pain that wakes pt up from sleep, a/w redness, tearing, stuffed/runny nose, Horner syndrome ipsilaterally

Answer 771

Cluster H/A

Question 772

Recommended PPx of cluster H/A

Answer 772

Verapamil, Li, ergotamine

Question 773

Tx of cluster H/A

Answer 773

100% O2, subcutaneous sumatriptan

Question 774

Reversible RF of PACs and how to Tx Sx

Answer 774

EtOH, tobacco; Beta-blockers

Question 775

Large pedunculated exophytic papule w/ a collarette of scale, resembles a large pyogenic granuloma or cherry angioma; extremely prone to bleeding

Answer 775

Bacillary angiomatosis

Question 776

Pathophs of hypercalcemia of malignancy

Answer 776

Osteolytic mets, PTHrP, VitD, IL6 production (MM)

Question 777

Hypercalcemia of malignancy typically has levels …, c.f. hypercalcemia from primary hyperparathyroidism

Answer 777

> 13

Question 778

Holocranial HA, vision changes, pulsatile tinnitis (‘whoosh’), Dx?

Answer 778

Idiopathic intracranial hypertension

Question 779

Idiopathic intracranial hypertension typically has … on LP

Answer 779

inc. opening pressure, >250 mmHg (papilledema is not a CxIx in absence of non-communicating hydrocephalus or mass lesion)

Question 780

MEN 1 syndrome tumors

Answer 780

Parathyroid, pancreas, pituitary

Question 781

MEN 2A syndrome tumors

Answer 781

Parathyroid, MTC, pheo

Question 782

MEN 2B syndrome tumors

Answer 782

MTC, pheo, mucosal neuromas, marfanoid; more aggressive

Question 783

This physical exam maneuver suggests cardiac c.f. liver cause of lower extremity edema

Answer 783

Hepatojugular reflex (>3 cm elevation during abdominal compression)

Question 784

Malignant HTN is a/w … (3)

Answer 784

Retinal hemorrhages, exudates, or papilledema

Question 785

ITP is a/w … and …, so all pts w/ ITP should get tested

Answer 785

Hep C, HIV

Question 786

SJS vs TEN

Answer 786

SJS 30% BSA

Question 787

SJS is esp. common with which meds

Answer 787

Sulfa drugs, NSAIDs, anticonvulsants, allopurinol; involves mucous membranes

Question 788

Dx of cor pulmonale, and definitive Dx

Answer 788

Clinical features + echo (RVH, tricuspid regurgitation, RAE)

Definitive Dx = pulmonary artery BP > 25 mmHg via right heart catheterization

Question 789

Pt has features of cholestasis (fatigue, pruritus, inc. alk phos), RUQ U/S suggests intrahepatic cause, next step?

Answer 789

Anti-mitochondrial Ab looking for PBC

Question 790

Dx of Sjogren syndrome?

Answer 790

Auto-Ab against SSA (Ro)/ SSB (La) or histologic evidence of lymphocytic infiltration of salivary glands

Question 791

First line Tx for PCOS

Answer 791

Weight loss and OCPs

Question 792

MC causes of secondary digital clubbing

Answer 792

Lung malignancies, cystic fibrosis, R –> L cardiac shunts

Question 793

COPD does not cause …

Answer 793

digital clubbing; presence of digital clubbing, need to search for malignancy

Question 794

Non-alcoholic fatty liver disease is a/w …

Answer 794

insulin resistance

Question 795

… is a glutamate inhibitor approved for ALS

Answer 795

Riluzole

Question 796

These live vaccinations are indicated in HIV pts if CD4 > 200

Answer 796

MMR and VZV

Question 797

… are well known complications of giant cell arteritis 2/2 …

Answer 797

Aortic aneurysms; involvement of the branches of aorta; need serial CXR to evaluate

Question 798

… is a complication of aortic dissection w/ an early diastolic murmur

Answer 798

Aortic regurgitation

Question 799

This disease is exacerbated by bladder filling and relieved by voiding; normal UA

Answer 799

Interstitial cystitis (painful bladder syndrome)

Question 800

Besides bladder filling, these activities cause pain with interstitial cystitis

Answer 800

Dyspareunia, exercise, alcohol consumption

Question 801

Long-term Tx of hypercalcemia of malignancy

Answer 801

Zoledronic Acid (bisphosphonate)

Question 802

In pt w/ postop urinary retention and inconclusive bladder scan, next step?

Answer 802

Bladder catheterization

Question 803

Dx of acoustic neuroma

Answer 803

MRI w/ gadolinium

Question 804

Middle ear effusion w/o signs of infections; dull tympanic membrane that is hypomobile

Answer 804

Serous otitis media

Question 805

Most common middle ear pathology of AIDS

Answer 805

Serous otitis media

Question 806

Tx of Graves’ that is a/w worsening of ophthalmopathy

Answer 806

Radioactive iodine

Question 807

Most rapid and sensitive test for Dx of disseminated histo in IC pts is…

Answer 807

serum or urine assay for antigen

Question 808

Disseminated histo Tx

Answer 808

IV lipsomal amphotericin B for 2 weeks, followed by itraconazole for 1 year

Question 809

Prevention of kidney stones

Answer 809

1. Dec. dietary protein and oxalate
2. Dec. Na+
3. Inc. fluid intake
4. Inc. dietary Ca++

Question 810

Fever + painful enlargement of testes + irritative voiding

Answer 810

Acute epididymitis

Question 811

Most common cause of non-sexually acquired acute epididymitis

Answer 811

E. coli (old men with UTI)

Question 812

Most common cause of sexually acquired acute epididymitis

Answer 812

Chlamydia/ gonnorrhea

Question 813

EtOH is metabolized to …, which competes with … for excretion

Answer 813

lactate; uric acid

Question 814

Prevention of gout

Answer 814

Stop EtOH, diet low in purines, avoid diuretics and pyrazinamide

Question 815

Tx of choice for iron deficiency in dialysis pts is…

Answer 815

IV iron prep, such as iron dextran

Question 816

Pathophys of cluster HA

Answer 816

Alterations in circadian pacemaker, may be due to hypothalamic dysfunction

Question 817

RA predisposes to …

Answer 817

amyloidosis (most common cause of AA)

Question 818

h/o RA, enlarged kidneys, hepatomegaly

Answer 818

Amyloidosis

Question 819

Most common cause of AL Amyloidosis

Answer 819

Multiple Myeloma

Question 820

Best initial screening tests for pts w/ adrenal insufficiency are …

Answer 820

Early morning cortisol, ACTH, and cosyntropin stimulation test

Question 821

An inc. in serum cortisol … 30-60 min after administration of 250 microg cosyntropin r/o …

Answer 821

> 20 microg/dL; primary adrenal insufficiency

Question 822

An abnormal Rinne (BC>AC) suggests …

Answer 822

conductive hearing loss

Question 823

Pts w/ conductive hearing loss lateralize … the problem on Weber

Answer 823

Towards

Question 824

Pts w/ sensorineural hearing loss lateralize … the problem on Weber

Answer 824

Away from

Question 825

Conductive hearing loss caused by …

Answer 825

cerumen impaction, middle ear fluid/ infection, dec. movements of small bones, bony tumors

Question 826

Conductive hearing loss in 20s-30s; Dx and Tx?

Answer 826

Otosclerosis; hearing amplification, surgical stapedectomy

Question 827

Hamartomatous polyps =

Answer 827

juvenile polyp (non-malignant)
Peutz-Jeghers (generally non-malignant)

Question 828

Most common type of polyp,

Answer 828

Adenomatous polyps

Question 829

Features of malignant vs. benign polyps

Answer 829

Sessile (Cx) vs. pedunculated
Villous (Cx) vs. tubular or tubulovillous
>2.5 cm (Cx) vs.

Question 830

DLCO in asthma is …, while DLCO in COPD is …

Answer 830

normal or increase; never increased

Question 831

Leading risk factor for aortic dissection =

Answer 831

HTN

Question 832

MC cause of fatal sporadic encephalitis in US

Answer 832

Herpes encephalitis

Question 833

Herpes encaphlitis can cause …

Answer 833

behavioral symptoms (hypomania, Kluver-Bucy, amnesia)

Question 834

CSF of herpes encephalitis

Answer 834

Lymphocytic pleocytosis, inc. erythrocytes, inc. protein

Question 835

Hepatic encephalopathy stages

Answer 835

Stage 1 (insomnia/ hypersomnia) vs. Stage 4 (stupor/ coma)

Question 836

Case-control study looks at people w/ disease (cases) vs. people w/o disease (control), and measures …

Answer 836

exposure odds ratio

Question 837

If measuring aldosterone/renin ratio, need to d/c …

Answer 837

spironolactone/ amiloride 4 weeks before measurement

Question 838

Sudden change in functional status (step-wise decline) + FND

Answer 838

Vascular dementia

Question 839

Pain/ tenderness 2-6 cm above posterior calcaneus, Dx?

Answer 839

Achilles tendinopathy

Question 840

RFs for accelerated for atherosclerosis

Answer 840

SLE and chronic steroid use

Question 841

Deep breathing secondary to acidosis

Answer 841

Kussmaul’s respirations

Question 842

Bronchiectasis is a/w …

Answer 842

> 100 mL/day sputum production, recurrent fever, hemoptysis, Pseudomonas

Question 843

How to Dx bronchiectasis

Answer 843

High-resolution CT, then sputum analysis for bacteria

Question 844

Neurogenic arthropathy 2/2 dec. vit B12, DM, or tabes dorsalis (among others)

Answer 844

Charcot joint

Question 845

Management of charcot joint

Answer 845

Tx underlying disease, mechanical devices to assist weight-bearing and dec. trauma

Question 846

Functional limitations, deformity, DJD, and Loose bodies on imaging

Answer 846

Charcot joint

Question 847

Dx gold standard of acute angle-closure glaucoma

Answer 847

Gonioscopy from ophthalmoscopic consultation

Question 848

If ophthalmologist is not available to Dx acute angel-closure glaucoma, what is the next best test

Answer 848

Tonometry to measure IOP

Question 849

Tx of acute angle-closure glaucoma

Answer 849

Pressure-lowering eyedrops, laser or surgical interventions (iridotomy, iridectomy)

Question 850

Best Tx for inflammatory myopathies

Answer 850

Corticosteroids

Question 851

Major cause of death within 24 hours of SAH

Answer 851

Rebleeding

Question 852

… occurs in 30% of pts w/ SAH after 3-10 days; can be fatal

Answer 852

Vasospasm

Question 853

How to Dx vasospasm after SAH

Answer 853

CT angiogram

Question 854

PPX of vasospasm after SAH

Answer 854

Nimodipine

Question 855

Survivors of Hodgkin Lymphoma are at inc. risk of …

Answer 855

cardiac disease

Question 856

Inc. JVP w/ prominent X and Y descents and hepatojugular reflex; Kussmaul’s sign (lack of dec or inc. in JVP on inspiration), pericardial knock (mid-diastolic)

Answer 856

Constrictive pericarditis

Question 857

Tx of constrictive pericarditis

Answer 857

Diuretics followed by pericardiectomy for definitive treatment

Question 858

Multiple peptic ulcers (duodenal and jejunal) + diarrhea

Answer 858

ZES

Question 859

Pathophys of ZES diarrhea

Answer 859

Inc. gastrin –> parietal cell hyperplasia –> inc. acid secretion –> inc. enzyme inactivation –> diarrhea and steatorrhea

Question 860

Dx of ZES

Answer 860

Inc. serum gastrin (>1000) in presence of acidic gastric pH (

Question 861

Erysipelas; what is it and how does it present

Answer 861

Specific type of cellulitis; superficial dermis; sharply-demarcated, erythematous, edematous, tender skin

Question 862

Most common cause of erysipelas

Answer 862

Group A Strep

Question 863

Lower cutoff point inc. … and dec. …

Answer 863

sensitivity; specificity

Question 864

Raising cutoff point inc. … and dec. …

Answer 864

specificity; sensitivity

Question 865

Screening tests need to be …, while confirmatory tests need to be …

Answer 865

sensitive, specific

Question 866

Digitalis is most useful in which pts?

Answer 866

HF w/ systolic dysfunction and RVR 2/2 Afib or flutter

Question 867

Watery diarrhea (tea-colored), hypokalemia, hypo- or achlorhydria, along with flushing, N/V, fatigue, hypercalcemia, and hyperglycemia

Answer 867

VIPoma

Question 868

Dx of VIPoma

Answer 868

VIP levels >75; mostly in pancreatic tail

Question 869

Tx of VIPoma

Answer 869

Volume repletion; octreotide to dec. diarrhea; possible hepatic resection if mets

Question 870

No role for synchronized cardioversion or defibrillation in …

Answer 870

PEA/ asystole

Question 871

… breath sounds have full expiratory phase

Answer 871

Bronchial

Question 872

… can cause seizures and can be worsened with supplemental O2

Answer 872

Hypercapnia

Question 873

Hallmark EKG findings of persistent ST elevations after recent MI and deep Q waves in same leads

Answer 873

Ventricular aneurysm

Question 874

Spontaneous rupture of esophagus

Answer 874

Boerhaave syndrome

Question 875

Present w/ retrosternal pain and crepitus in suprasternal notch (pneumomediastinum)

Answer 875

Boerhaave syndrome

Question 876

Incomplete mucosal tear at GE junction causing self-limited hemetemisis

Answer 876

Mallory-Weiss tear

Question 877

Unprovoked DVT + smoking Hx + systemic Sx =

Answer 877

Need to r/o malignancy

Question 878

Needlestick w/ Hep B positive pt and non-immunized victim

Answer 878

Administer Hep B Ig + vaccine immediately

Question 879

+ Hep Be antigen indicates …

Answer 879

higher risk of transmission

Question 880

Sicca syndrome

Answer 880

(caused by Sjogren’s syndrome) dry mucous membrane, irritated eyes, cough, dyspareunia

Question 881

Most common thyroid cancer

Answer 881

Papillary (70%), has best Px

Question 882

Risk factors for papillary thyroid cancer

Answer 882

Radiation during childhood, Fam Hx

Question 883

Benzo OD vs. opioid OD

Answer 883

BZD lacks severe resp depression and miosis

Question 884

Benzo OD vs. EtOH/phenytoin OD

Answer 884

The latter cause nystagmus

Question 885

Niacin hypersensitivity can be reduced with …

Answer 885

low-dose ASA

Question 886

Severe HTN w/ end-organ dysfunction (renal failure, CHF) can be Tx w/ …

Answer 886

Nitroprusside

Question 887

Nitroprusside can cause …

Answer 887

cyanide toxicity in pts getting prolonged infusions or high doses

Question 888

Cyanide toxicity presents as …

Answer 888

AMS, lactic acideosis, seizures, coma, more common w/ renal failure

Question 889

Neuroleptic malignant syndrome Tx w/

Answer 889

Dantrolene, followed by bromocroptine and amantadine

Question 890

Red flag Sx indicating cavernous sinus thrombosis

Answer 890

Severe HA, bilateral periorbital edema, CN III-VI dysfunction

Question 891

Anticoagulation in Afib, how do you decide?

Answer 891

CHADS2 score: >=1 get anticoag
CHF - 1
HTN - 1
Age > 75 - 1
DM - 1
Stroke - 2

Question 892

HTN + bilateral palpable abd mass + microhematuria =

Answer 892

ADPKD

Question 893

ADPKD complications

Answer 893

Berry aneurysms, hepatic cysts, mitral valve prolapse or aortic regurg, colonic diverticula, abdominal wall or inguinal hernias

Question 894

Pt w/ recent h/o URI gets pneumonia bilaterally + multiple thin-walled cavities, Dx?

Answer 894

Bacterial superinfection AKA secondary bacterial pneumonia

Question 895

Most common pathogens of bacterial superinfection

Answer 895

Strep pneumo, Staph, H. influenza

Question 896

In pts/ w/ non-specific GI Sx + night sweats + arthralgias + LAD, next step?

Answer 896

Test for HIV before colonoscopy for IBD (low threshold for HIV)

Question 897

Dilated ventricles on CT/MRI w/ normal opening pressure on LP

Answer 897

Normal pressure hydrocephalus

Question 898

Osteoarthritics, Bouchard vs. Heberden nodes

Answer 898

Bouchard = PIP
Heberden = DIP

Question 899

S4 heart sounds occurs from …

Answer 899

LA kick against stiff LV

Question 900

3 most common causes of aortic stenosis

Answer 900

Senile calcific, bicupsid, RHD

Question 901

Most common renal pathologies seen w/ analgesic nephropathy

Answer 901

Papillary necrosis, tubulointerstitial nephritis

Question 902

Acanthosis nigricans is a/w …

Answer 902

insulin resistance (DM, PCOS) or GI malignancy

Question 903

Besides for typical anticholingergic Sx, other Sx include

Answer 903

HA, dizziness, and tachycardia

Question 904

Complication of acute diverticulitis, Chrohn’s, or colon malignancy

Answer 904

Colovesical fistula

Question 905

How does colovesical fistula present

Answer 905

fecaluria, pneumaturia, recurrent UTI (polymicrobial)

Question 906

How to Dx colovesical fistula

Answer 906

Abd CT w/ oral or rectal (not IV) contrast, f/b colonoscopy to r/o cancer

Question 907

Need to wait how long between taking sildenafil and alpha-blockers?

Answer 907

4 hours, risk of hypotension

Question 908

Median onset of hypercalcemia of immobilization

Answer 908

4 weeks

Question 909

How to PPx for hypercalcemia of immobilization

Answer 909

Bisphosphonate

Question 910

Inc. levels of … inc. risk of VTE and atherosclerosis

Answer 910

homocysteine

Question 911

How to normal inc. level of homocysteine

Answer 911

Vit B6 (and B12 if low)
B6 acts as a cofactor for cysthionine Beta-synthase, which converts homocysteine to cystathionine

Question 912

MC cause of infective endocarditis in IVDU

Answer 912

S. aureus

Question 913

Most appropriate empiric Abx for IE from IVDU

Answer 913

Vancomycin

Question 914

Ascending paralysis over hours (c.f. days seen w/ GBS)

Answer 914

Tick-bourne paralysis

Question 915

Tx of tick-bourne paralysis

Answer 915

Removal of tick causes improvement w/i an hour, and complete recovery w/i days

Question 916

Tx of GBS

Answer 916

plasmapharesis and IVIG

Question 917

All pts w/ new-onset Afib should have … tested

Answer 917

TSH and Free T4

Question 918

Acute onset lower Abd pain followed by bloody diarrhea within 12-24 hours of surgery w/ h/o atherosclerosis

Answer 918

Ischemic colitis

Question 919

Work-up for ischemic colitis

Answer 919

Sometimes inc. lactic acid

May show thumb-printing on radiograph

Question 920

PE findings in pts w/ aortic stenosis

Answer 920

Pulsus parvus et tardus
Mid-to-late peaking systolic murmur
Soft and single S2 (from delayed aortic valve closure that occurs with pulmonic valve closure)

Question 921

Complications of UC

Answer 921

Toxic megacolon
PSC
Colorectal Cx
Erythema nodosum
Pyoderma gangrenosum
Spondyloarthritis

Question 922

Porphyria cutanea tarda pathophys

Answer 922

Deficiency of uroporphyrinogen decarboxylase

Question 923

Porphyria cutanea tarda

Answer 923

Painless blisters, facial hypertrichosis/ hyperpigmentation; triggered by ingestion of substances (EtOH, estrogens)

Question 924

Dx of porphyria cutanea tarda

Answer 924

Urinary porphyrin levels

Question 925

Tx of porphyria cutanea tarda

Answer 925

Phlebotomy, hydroxychloroquine, IFN-alpha if concurrent Hep C

Question 926

Tx for C. dif in pt who cannot tolerate PO vancomycin

Answer 926

Fidaxomicin

Question 927

Meniere’s disease pathophys

Answer 927

Abnormal accumulation of endolymph w/i inner ear

Question 928

Type of B-lymphocytic derived chronic leukemia

Answer 928

Hairy cell leukemia

Question 929

Dx of Hairy cell leukemia

Answer 929

Tartrate-resistant acid phosphatase stain; CD11c +

Question 930

Pt w/ IE found to be S. mutans susceptible to penicillin, on empiric vancomycin; next step?

Answer 930

Switch to IV aqueous pen G or IV ceftriaxone (easier 2/2 once daily dosing)

Question 931

Palpable nodule at periphery of prostate gland

Answer 931

Prostate Cx

Question 932

Dyspepsia; who should get endoscopy vs. who should get H. pyori testing?

Answer 932

Endoscopy: Yes alarm Sx, age > 55

H. pylori testing: No alarm Sx, age

Question 933

Tx of PCP in HIV pt

Answer 933

TMP-SMX x21 days + adjunctive corticosteroids if:

PaO2 35 mmHg on RA

Question 934

Hx of anticoagulation + weakness/ dizziness + anemia + tachycardia =

Answer 934

internal hemorrhage

Question 935

Pt w/ liver failure and bleeding d/o; Tx?

Answer 935

FFP

Question 936

Pt w/ TB taking INH gets rise of LFTs b/w 50-100; next step?

Answer 936

Observe (transient rise occurs in 10-20%; make sure it stays

Question 937

If pt w/ TB on INH gets rise in LFTs and also: >50yrs, drinsk EtOH daily, has liver disease; next step?

Answer 937

Stop INH

Question 938

Sx of Vit D toxicity

Answer 938

Constipation, Abd pain, polyuria, polydipsia

Question 939

Complications of infectious mononucleosis

Answer 939

Splenic rupture, LAD compromising airway, AIHA w/ TCP (cold-agglutinins)

Question 940

Unconjugated hyperbilirubinemia + jaundice in pt w/ recent event, such as fasting, fat-free diet, physical exertion, illness, stress

Answer 940

Gilbert’s syndrome

Question 941

Labs for pt w/ Gilbert’s syndrome

Answer 941

Normal LFTs, CBC, smear, retic count

Question 942

Crigler-Najjar type 1

Answer 942

Severe jaundice + kernicterus causing neurologic impairment

Question 943

Tx for Crigler-Najjar type 1

Answer 943

Phototherapy, plsamapharesis; liver tplant is definitive

Question 944

Crigler-Najjar type 2

Answer 944

Milder, no kernicterus; phenobarbital causes a dec. in serum bili (c.f. CN type 1)

Question 945

Non-gonococcal urethritis + asymmetric oligoarthritis + conjuncitivitis

Answer 945

Reactive arthritis (seronegative spondyloarthropathy)

Question 946

In addition to classic triad for reactive arthritis, what are other Sx?

Answer 946

Mucocutaneous lesions and enthesitis (Achilles tendon pain)

Question 947

Synovial fluid analysis in reactive arthritis

Answer 947

Sterile

Question 948

First line Tx of reactive arthritis

Answer 948

NSAIDs

Question 949

Which Cx causes hypercalcemia?

Answer 949

Squamous cell (sCa++mous cell) from PTHrP

Question 950

Paraneoplastic syndromes caused by small cell lung cancer

Answer 950

Inc. ACTH, SIADH

Question 951

Falling on outstretched hand causes which Dx?

Answer 951

Classic for rotator cuff tear, limited ROM s/p lidocaine injection

Question 952

Dx of rotator cuff tear

Answer 952

MRI shoulder

Question 953

Pt w/ new Dx of FAP needs …

Answer 953

proctocolectomy at time of Dx

Question 954

Achilles tendon reflex is commonly …

Answer 954

absent in elderly pt

Question 955

Most common cause of urinary retention in males

Answer 955

Enlarged prostate

Question 956

Fatigue, myalgias, proximal muscle weakness, sluggish reflexes, normal ESR, elevated CK, Dx?

Answer 956

Hypothyroid myopathy

Question 957

Guidelines for lipid-lowering therapy

Answer 957

1. Clinically significant atherosclerotic disease
2. LDL >= 190 mg/dL
3. Age 40-75 w/ DM
4. Estimated 10yr ASCVD risk >= 7.5%

Question 958

High intensity statins =

Answer 958

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

Question 959

Sudden onset chest pain, dyspnea, and tachycardia w/ a hemorrhagic exudative pleural effusion and absence of consolidation on imaging; Dx?

Answer 959

Pulmonary embolism

Question 960

Causes of exudative pleural effusion

Answer 960

Infection, malignancy, pulmonary embolism, CTD

Question 961

A urine osmolality … suggests primary polydipsia or beer potomania

Question 962

Primary polydipsia is more common in …

Answer 962

psychiatric patients

Question 963

Earliest renal abnormality seen in DM nephropathy?

Answer 963

Glomerular hyperfiltration

Question 964

First renal abnormality seen in DM nephropathy that can be quantified?

Answer 964

Thickening of GBM

Question 965

Loud S1 + mid-diastolic rumbling murmur heard best at apex?

Answer 965

Mitral stenosis

Question 966

Empiric therapy for CAP

Answer 966

Outpatient healthy: doxy or macrolides
Outpatient comorbid (DM, malig): FQ or B-lactam + macrolide
Inpatient wards: FQ or B-lactam + macrolide
Inpatient ICU: B-lactam + macrolide (IV) or B-lactam + FQ

Question 967

Rapid and massive increase in transaminases w/ modest inc. in Tbili or alk phos

Answer 967

Ischemic hepatopathy

Question 968

AAA screening recommendations

Answer 968

Men age 65-75 w/ smoking Hx get one-time Abd U/S

Question 969

Sx/Sx of hypokalemia?

Answer 969

Weakness, fatigue, muscle cramps, flaccid paralysis, hyporeflexia, tetany, rhabdo, arrhythmias

Question 970

EKG changes w/ hypokalemia?

Answer 970

Broad flat T waves, U waves, ST depression, PVCs

Question 971

Slowly progressive proximal weakness of LE w/o skin conditions

Answer 971

Polymyositis

Question 972

Dx of polymyositis

Answer 972

Muscle Bx showing mononuclear infiltrate surrounding necrotic and regenerating muscle fibers

Question 973

Inflammation, fibrosis, and structuring of medium-sized and large intrahepatic and extrahepatic bile ducts, leading to ESLD and portal HTN, Dx?

Answer 973

PSC

Question 974

Dx of PSC

Answer 974

Cholangiogram showing multifocal narrowing w/ intra-and extrahepatic duct dilation (beading)

Question 975

Meds that cause IIH:

Answer 975

Growth hormone, tetracyclines, excessive Vit A

Question 976

Bilateral diffuse infiltrates beginning in perihilar regions =

Answer 976

Xray findings of PCP

Question 977

Tx of torsades if stable and unstable

Answer 977

Stable: IV Mg (even if serum Mg normal)
Unstable: immediate defibrillation

Question 978

Contralateral motor or sensory deficits more pronounced in lower extremity +/- urinary incontinence

Answer 978

ACA stroke

Question 979

6 criteria to clinically Dx OA

Answer 979

Age > 50
No morning stiffness
Bony tenderness
Bony enlargement
Crepitus
No warmth to joint

Question 980

Progressive and bilateral loss of central vision

Answer 980

Macular degeneration

Question 981

Pathophys of macular degeneration

Answer 981

Degeneration and atrophy of outer retina, retinal pigment epithelium, Bruch’s membrane, and choriocapillaries

Question 982

Common causes of asterixis

Answer 982

Hepatic encephalopathy, uremic encephalopathy, CO2 retention

Question 983

Best indicator of extent of TCA OD

Answer 983

EKG (esp. QRS duration), as this predicts likelihood of seizures and ventricular arrhythmias

Question 984

Pts w/ hyperparathyroidism have hypercalcemia and hypophosphatemia and are at inc. risk of developing …, which presents as …

Answer 984

Pseudogout, rhomboid-shaped, +ly birefringent crystals

Question 985

Two therapies shown to decrease mortality in COPD pts

Answer 985

Smoking cessation, home O2 therapy

Question 986

Dx of melanoma

Answer 986

Excisional Bx w/ narrow margins

Question 987

If depth of melanoma invasion is

Answer 987

Excision w/ 1 cm margins

Question 988

If depth of melanoma invasion is > 1mm, … should be performed

Answer 988

sentinel lymph node biopsy

Question 989

Complicated vs. uncomplicated vs. empyema parapneumonic effusions

Answer 989

Complicated - persistent bacterial invasion into pleural space, causing glucose

Question 990

Central hypogonadism (dec. test., dec. LH) + central hypothyroidism (dec. T4, dec. TSH) + inc. prolactin suggests …

Answer 990

pituitary adenoma

Question 991

Pleural fluid w/ inc. amylase could mean … or …, differentiate by …

Answer 991

pancreatitis, esophageal rupture (Boerhaave syndrome); widening of mediastinum on xray + chest pain vs. back pain

Question 992

Severe pancreatitis can cause shock via:

Answer 992

release of activated pancreatic enzymes that enter vascular system and inc. vascular permeability around pancreas –> lots of fluid entering retroperitoneum

Question 993

Tx of shock from severe pancreatitis

Answer 993

Supportive w/ several liters of fluid

Question 994

Main cause of hyperkalemia in DKA

Answer 994

Extracellular shift

Question 995

PPx for hypokalemia from DKA by …

Answer 995

giving K+ once serum K+ drops below 4.5

Question 996

Tx for rosacea

Answer 996

Topical metronidazole

Question 997

Side effects of PTU and methimazole

Answer 997

Both cause agranulocytosis
PTU: hepatic failure, ANCA-vasculitis
Methimazole: 1st trimester teratogen, cholestasis

Question 998

4 Strep spp. of viridans

Answer 998

mitis, sanguis, mutans, salivarius

Question 999

Solitary pulmonary nodule w/o comparison CXR, next step?

Answer 999

CT scan

Question 1000

Syncopal episodes can cause … 2/2

Answer 1000

clonic jerks w/o being seizures, brain hypoxia

Question 1001

Cause of syncope in pt w/ structural heart disease, w/o warning signs, and frequent ectopic beats

Answer 1001

Arrhythmia

Question 1002

Class IC anti-arrhythmics used to Tx …

Answer 1002

Flecainide, propafenone; Afib for rhythm control

Question 1003

Class IC anti-arrhythmics are …, meaning they cause widening of QRS at fast HR 2/2 …

Answer 1003

‘use-dependent’, less time to dissociate from Na+ channels

Question 1004

Use dependence is seen with … and …

Answer 1004

Class IC anti-arrhythmics and CCBs (class IV)

Question 1005

Medical Tx for variant angina (Prinzmetal’s)

Answer 1005

CCB or nitrates

Question 1006

Two-sample T test is used to …

Answer 1006

compare two means

Question 1007

ANOVA is used to …

Answer 1007

compare >=3 means

Question 1008

Postpartum woman w/ pulmonary Sx + multiple lesions on CXR

Answer 1008

Choriocarcinoma

Question 1009

Choriocarcinoma is a type of …, and can occur after …

Answer 1009

gestational trophoblastic disease; normal or molar pregnancy

Question 1010

Hemochromatosis is a/w …, causing … and causes …

Answer 1010

CPPD depositions in joint; chondrocalcinosis; pseudogout/ chronic arthropathy

Question 1011

Tx of hemochromatosis

Answer 1011

Phlebotomy

Question 1012

Dx of hemochromatosis

Answer 1012

Genetic tests (HFE) or liver Bx

Question 1013

Avoid these mediations when taking cocaine

Answer 1013

Beta-blockers

Question 1014

Biliary colick lasts …, while cholecystitis lasts …

Answer 1014

6 hours

Question 1015

Dx of bronchiectasis

Answer 1015

CT chest showing dilated bronchi w/ thickened walls

Question 1016

Complication of bronchiectasis

Answer 1016

Hemoptysis, sometimes requiring bronchial a. embolization

Question 1017

Pts w/ MVP and ass. regurgitation have a 5-8x higher risk of …

Answer 1017

infective endocarditis

Question 1018

Drug of choice for Raynaud Phenomenon

Answer 1018

Dihydropyridine CCB (nifedipine, amlodipine)

Question 1019

One of most common causes of thyrotoxicosis w/ dec. RAIU

Answer 1019

Subacute lymphocytic thyroiditis (painless thyroiditis)

Question 1020

Subacute lymphocytic thyroiditis commonly occurs …

Answer 1020

postpartum

Question 1021

Other causes of thyrotoxicosis w/ dec. RAIU

Answer 1021

• Subacute granulomatous (De Quervain = pain) thyroiditis
• Levothyroxine OD
• Iodine-induced thyrotoxicosis
• Struma ovarii

Question 1022

HIT is highly …, and can cause …

Answer 1022

thrombogenic; arterial or venous clots

Question 1023

Hearing loss, inc. hat size, HA, isolated inc. alk phos =

Answer 1023

Paget’s disease of bone

Question 1024

Mallory-Weiss tears are …, while variceal bleeding is …

Answer 1024

arterial, venous

Question 1025

Meds used to PPx against gout

Answer 1025

Allopurinol, probenecid

Question 1026

Severe pain in a pt w/ mild urinary retention (BPH) can cause retention from …

Answer 1026

inability to valsalva

Question 1027

SAAG is calculated by …

Answer 1027

serum albumin - peritoneal fluid albumin

Question 1028

SAAG > 1.1 indicates …

Answer 1028

portal HTN (cardiac ascites, cirrhosis)

Question 1029

SAAG

Answer 1029

other etiologies (malignancy, pancreatitis, nephrotic syndrome, TB)

Question 1030

Pt has down-trending ALT/AST w/ worsening PT/INR and bilirubin, Dx?

Answer 1030

Acute liver failure (fulminant hepatitis)

Question 1031

… is most important prognostic factor in fulminant hepatitis

Answer 1031

PT

Question 1032

Next step in pt w/ known immunity to Hep B with needle-stick with Hep B + pt

Answer 1032

Reassurance

Question 1033

AECOPD should get …

Answer 1033

noninvasive positive pressure ventilation (dec. mortality, rate of intubation, hospital length, nosocomial infections)

Question 1034

… for AECOPD who fail 2 hour trial of NPPV

Answer 1034

Endotrachial intubation

Question 1035

Alcoholic hepatitis labs

Answer 1035

Modest elevations in AST/ALT (2:1), inc. GGT, inc. ferritin

Question 1036

Acute lung injury 2/2 aspiration of acidic and sterile stomach contents, presents w/i hours of event

Answer 1036

Aspiration pneumonitis

Question 1037

Initial screening for thalassemias

Answer 1037

CBC

Question 1038

Most common adverse reaction that occurs w/i 1-6 hours of transfusion

Answer 1038

Febrile non-hemolytic transfusion reaction

Question 1039

… can PPx against febrile non-hemolytic transfusion reaction

Answer 1039

Leukoreduction

Question 1040

Diastolic decrescendo murmur heard best at right sternal border + severe hypertension

Answer 1040

Aortic dissection

Question 1041

Dx of aortic dissection

Answer 1041

TEE > CT chest w/ contrast

Question 1042

Labs w/ Vit D deficiency

Answer 1042

Dec. Ca++, dec. PO4, inc. PTH

Question 1043

Nontender enlargement of submandibular glands

Answer 1043

Sialadenosis

Question 1044

Sialadenosis is commonly seen w/

Answer 1044

Liver disease (EtOH + non-EtOH), DM, bulemia

Question 1045

MM lytic lesions are seen w/ …

Answer 1045

skeletal sruvey (xray) not bone scan

Question 1046

… are still seen w/ brain death

Answer 1046

deep tendon reflexes

Question 1047

Dec. PCWP + inc. mixed venous O2 saturation =

Answer 1047

septic shock

Question 1048

Inc. mixed venous O2 saturation is 2/2 …

Answer 1048

hyperdynamic circulation

Question 1049

… is most common brain mets

Answer 1049

Lung cancer

Question 1050

HA, N/V abd pain, confusion, coma, pinkish skin hue =

Answer 1050

Carbon monoxide poisoning

Question 1051

Dx of carbon monoxide poisoning

Answer 1051

Carboxyhemoglobin levels

Question 1052

Goal rate of plasma Na+ correction in hypernatremia

Answer 1052

1 mEq/L/hr

Question 1053

What IVF to give for severe hypernatremia?

Answer 1053

0.9% saline

Question 1054

What IVF to give for mild hypernatremia?

Answer 1054

5% dextrose in 0.45% saline

Question 1055

CNIII parasympathetic fibers are damaged via … and cause …

Answer 1055

compression (outer); fixed, dilated pupil

Question 1056

CNIII somatic fibers are damaged via … and cause …

Answer 1056

ischemia (i.e. DM; inner); down and out w/ normal pupil

Question 1057

Characteristics of simple renal cyst

Answer 1057

thin wall, no solid component, no contrast enhancement

Question 1058

Characteristics of malignant cystic masses

Answer 1058

heterogenous, multiple septations, yes contrast enhancement

Question 1059

Managment of simple renal cyst

Answer 1059

Reassurance

Question 1060

Who needs screening for bladder Cx?

Answer 1060

Noone.

Question 1061

Recent nasal packing + rapid onset diffuse macular erythroderma (like sunburn), hypotension, diarrhea, TCP =

Answer 1061

toxic shock syndrome

Question 1062

Presence of biliary dilation =

Answer 1062

extrahepatic cholestasis; vice versa

Question 1063

Mechanical and medical Tx for paroxysmal SVT MOA

Answer 1063

Dec. AV node conductivity (c.f. SA node)

Question 1064

Overflow incontinence w/ high PVR volume (>50 mL) can be …

Answer 1064

neurogenic bladder 2/2 diabetic autonomic neuropathy

Question 1065

… studies determine outcome then look for associated risk factors

Answer 1065

Case-control studies

Question 1066

… studies ascertain risk factor exposure then determine outcome

Answer 1066

Retrospective cohort studies

Question 1067

… cannot occur on palms and soles

Answer 1067

Molluscum contagiousum

Question 1068

Consider … in pts w/ molluscum contagiosum

Answer 1068

HIV testing

Question 1069

Central clearing and blistering w/ crusting and scaling at borders on perineum, extremities, or face

Answer 1069

Necrolytic migratory erythema

Question 1070

Necrolytic migratory erythema, weight loss, diarrhea, anemia

Answer 1070

Glucagonoma

Question 1071

Dx of glucagonoma

Answer 1071

Serum glucagon > 500 pg/mL

Question 1072

Initial Tx for PAD

Answer 1072

Low-dose ASA, statin, supervised exercise program

Question 1073

PAD with persistent Sx after initial therapy

Answer 1073

Cilostazol, percutaenous or surgical revascularization

Question 1074

Definitive Dx of sarcoidosis

Answer 1074

Mediastinoscopy/ bronchoscopy for tissue Bx

Question 1075

Hodgkin’s Lymphoma patients have a 18.5x higher risk of developing

Answer 1075

secondary malignancy

Question 1076

Most frequent location of ectopic foci that cause Afib

Answer 1076

Pulmonary veins

Question 1077

Drug of choice for flash pulmonary edema 2/2 myocardial infarction

Answer 1077

Loop diuretic

Question 1078

These drugs are CxIx for flash pulmonary edema even though they have mortality benfit in pts with acute MI

Answer 1078

Beta-blockers

Question 1079

Tx of choice for TTP-HUS

Answer 1079

Plasmapharesis

Question 1080

Pathologic mechanism of osteomyelitis from ulcer

Answer 1080

contiguous spread, not direct inoculation

Question 1081

HIV pt w/ CD4

Answer 1081

TMP-SMX (PCP), azithromycin (MAC)

Question 1082

Inferior MI is most commonly a/w … 2/2 …

Answer 1082

sinus bradycardia; inc. vagal tone in first 24 hours s/p MI

Question 1083

Surgery for IE if:

Answer 1083

heart failure, persistent infection, recurrent septic embolization

Question 1084

… is notorious for causing refractory hypokalemia

Answer 1084

Hypomagnesemia

Question 1085

Chronic nocturnal cough = …, next step = …

Answer 1085

Asthma; PFTs

Question 1086

3 main classes of anti-anginal drugs

Answer 1086

Beta-blockers, CCBs, nitrates

Question 1087

GLP-1 agonists (exanatide, liraglutide) induce … but …

Answer 1087

weight loss, inc. risk for pancreatitis

Question 1088

If unwitnessed arrest or occurring > 5 min before defibrillation, do …

Answer 1088

one round of CPR first

Question 1089

Fastest way to drive K+ into cells during hyperkalemia

Answer 1089

insulin + glucose

Question 1090

… predicts risk of future ulcers

Answer 1090

10-g monofilament

Question 1091

Serum TG > 1000 can cause …

Answer 1091

pancreatitis and eruptive xanthomas

Question 1092

Inc. DHEAS levels are specifically seen w/ …

Answer 1092

androgen-producing adrenal tumors

Question 1093

Uncomplicated cystitis: can get Tx w/o …

Answer 1093

urine Cx

Question 1094

Tx for uncomplicated cystitis

Answer 1094

TMP-SMX x3 days
Nitrofurantoin x5 days
Fosfomycin single dose

Question 1095

What makes cystitis complicated

Answer 1095

DM, CKS, preggo, IC, urinary tract obstruction, procedure, foreign body (foley), hospital acquired

Question 1096

Need … prior to Tx of complicated cystitis or pyelonephritis

Answer 1096

urine Cx

Question 1097

Tx of complicated cystitis or uncomplicated pyelonephritis

Answer 1097

PO FQs

Question 1098

Tx of complicated pyelonephritis

Answer 1098

IV ceftriaxone

Question 1099

Best tests for Dx of acute Hep B infection

Answer 1099

HBsAg, anti-HBc (anti-HBc remains elevated through window period)

Question 1100

progressive painful ulcer w. purulent base and violaceous border

Answer 1100

Pyoderma gangrenosum

Question 1101

Pyoderma gangrenosum is us. a/w …

Answer 1101

underlying illness (IBD, RA, AML)

Question 1102

Dx and Tx of pyoderma gangrenosum

Answer 1102

Dx = skin Bx
Tx = corticosteroids

Question 1103

Senile purpura occurs 2/2

Answer 1103

loss of elastic fibers in perivascular tissue

Question 1104

Drug of choice for OA

Answer 1104

Acetaminophen

Question 1105

Pt w/ persistent Sx of venous insufficiency (after conservative measures)

Answer 1105

venous duplex U/S and endovenous ablation if signs of reflux

Question 1106

Tx of aspergilloma

Answer 1106

Itraconazole, surgical resection or bronchial artery embolization depending on location

Question 1107

Plasmodium (malaria) is transmitted by …

Answer 1107

Anopheles mosquitoes

Question 1108

Dx of plasmodium

Answer 1108

Blood smear

Question 1109

Most useful intervnetion to improve functional capacity and reduce claudication in PAD patients

Answer 1109

A supervised graded exercise program

Question 1110

Nonpuritic maculopapular rash involving the entire body, including the palmsa nd soles with generalized lymphadenopathy

Answer 1110

Secondary syphilis

Question 1111

Painless chancre that resolves in 3-6 weeks

Answer 1111

Primary syphilis

Question 1112

Test for syphilis

Answer 1112

PRP or VDRL followed by a treponemal test (FTA-ABS)

Question 1113

Hereditary hemochromatosis is a/w a 20-200x increased risk of …

Answer 1113

HCC

Question 1114

CSF findings in GBS

Answer 1114

High protein concentration with normal WBC count (albuminocytologic dissociation); CSF RBC and glucose should be normal

Question 1115

Tx of GBS

Answer 1115

IVIG or plasmapharesis

Question 1116

Tx of Candida esophagitis in HIV patients

Answer 1116

Empirically with 3-5 days of PO fluconazole

Question 1117

Sharp, pleuritic chest pain worse in supine position and improved by sitting up and leaning forward several days s/p MI

Answer 1117

Acute pericarditis

Question 1118

EKG changes with acute pericarditis

Answer 1118

Diffuse ST elevations, especially with PR depressions

Question 1119

Side effects of cyclophosphamide

Answer 1119

Hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression (bladder problems are caused by acrolein, a metabolite)

Question 1120

How to prevent side effects of cyclophosphamide

Answer 1120

Drinking lots of fluids, voiding frequently, and taking MESNA

Question 1121

In HIV pt, rapidly progressing bilateral necrotizing retinitis (“acute retinal necrosis syndrome”) presents with keratitis and conjunctivitis, followed by rapidly progressive visual loss; fundoscopy reveals widespread, pale, peripheral lesions and central necrosis of the retina

Answer 1121

HSV retinitis

Question 1122

Compared to HSV retinitis, CMV retinitis is …, and fundoscopy shows …

Answer 1122

painless; fluffy or granular retinal lesions located near the retinal vessels and associated hemorrhages

Question 1123

Menstrual irregularities and male-pattern baldness, Dx?

Answer 1123

PCOS

Question 1124

Preferred method of screening for glucose intolerance and T2DM

Answer 1124

75g 2-hour oral glucose tolerance test (OGTT)

Question 1125

Management of acute bacterial prostatitis

Answer 1125

Collect mid-stream urine sample, start empiric Abx Tx with TMP-SMX or FQ and tailor therapy based on UCx results; Tx for 4-6 weeks in most cases

Question 1126

Monomorphous erythematous papules distributed over face, arms and trunk without open or closed comedones

Answer 1126

Steroid acne

Question 1127

Physical exam maneuver that can help Dx aortic regurgitation

Answer 1127

Left lateral decubitus position - brings enlarged left ventricle closer to the chest wall and causes a pounding sensation and increased awareness of the heartbeat

Question 1128

Symmetrical proximal muscle weakness and erythematous rash on the dorsum of the fingers (Gottron’s sign) and/or upper eyelids (heliotrope eruption)

Answer 1128

Dermatomyositis

Question 1129

Indicators of severe asthma attack

Answer 1129

normal to increased PCO2 values, speech difficulty, diaphoresis, AMS, cyanosis, and ‘silent’ lungs

Question 1130

Blood gas findings that t are suggestive of CHF c.f. COPD

Answer 1130

Hypoxia, hypocapnia, respiratory alkalosis (COPD exacerbation would cause respiratory acidosis)

Question 1131

Medications to avoid in RV MI

Answer 1131

These pts are preload-dependent and should be Tx with IVF; avoid nitrates and diuretics

Question 1132

Most common Sx of mitral regurgitation

Answer 1132

Exertional dyspnea and fatigue; heard best at apex with radiation to the axilla

Question 1133

Nagging epigastric pain worse at night, food intolerance, weight loss, and enlarged nontender gallbladder and icterus is suggestive of …

Answer 1133

Pancreatic cancer

Question 1134

Recurrent chalazion requires … because there is a risk for underlying …; additionally, … is the most common malignancy of the lid margin and may appear similar to a chalazion

Answer 1134

histopathologic examination; sebaceous (meibomian gland) carcinoma; BCC

Question 1135

Beck’s triad a/w cardiac tamponade:

Answer 1135

Hypotension, distended neck veins, muffled heart sounds

Question 1136

Rough, scaly nodule or nonhealing, painless ulcer that develops in setting of a scar or chronic inflammatory lesion

Answer 1136

Squamous cell carcinoma

Question 1137

SCC arising in a wound or burn is a/w an increased risk of …

Answer 1137

metastasis (termed a Marjolin ulcer)

Question 1138

Tx for cellulitis with systemic signs

Answer 1138

IV nafcillin or cefazolin

Question 1139

These pts are more likely to have atypical chest pain and should get a cardiac workup prior to pursuing other pathologies

Answer 1139

Women, elderly, DM

Question 1140

Anabolic steroid use by a man can produce infertility by suppressing the production of …

Answer 1140

GnRH, LH, and FSH

Question 1141

Gradual loss of peripheral vision over a period of years, and eventual tunnel vision

Answer 1141

Open angle glaucoma

Question 1142

Charcot triad and Reynolds pentad

Answer 1142

Fever, jaundice, RUQ pain

AMS, hypotension

Question 1143

HIV + pt has a positive PPD but neg CXR, next step?

Answer 1143

Isoniazid for 9 months + pyridoxine to prevent possible neuropathy

Question 1144

Next step for pt with DVT who has CxIx to anticoagulation (recent surgery, acute hemorrhagic stroke, bleeding diathesis, or active bleeding) or current DVTs after Tx with antiocoagulation

Answer 1144

IVC filters

Question 1145

Many pts w/ biopsy confirmed celiac disease will have negative results on IgA antibody testing due to an …

Answer 1145

IgA deficiency (which is common in celiac disease)

Question 1146

Inflammatory disorder with recurrent high fevers, maculopapular and nonpruritic rash on trunk and extremities, and arthritis

Answer 1146

Adult Still’s disease

Question 1147

Key steps to management of grade 1 and 2 diabetic ulcer

Answer 1147

Proper wound care and debridement

Question 1148

Patients with grade 4 and 5 ulcers need …

Answer 1148

urgent hospitalization and surgical consultation for possible amputation

Question 1149

… alone do not cure diabetic ulcers

Answer 1149

Abx

Question 1150

Intensely pruritic rash often worse at night in the flexor surfaces of wrist, lateral surfaces of fingers, and finger webs

Answer 1150

Scabies (delayed type IV HSN reaction to the mite)

Question 1151

Dx of scabies

Answer 1151

Skin scarpins from lesions revealing mites, ova, and feces under light microscopy

Question 1152

Tx of scabies

Answer 1152

Topical permetrhin 5% cream (applied to neck down and left overnight) or oral ivermectin

Question 1153

Dx of ankylosing spondylitis

Answer 1153

Anteroposterior xray of the sacroiliac joints, which shows fusion of the SI joints and/or bamboo spine

Question 1154

Preferred HIV screening test

Answer 1154

4th generation assay that detects both HIV p24 antigen and HIV Abs

Question 1155

Pts with + assay results for HIV should undergo a confirmatory test with …

Answer 1155

HIV-1/-2 Ab differentiation immunoassay

Question 1156

This type of testing is recommended in pts with negative serological tests and high clinical supsicion of acute HIV

Answer 1156

Plasma HIV RNA

Question 1157

Vasvovagal syncope is usually a clinical diagnosis and needs no further testing; however, in uncertain cases, a … is used to establish Dx

Answer 1157

upright tilt table test

Question 1158

Palpable mass in the epigastrium four weeks after onset of acute pancreatitis

Answer 1158

Pancreatic pseudocyst formation

Question 1159

Preferred means of imaging pseudocysts

Answer 1159

U/S

Question 1160

Drainage of pseudocysts should be performed if …

Answer 1160

persists for >6 weeks, >5 cm in diameter, or becomes secondarily infected

Question 1161

Tx all confirmed or suspected influenza w/i … w/ …

Answer 1161

48 hours; neuraminidase inhibitors (oseltamivir, zanamivir)

Question 1162

Gastrin level of … is Dx of gastrinoma

Answer 1162

> 1000 pg/mL

Question 1163

If gastrin level is elevated, a … should be measured because …

Answer 1163

gastric pH; gastrin may also be elevated 2/2 failure of gastric acid secretion (achlorhydria)

Question 1164

If gastrin levels are not too low or not too high, a … needs to be performed

Answer 1164

secretin stimulation test

Question 1165

… stimulates the release of gastrin by gastrinoma cells

Answer 1165

Secretin

Question 1166

Immediate treatment of choice for patients with symptomatic moderate or severe hypercalcemia

Answer 1166

IV saline hydration

Question 1167

… should also be administered along with saline hydration

Answer 1167

Calcitonin

Question 1168

… are recommended for long-term management in addition to treatment of the underlying cause

Answer 1168

Bisphosphonates

Question 1169

Severe symptomatic HTN with HA, epistaxis, and LVH on ECG

Answer 1169

Coarctation of aorta

Question 1170

How to evaluate for coarctation of the aorta

Answer 1170

• Simultaneous palpation of the brachial and femoral pulses to assess for ‘brachial-femoral’ delay
• Supine bilateral arm (brachial) and prone right and/or left leg (popliteal) blood pressures

Question 1171

Name an example of acquired coarctation of the aorta

Answer 1171

Takayasu arteritis

Question 1172

Decrescendo early diastolic murmur that is high-pitched, blowing in quality, and best heard along the left sternal border at the third and fourth intercostal spaces

Answer 1172

Aortic regurgitation

Question 1173

Most common cause of isolated aortic regurg in young adults in developed countries vs. non-developed countries

Answer 1173

Developed - congenital bicuspid aortic valve

Non-developed - rheumatic heart disease

Question 1174

IVDU causes endocarditis on which side of the heart?

Answer 1174

Trick question: both sides of the heart

Question 1175

Dense intramembranous deposits that stain for C3 but not Ig

Answer 1175

Membranoproliferative glomerulonephritis (AKA dense deposit disease)

Question 1176

Pathophys of MPGN

Answer 1176

Caused by IgG Ab (termed C3 nephritic factor) directed against C3 convertase of the alternative complement pathway –> lead to persistent complement activation and kidney damage

Question 1177

How to DDx b/w primary HIV infection and IM?

Answer 1177

Rash and diarrhea are less common in IM; tonsillar exudate is uncommon in primary HIV (should perform heterophile antibody test before HIV test in those cases)

Question 1178

Compression of spinal nerve roots, resulting in changes in sensation to saddle area, motor innervation to the sphincters, and parasympathetic innervation to the bladder and lower bowel

Answer 1178

Cauda equina syndrome

Question 1179

Cauda equina syndrome vs. conus medullaris syndrome

Answer 1179

Conus medullaris is part of the spinal cord, and so will have UMN signs

Question 1180

Management of cauda equina syndrome and conus medullaris syndrome

Answer 1180

Emergency MRI, IV glucocorticoids, and neurosurgical evaluation

Question 1181

Tick that causes Ehrlichiosis

Answer 1181

Lone-star tick

Question 1182

Acute febrile illness with malaise and AMS not a/w rash; leukopenia and/or TCP and inc. LFTs and LDH

Answer 1182

Ehrlichiosis

Question 1183

Dx of ehrlichiosis

Answer 1183

Intracytoplasmic morulae in WBCs or through PCR testing

Question 1184

Tx of ehrlichiosis

Answer 1184

Doxycycline

Question 1185

Drug of choice for PBC

Answer 1185

Ursodeoxycholic acid (not steroids); liver Tplant is definitive

Question 1186

Eating light bulbs or hair

Answer 1186

Pica (manifestation of iron deficiency anemia)

Question 1187

Oxalate absorption is inc. in …

Answer 1187

Chrohn disease and all other intestinal diseases causing fat malabsorption

Question 1188

It is safe to continue statin therapy in pts with NAFLD

Answer 1188

okay.

Question 1189

DTs occur after … hours of EtOH cessation; Sx include …

Answer 1189

48-96; HTN, agitation, tachycardia, hallucinations, and fever (mortality rate of 5%)

Question 1190

Common choice of Tx for EtOH withdrawal

Answer 1190

Chlordiazepoxide (Librium)

Question 1191

Flaccid bullae that appear spontaneously, tender and painful when they rupture; first appear on oral mucous membrane and rapidly become erosive; Nikolsky’s sign positive; IgG deposits intercellularly in the epidermis

Answer 1191

Pemphigus vulgaris

Question 1192

Tx of pemphigus vulgaris

Answer 1192

Immunosuppressive agents such as azathioprine may be used with prednisone and methotrexate

Question 1193

Type 2 HIT is immune-mediated 2/2 …

Answer 1193

Ab against heparin-PF 4 complexes; causes platelet activation, TCP, and a pro-thrombic state

Question 1194

Wheezing and prolonged expiration indicates …

Answer 1194

bronchoconstriction

Question 1195

Asthma may be exacerbated by … or …

Answer 1195

ASA (esp w/ chronic rhinitis and nasal polyps)

Beta-blockers

Question 1196

… are 2/2 tearing of the bridging veins; … is the most common cause, and … is us. required

Answer 1196

Subdural hematomas; trauma; surgical evacuation

Question 1197

Dx of Entamoeba histolytica

Answer 1197

Serologic testing for Abs; stool microscopy is insensitive by the time a liver abscess has formed

Question 1198

Tx of amebic liver abscess is w/ …

Answer 1198

MTZ; drainage is NOT RECOMMENDED 2/2 high response rate to appropriate antiamebic Tx and the risk of rupture into the peritoneum

Question 1199

In contrast to E. histolytica, … can be Tx w/ …

Answer 1199

Echinococcus; aspiration in combination with albendazole

Question 1200

Primary adrenal insufficiency is characterized by dec. …, …, and …

Answer 1200

cortisol, sex hormone, and aldosterone

Question 1201

Acid base disorder seen with adrenal insufficiency

Answer 1201

Kidney inappropriately loses Na while retaining excessive potassium and hydrogen ions, resulting in non-gap hyperkalemic and hyponatremic metabolic acidosis

Question 1202

Flank pain, low volume voids with or without occasional high volume voids, and (if bilateral) renal dysfunction

Answer 1202

Obstructive uropathy

Question 1203

Chronic bloody diarrhea, abd pain, and CD4 count

Answer 1203

CMV colitis

Question 1204

Tx of CMV

Answer 1204

Ganciclovir; foscarnet in case of failure or intolerance

Question 1205

In pt taking PTU, routine … is not cost effective and not advocated

Answer 1205

monitoring of granulocyte count

Question 1206

Pt taking PTU has fever and sore throat; next step?

Answer 1206

Antithyroid drug should be discontinued promptly and the WBC count measured

Question 1207

Preferred med for HTN a/w ADPKD

Answer 1207

ACEi

Question 1208

Tx for Meiere’s disease

Answer 1208

Lifestyle - avoid EtOH, caffeine, nicotine, foods high in salt
Medication - diuretics, antihistamines, or anticholinergics (if lifestyle mods are unsuccessful)

Question 1209

How does taking oral estrogen affect thyroid hormone?

Answer 1209

Oral estrogens decrease clearance of thyroxine-bind globulin (TBG), leading to inc. TBG levels (oral hormone –> dec. TBG clearance –> inc. TBG levels –> dec. free thyroxine and inc. TSH)

Question 1210

Broncheolar lavage is >90% sensitive and specific for …

Answer 1210

PCP

Question 1211

Photopsia (flashes of light) and floaters (spots in the visual field) w/ “curtain coming down over my eyes”

Answer 1211

Retinal detachment

Question 1212

… is a class III antiarrhythmic agent well known for causing pulmonary fibrosis, thyroid dysfuction, hepatotoxicity, corneal deposits and skin discoloaration

Answer 1212

Amiodarone

Question 1213

The most reliable and predictive sign of opioid intoxication is …

Answer 1213

dec. respiratory rate

Question 1214

Painful red eye and opacification and ulceration of the cornea has typical features of …

Answer 1214

contact lens-associated keratitis

Question 1215

Most cases of contact lens-associated keratitis are due to …

Answer 1215

Gram-negative organisms like Pseudomonas or Serratia

Question 1216

Contact lens-associated keratitis is a … and can lead to …

Answer 1216

medical emergency; corneal perforation, scarring, and permanent vision loss if not addressed promptly

Question 1217

Alopecia, abnormal taste, bullous, pustulous lesions surrounding body orifices and/or extremities, and impaired wound healing

Answer 1217

Zinc deficiency

Question 1218

Most appropriate net step in pt with suspected IE?

Answer 1218

Blood cultures, prior to starting Abx and getting TEE

Question 1219

For acne, one should try … prior to …

Answer 1219

topic Abx (erythromycin); oral ABx (minocycline)

Question 1220

Uric acid stones are most commonly seen in pts with …; they appear … on KUB

Answer 1220

unusually low urine pH (may be 2/2 defect in renal ammonia excretion) and hyperuricosuria; radiolucent

Question 1221

Tx of uric acid stones

Answer 1221

Hydration, alkalinization of urine with potassium citrate, and a low-purine diet

Question 1222

For pts with a single brain mets in a good location, what is the Tx?

Answer 1222

Surgical resection, followed by stereotactic radiosurgery or whole brain radiation therapy to the tumor bed

Question 1223

Syringomyelia is a/w …

Answer 1223

Arnold Chiari malformation type 1

Question 1224

Most common cause of gross lower GI bleeding in adults

Answer 1224

Diverticulosis

Question 1225

Dysphagia which is initially with solids but eventually liquids indicates …

Answer 1225

Mechanical obstruction

Question 1226

Dysphagia with liquids and solids at the onset indicates …

Answer 1226

Motility disorder

Question 1227

Initial test for pt with esophageal motility disorder

Answer 1227

Barium swallow; followed by manometry to confirm Dx

Question 1228

Best nonpharmacologic meausre to decrease BP in overweight individuals who smoke

Answer 1228

Weight loss > smoking cessation

Question 1229

Main mechanism of kidney damage in SLE patients is…

Answer 1229

immune complex-mediated

Question 1230

Young-AA women re at inc. risk of developing …

Answer 1230

SLE (haha, not sarcoid this time)

Question 1231

Fatigue, fever, WL, non-deforming arthritis, oral ulcers, serositis, hematologic abnormalities, proteinuria, and rash

Answer 1231

SLE

Question 1232

Pts >35 years with gross hematuria should be evaluated for …

Answer 1232

urological neoplasms with diagnostic imaging (CT urogram) and cystoscopy

Question 1233

Most common method to confirm Dx of Legionella

Answer 1233

Urine antigen testing

Question 1234

DIP joints, morning stiffness, dactylitis (“sausage digits”), and nail involvement

Answer 1234

Psoriatic arthritis

Question 1235

A dose of … is recommended during each pregnancy regardless of the number of years since prior vaccination

Answer 1235

Tdap

Question 1236

Pap screening recommendations

Answer 1236

Pap smears every 3 years or with a combination of Pap smear and HPV testing every 5 years

Question 1237

Crepitus between the third and fourth toes (Mulder sign) that commonly occurs in runner

Answer 1237

Interdigital (Morton) neuroma

Question 1238

Sudden onset of chest pain, ST segment elevation, holosystolic murmur at apex, and bibasilar crackles, Dx?

Answer 1238

Acute inferior MI with papillary muscle displacement, leading to acute mitral regurg and pulmonary edema

Question 1239

Dome-shaped, firm, and freely movable cyst or nodule with a central punctum (small, dilated, pore-like opening)

Answer 1239

Epidermal inclusion cyst

Question 1240

Pneumococcal conjugate vaccine (PCV13) -

Pneumococcal polysaccharide vaccine (PPSV23) -

Answer 1240

T-cell-independent B-cell response

T-cell-dependent B-cell response

Question 1241

Acute hemolytic transfusion reaction is a medical emergency caused by …

Answer 1241

ABO incompatibility within an hour after the transfusion

Question 1242

Dx of acute hemolytic transfusion reaction

Answer 1242

Positive direct Coombs test, pink plasma, hemoglobinuria, and repeat type and cross-match showing a mismatch

Question 1243

Most common cause of nephrotic syndrome in adults, esp. …

Answer 1243

AA, HIV, heroin, and morbid obesity

Question 1244

Defined as cardiac output divided by body surface area and is … in HF

Answer 1244

Cardiac index; reduced

Question 1245

Life-threatening condition characterized by diplopia, ptosis, weakness of proximal muscles, and weakness of the bulbar muscles and iaphragm leading to respiratory distress

Answer 1245

Myasthenia crisis

Question 1246

Tx of myesthenia crisis

Answer 1246

Intubation for airway protection; AchE used in daily management of MG are held to temporarily avoid excess secretions; IVIG or plasmapheresis (preferred) in addiction to corticosteroids

Question 1247

Most common ocular manifestation of temporal arteritis; detected on funduscopy by the presence of a swollen and pale disc with blurred margins

Answer 1247

Anterior ischemic optic neuropathy

Question 1248

Characteristic lab finding include a prolonged PTT, dec. factor VIII or IX

Answer 1248

Hemophilia

Question 1249

Tx of moderate symptoms of hyponatremia

Answer 1249

Hypertonic saline during the first 3-4 hours

Question 1250

… is characterized by a positive hydrogen breath test, positive stool test for reducing substances, low stool pH and increased stool osmotic gap with no steatorrhea

Answer 1250

Lactose intolerance

Question 1251

2/2 defective heme synthesis, most commonly 2/2 pyridoxine-dependent impairment in early steps of protoporphyrin synthesis in pt taking isoniazid

Answer 1251

Sideroblastic anemia

Question 1252

These are pathognomonic for dermatomyositis

Answer 1252

Gottron’s papules (slightly scaly papules overlying the joints)

Question 1253

Classic Ab a/w dermatomyositis

Answer 1253

anti-Jo-1 and anti-Mi-2

Question 1254

Malignancies most commonly a/w dermatomyositis

Answer 1254

Ovarian, lung, pancreatic, stomach, or colorectal cancers, or non-Hodgkin lymphoma

Question 1255

Brain death is a legally acceptable definition of death, and artificial life support does not need to be continued.

Answer 1255

(Do not legally need family permission to discontinue mechanical ventilation in pt with brain death)

Question 1256

Pts with possible ACS and low risk for aortic dissection should receive … ASAP

Answer 1256

ASA

Question 1257

Pt with recently Dx DVT and has difficulties with warfarin anticoag therapy, has progression of DVT in setting of subtherapeutic INR; next step?

Answer 1257

Rivaroxaban

Question 1258

Rivaroxaban is a … with a rapid MOA that can be used as a single agent in Tx of acute DVT or PE, or pts with recurrent or refractory DVT

Answer 1258

direct factor Xa inhibitor

Question 1259

Rivaroxiban adverse effects

Answer 1259

Carries a higher risk of irreversible bleeding as no antidote is availabel in the event of major hemorrahge

Question 1260

Duration of therapy for Nocardiosis is …

Answer 1260

long (6-12 months)

Question 1261

Multiple, small (usually

Answer 1261

Neurocysticercosis (Taenia solium)

Question 1262

Taenia solium is most common in …

Answer 1262

rural areas with poorer sanitary conditions and where pigs are raised

Question 1263

Chronic Hep C is a/w …

Answer 1263

porphyria cutanea tarda, essential mixed cryoglobulinemia, and membranoproliferative glomerulonephritis

Question 1264

Dx of polycythemia vera

Answer 1264

JAK2 mutation and low EPO levels

Question 1265

S1 is the sound formed by closure of the … valves and improper closure of these cause a …

Answer 1265

mitral and tricupsid; soft sound

Question 1266

Major radiographic features of OA

Answer 1266

Joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts

Question 1267

Constitutional symptoms, embolic phenomenon and echo with left atrial mass =

Answer 1267

Left atrial myxomas

Question 1268

80% of myxomas occur in the …

Answer 1268

left atrium

Question 1269

Tx for atrial myxoma

Answer 1269

Prompt surgical resection to avoid complications of embolization

Question 1270

Preferred modality to Tx ureteral stone …

Answer 1270

U/S or noncontrast spiral CT

Question 1271

Primary intervention proven to slow decline in GFR once azotemia develops

Answer 1271

Intensive blood pressure control

Question 1272

Side effects of androgen use in men

Answer 1272

Depressed testicular function, decreased sperm production, testicular atrophy, gynecomastia, mood disturbances, aggressive behavior

Question 1273

Periorbital edema, myositis, and eosinophilia +/- elevated CK

Answer 1273

Trichinellosis

Question 1274

Trichinella is most common in

Answer 1274

Mexico, China, Thailand, parts of central Europe, and Argentina

Question 1275

Common predisposing conditions to acalculous cholecystitis

Answer 1275

Recent surgery, severe trauma, extensive burns, sepsis or shock, prolonged fasting, TPN, critical illness requiring mechanical intubation

Question 1276

Complications of acalculous cholecysitis

Answer 1276

gangrene, perforation, emphysematous cholecysitis

Question 1277

The development of a new conduction abnormality in pts with IE should raise suspicion for …

Answer 1277

perivalvular abscess extending into the adjacent cardiac conduction pathways

Question 1278

Hydroxychloroquine can cause …

Answer 1278

eye damage (retinopathy, corneal damage)

Question 1279

… is FDA-approved for smoking cessation. It should be used in conjunction w/ … and …

Answer 1279

Bupriopion; counseling and nicotine replacement

Question 1280

Trousseau’s syndrome

Answer 1280

Migratory superficial thrombophebitis

Question 1281

Trousseau’s syndrome could indicate …

Answer 1281

occult visceral malignancy (most likely pancreas, lung, prostate, stomach, colon, and acute leukemias)

Question 1282

When empyema is localized, complex, and has a thick rim, … is the only Tx

Answer 1282

Surgery

Question 1283

CxIx to fibrinolytic Tx

Answer 1283

Recent motor vehicle trauma

Question 1284

Recent onset empyema can be removed via …

Answer 1284

fibrinolytic Tx

Question 1285

Hemi-sensory loss with severe dysesthesia of the affected area, Dx?

Answer 1285

Thalamic stroke

Question 1286

Tx for polymyalgia rheumatica

Answer 1286

Los-dose glucocorticoids

Question 1287

Polymylagia rheumatica is commonly a/w

Answer 1287

giant cell arteritis (they should get much higher-doses of steroids)

Question 1288

Muffled or ‘hot-potato’ voice and deviation of the uvula suggest …

Answer 1288

peritonsillar abscess

Question 1289

Peritonsillar abscess can be fatal via…

Answer 1289

airway obstruction or spread of the infection into the parapharyngeal space, which may lead to involvement of the carotid sheath

Question 1290

Dx of Bartonella

Answer 1290

Clinical, but Ab test or tissue specimen with + Warthin-Starry stain supports Dx

Question 1291

Tx of Bartonella

Answer 1291

5 days of azithromycin

Question 1292

Amenorrhea and galactorrhea in females, hypogonadism in males w/o signs of mass effect

Answer 1292

Microprolactinoma

Question 1293

Primary Tx for all prolactinomas (micro or macro) =

Answer 1293

DA agents (bromocriptine, cabergoline)

Question 1294

What is hyposthenuria

Answer 1294

Impairment of kidney’s ability to concentrate urine

Question 1295

Hyposthenuria is commonly a/w

Answer 1295

Sickle cell disease or trait

Question 1296

… typically appear on CXR as an enlarged or globular cardiac silhouette (“water bottle” shaped) with clear lung fields

Answer 1296

Large pericardial effusion

Question 1297

Imaging modality of choice for AAA

Answer 1297

Abd U/S

Question 1298

Tx of cancer-related anorexia/cachexia syndrome

Answer 1298

Progesterone analogues (megestrol acetate) or corticosteroids are effective at increasing appetite, causing weight gain, and improving well-being

Question 1299

Most common cause of acquired angioedema

Answer 1299

ACEi

Question 1300

Edema of the face, mouth, lips, tongue, glottis, or larynx

Answer 1300

Angioedema

Question 1301

Long-term use of OCPs, anabolic androgen use, or pregnancy can cause …

Answer 1301

hepatic adenoma

Question 1302

This type of skin lesion is common in pt w/ h/o organ tplant or on chronic immunosuppressants

Answer 1302

SCC

Question 1303

Leukocyte esterase in urine indicates …, while nitrites indicate …

Answer 1303

significant pyuria, presence of Enterobacteriaceae

Question 1304

Hydatid cyst is 2/2

Answer 1304

Echinococcus granulosus

Question 1305

Definitive host of Echinococcus

Answer 1305

Dogs

Question 1306

“Eggshell” calcification of hepatic cyst seen on CT scan =

Answer 1306

Hydatid cyst

Question 1307

Tx of hydatid cyst

Answer 1307

Surgical resection under the cover of albendazole

Question 1308

Cherry angiomas are AKA

Answer 1308

Senilie hemangiomas

Question 1309

Strawberry (infantile) hemangiomas grow rapidly and then frequently regress spontaneously by age …

Answer 1309

5-8

Question 1310

Most common presenting Sxs of PML

Answer 1310

Hemiparesis and disturbances of speech, vision, and gait

Question 1311

Classic MRI findings for PML

Answer 1311

Multiple, demyelinating, non-enhancing lesions with no mass effects

Question 1312

Pt who eats rice and subsequently develops N/V w/i 1-6 hrs

Answer 1312

Bacillus cereus (heat-stable toxin)

Question 1313

Pts with DM and inc. baseline Cr are at inc. risk of …

Answer 1313

contrast nephropathy

Question 1314

Acute hyperglycemia can cause blurred vision 2/2

Answer 1314

Myopic increase in lens thickness and intraocular hypotension 2/2 hyperosmolarity

Question 1315

Indicators of flail chest

Answer 1315

Blunt thoracic trauma, respiratory distress despite bilateral chest tubes

Question 1316

Cause of flail chest

Answer 1316

> = 3 adjacent rib fractures that break in 2 places

Question 1317

Acute massive PE looks like … on TTE

Answer 1317

Dilated right ventricular cavity and hypokinesis of RV free wall with sparing of the apex (McConnell’s sign)

Question 1318

Sx of MTX toxicity

Answer 1318

Oral ulcers, acute rise in LFTs, alopecia, pulmonary tox, bone marrow suppression

Question 1319

Common staphylococcal abscess of the eyelid; Tx =

Answer 1319

External hordeolum or stye; application of warm compresses, w/ I&D if resolution does not begin in the next 48 hours

Question 1320

Most common cause of esophageal rupture

Answer 1320

Endoscopy

Question 1321

Dx of esophageal rupture

Answer 1321

Water-soluble contrast esophagram; barium study if water-soluble contrast study is nondiagnostic

Question 1322

Recurrent oral ulcers, recurrent genital ulcers, anterior uveitis and erythema nodosum; positive pathergy test

Answer 1322

Bacet’s syndrome

Question 1323

Tx of Bacet’s syndrome

Answer 1323

Corticosteroids offer Sx relief, but do not protect from progression to blindness or dementia

Question 1324

In pt w/ likely PE, what should be the order of testing vs. Tx

Answer 1324

Anticoagulation should be given PRIOR to Dx testing

Question 1325

Indication for bicarbonate Tx in pt w/ TCA OD

Answer 1325

QRS > 100 msec

Question 1326

How does bicarbonate dec. TCA toxicity?

Answer 1326

Increased pH decreases drug avidity for Na channels, and inc. EC Na+ increases electrochemical gradient across cardiac cells

Question 1327

Tx of warfarin-induced skin necrosis

Answer 1327

Immediate cessation of warfarin and administration of protein C concentrate

Question 1328

Most common renal vascular lesions seen w/ HTN

Answer 1328

arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary tufts

Question 1329

Most common lesions seen w/ DM nephropathy

Answer 1329

Inc. EC matrix, basement membrane thickening, mesangial expansion, and fibrosis

Question 1330

GI Sx, migratory polyarthritis, chronic cough, myocardial or valvular involvement, dementia, supranuclear ophthalmoplegia and myoclonus, Dx?

Answer 1330

Whipple’s disease

Question 1331

HA 2/2 increased ICP are often worse in the …

Answer 1331

morning

Question 1332

Pts should be tested for … before starting MTX

Answer 1332

Hep B, C, TB, and pregnancy

Question 1333

Pts who don’t respond to MTX w/i 6 months should switch to …

Answer 1333

biologics (TNFalpha inhibitors)

Question 1334

First line Tx for non-inflammatory or inflammatory acne

Answer 1334

Topical retinoids w/ organic preparations, or benzoyl peroxide

Question 1335

Severe or recalcitrant acne should be Tx w/

Answer 1335

Oral Abx or isotretinoin

Question 1336

Work-up for patient with Reynaud’s phenomenon

Answer 1336

CBC and BMP
UA
ANA and RF
ESR and C3, C4

Question 1337

pRBCs are not recommended for pts w/ acute GI bleeding who are otherwise stable unless …

Answer 1337

Hgb

Question 1338

Pt needs blood transfusion, but wife walks in and says he’s a Jehovah’s Witness; there is no documentation on him or with his wife; next step?

Answer 1338

Without documentation or if any uncertainty remains, it is advisable not to withhold blood in life-threatening situations

Question 1339

High-grade fever, severe sore throat w/ odynophagia, drooling, and progressive airway obstruction; harsh-shrill (stridor), Dx?

Answer 1339

Epiglottitis

Question 1340

Most common pathogens that cause epiglottitis

Answer 1340

H. flu and GAS

Question 1341

… infections are the leading causes of non-purulent cellulitis; … infections are the leading cause of purulent cellulitis

Answer 1341

Streptococcal (GAS); Staphylococcal

Question 1342

Commonly a/w burst fracture of vertebra; presents w/ total loss of motor function below level of lesion w/ loss of pain and temp on both sides below the lesion w/ sparing of proprioception

Answer 1342

Anterior cord syndrome

Question 1343

Urease-producing bacteria

Answer 1343

Proteus mirabilis, Klebsilla spp, Pseudomonas spp, Providencia spp, Staphylococcus spp, Ureaplasma urealyticum

Question 1344

The presence of … indicates a poor Px for CLL

Answer 1344

TCP

Question 1345

PBC is a/w … (4)

Answer 1345

Severe HLD, hepatobiliary malignancy, malabsorption w/ nutritional deficiencies, metabolic bone disease manifesting as osteoporosis

Question 1346

Most common type of testicular sex-cord stromal tumors

Answer 1346

Leydig cell tumors

Question 1347

… cells are the source of testosterone and can make estrogen

Answer 1347

Leydig

Question 1348

Inc. serum beta-HCG indicates which type of tumor?

Answer 1348

Choriocarcinoma (germ-cell tumor)

Question 1349

Inc. serum AFP indicates which type of tumor?

Answer 1349

Yolk sac tumor (germ-cell tumor)

Question 1350

Recurrent pneumonias in the same anatomic region of lung suggest …

Answer 1350

bronchial obstruction 2/2 underlying abnormality

Question 1351

… can cause cyanide toxicity, which can manifest as …

Answer 1351

Nitroprusside; lactic acidosis

Question 1352

Tx of cyanide toxicity

Answer 1352

Sodium thiosulfate

Question 1353

Which type of thalassemia is more common Mediterranean vs. Southeast Asia

Answer 1353

Beta = Mediterranean
Alpha = SE Asia

Question 1354

Tx for Beta-thalassemia minor

Answer 1354

None

Question 1355

Common extrapulmonary manifestations of Nocardiosis

Answer 1355

Brain and skin involvement

Question 1356

Pernicious anemia/ B12 deficiency can cause inc. …

Answer 1356

intravascular hemolysis

Question 1357

Risk factors for pancreatic cancer

Answer 1357

Cigarette smoking, nonhereditary chronic pancreatitis, and obesity with low physical activity

Question 1358

Malaria PPx in regions w/ high chloroquine-resistant Plasmodium falciparum

Answer 1358

Mefloquine
Atovaquone-proguanil
Doxycycline

Question 1359

Malaria PPx in regions w/ low chloroquine-resistant Plasmodium falciuparum

Answer 1359

Choloroquine

Hydroxychloroquine

Question 1360

Pts with PID should be tested for …

Answer 1360

GC/ chlam, HIV, syph, Hep B, pap smear; Hep C if h/o IVDU

Question 1361

Risk factors a/w diverticulosis complications

Answer 1361

Heavy meat consumption, ASA or NSAID use, obesity, smoking possibly