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Missed Q's Flashcards

1
Q

What presents with diarrhea, constricted visual fields, RF, tachycardia, HTN, and peripheral neuropathy

Treatment?

A

Mercury poisoning

Succimer, dimercaprol, penicillamine

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2
Q

What is chonrdromalacia?

A

Patellofemoral syndrome

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3
Q

Pt that is immunosuppressed has a negative PPD if what?

A

< 5mm

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4
Q

A pt brings a suit against a surgeon and the hospital bc of failure to remove a surgical sponge following surgery, this is called what?

A

Vicarious liability - employers are liable for negligence of their employees

Key word in vignette: AND HOSPITAL

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5
Q

Koilonychia means what?

Seen in what?

A

Spoon nails

Fe def anemia

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6
Q

What is Winter’s formula?

A

Expected CO2 = 1.5*HCO3 + 8 +/- 2

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7
Q

What test has the pt supinate the arm while the elbow is flexed at a 90 degree angle?

Tests what?

A

Yergason

Biceps tendinitis

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8
Q

Sinus tachycardia is rarely above what HR?

A

< 140

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9
Q

Origin of teres major?

Action?

A

Inf angle of scapula

ADDuction and IR of humerus

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10
Q

ABD Xray that shows a double loop sign means what?

Another name for this sign?

MC caused by what?

A

Sigmoid volvulus

Coffee bean

Chronic constipation

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11
Q

What is St John’s wort widely used to treat?

How does it effect enzymes?

A

Depression

CYP3A4 inducer

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12
Q

What are the 5 Major findings of LVH on EKG?

A 
Inc QRS voltage
Inc QRS duration 
LAD
ST-T changes
LA abnormality

R wave amplitude is INC in leads I, aVL and V4-V6

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14
Q

Pt that is aSx until adolescence and then present w/amenorrhea/oligomenorrhea, increased acne, or hirsutism is most likely what?

Obtain what lab?

Treat how?

A

No classical CAH

17-hydroxyprogesterone

Prednisone

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15
Q

What test is described by the pt flex the elbow to 20-30 degrees w/forearm in supination and examiner resist forward flexion of the arm?

Tests what?

A

Speed’s

Bicep tendonitis

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16
Q

What describes gastric mucosal disorder that is assoc w/little or NO inflammation?

Tender point where?

MC cause?

A

Gastropathy

Left 5th ICS - acid TP

NSAID use - look for pt w/OA

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17
Q

Pt that is having a blood transfusion and develops fever, HoTN, tachycardia w/NO lung findings or dec in Hg after 2 hours has what?

A

Transfusion transmitted bacterial infection

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18
Q

Pt w/SAH, how do you tell if the ACOM or the PCOM is involved?

A

ACOM - will have bitemporal hemianopsia

PCOM - will have 1-sided ptosis and mydriasis

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19
Q

HTN is risk factor for what in a pregnant pt?

Causes what?

A

Placenta abruption

Painful bleeding

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20
Q

Nummular means?

Seen in what?

A

Coin-like

Eczema —> round to oval erythematous plaques

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21
Q

What nerve supplies the aDDuctor muscles?

What spinal levels?

A

Obturator n. (L2-L4)

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22
Q

When is tPA contraindicated?

A

If systolic BP > 185 or diastolic > 110

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23
Q

Which SITS muscle ER the shoulder?

A

Infraspinatus

Teres minor

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24
Q

Membranous glomerulopathy is MC in whom?

What major complication?

A

Whites, solid tumors, HepB

Hypercoaguability

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27
Q

Ataxic or cluster breathing is known as what?

Caused by what?

A

Biot’s

Head injury, CNS shit

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29
Q

What is ginkgo biloba used to treat?

MOA?

What is the serious side effect?

A

Dementia, memory impairment, vascular disorders

Inhibits binding of platelet activating factor

Serious bleeding, esp in pts taking anticoagulation or post-op

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30
Q

What is a more virulent bacteria than salmonella typhimurium, lactose(-) rod that directly invades the colon and produces a protein-synthesis inhibiting toxin?

MOA?

A

Shigella dysenteriae

Propels itself through actin polymerization

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31
Q

Granular casts are found in what?

Aka?

A

ATN

Muddy brown

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33
Q

Pt that presents w/ pruritis, blurry vision, and erythromelalgia (burning in hands and feet then blue/red discoloration) has what?

MC causes what?

Treat how?

A

Polycythemia Vera

Budd-Chiari syndrome

Anti-coagulate w/Warfarin

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35
Q

What is characterized by continued pain, allodynia, or hyperalgesia in 1 of the extremities?

Also presents w/what sx?

A

Complex regional pain syndrome

Edema, vasomotor instability, skin changes, dec ROM

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36
Q

How do you calculate the corrected HCO3 in a metabolic acidosis pt to see if there is additional acid/base disturbance?

A

(Measured AG - Normal AG) + measured HCO3

This is the corrected value
Then compare to 24
If > 24, then additional metabolic alkalosis
If < 24 then additional metabolic acidosis

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37
Q

What complex pain syndrome does not migrate and is defined peripheral nerve injury w/hx of Trauma?

A

Type 2

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38
Q

Periosteum elevation in a bone indicates what?

A

Periosteum abscess from osteomyelitis

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39
Q

What are the MC features of nephrotic syndrome?

A

> 3.5 G protein/day
Hypoalbuminemia
Hyperlipidemia
Edema

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39
Q

Where is the duodenal ulcer Ant Chapman point?

Gastric ulcer?

A

Right 8th ICS

Left 5th ICS

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40
Q

What drugs decrease the filtration fraction?

A

Loops
Thiazides
ACEi’s

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41
Q

Where is the Travell trigger point?

It is associated with what?

A

Right pectoralis muscle 5th ICS, medial to nipple line

SVT

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43
Q

What are the MC elevated enzymes in dermatomyositis?

A

CK and Aldolase

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44
Q

What is described by a constant, intense, dull discomfort in the RUQ, epigastric or substernal area that radiates to the right shoulder?

Seen in what?

A

Biliary colic

Cholelithiasis

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45
Q

What is echinacea goldenseal used for?

MOA?

SE’s?

Contraindicated in whom?

A

Stimulate immunity, prevents URIs

Inc synthesis of inflammatory cytokines

N/V, dyspnea, rash, hepatotoxicity

Autoimmune or CT disorders, or with hepatotoxic drugs

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46
Q

What is the only cure for PNH?

A

Alligeneic bone marrow transplant

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47
Q

What Chapman point is located at the Posterior left T3 intertransverse space?

A

Left Upper lobe of lung

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48
Q

What is the definitive management for foreign body extraction in pediatrics?

A

Rigid bronchoscopy

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50
Q

What Chapman reflex is located on the lateral thigh w/in the IT band from the greater trochanter to just above the knee?

A

Colon

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51
Q

What is an infection of the superficial layer of the skin by Corynebacterium minutissimum?

Affects what areas?

A

Erythrasma

Bw digits of foot, skin folds, and other moist areas

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52
Q

What are the 3 primary requirements of EMTALA?

A

Hospital must provide appropriate medical screening exam to anyone coming to ED and requires Dr participation
Hospital must treat and stabilize the emergency medical condition
Hospital must not transfer pt w/emergency medical condition that has NOT been stabilized unless specific criteria are met

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53
Q

Pt with vertigo of a few days and has accompanied or preceded URI most likely has what?

Treat how?

A

Viral labyrinthitis

Meclizine

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54
Q

Pt that has pain with single leg hop/pain radiating into the groin most likely has what?

A

Stress fracture

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55
Q

What age should a child stop using a belt positioning booster seat?

A

8 or older

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56
Q

What are the 5 diagnostic criteria for Kawasaki’s disease?

A 
Changes in Extremities - edema/erythema
Conjuctivitis - freq b/L
Rash
Cervical adenopathy, 1 node > 1.5 cm
Change in oral cavity - lips, tongue

will have a FEVER > 5 days

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58
Q

What are the levels like of the following in vWF?

Platelet count
PT
PTT
Bleeding time

A

Normal
Normal
Prolonged
Prolonged

vWF carries factor 8, and without it factor 8 is degraded easily

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60
Q

When is fibrinolysis indicated in STEMIs?

What evidence?

A

If cardiac intervention CANNOT be performed w/in 90 min

ISIS-2 trial

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61
Q

What is an iodine containing glycoprotein produced by the follicular cells of the thyroid gland and stored as colloid?

A

Thyroglobulin aka colloid antigen

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61
Q

Psoriasis causes what condition in the nails?

A

Onycholysis

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62
Q

Pt with Fe def anemia, what is the level of transferrin?

A

Increased

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64
Q

What study design is useful in gathering info on the Prevalence?

A

Cross-sectional

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65
Q

What presents with proximal symmetric muscle weakness, hyperreflexia, and autonomic changes?

What else about the muscle weakness?

A

Lambert-Eaton

IMPROVES with use

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66
Q

Describe the following in Addison’s disease:

Na
K+
Ca 2+
Cortisol

A

Low
High
High
Low

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67
Q

What is the most sensitive test for ACL diagnosis?

What does this test entail?

A

Lachman better than ant drawer

Pt supine, Flex leg to 30 degrees

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68
Q

Pts w/osteopenia should be started on Bisphosphonates when?

A

10-year probability of a hip fracture of 3%

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69
Q

How do NSAIDs effect kidney filtration?

A

Block PGs at afferent arteriole causing constriction and leading to DECREASED RPF and decreased GFR and therefore no change in FF

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70
Q

Secondary adrenal insufficiency occurs due to what?

A

Anything involving the pituitary and interferes w/ACTH secretion

Dec in ACTH secretion leads to decrease in the activity of the adrenal glands to produce cortisol

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72
Q

What lab values does rickets present with?

A

Inc ALP
Inc PTH
Dec PO4

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72
Q

What is a common complication of untreated thyroid storm?

What is 1st line treatment?

Why?

When should you give Iodine?

A

AFib

PTU

Methimazole CANNOT inhibit peripheral conversion of T4 to T3

1 hour after giving PTU

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73
Q

MC SE’s of Memantine?

MOA?

A

HA, confusion, dizziness

NMDA receptor antagonist

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73
Q

What causes anterior knee pain that presents with trouble going up and down stairs and gets better with physical activity?

Due to what pathology?

A

Patellofemoral syndrome

Weakness of Vastus medialis muscle

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73
Q

Pt that has RUQ pain, jaundice and palpable GB in the RUQ has what?

A

Choledocolithiasis

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74
Q

Tenderpoint medial to ASIS indicates what?

A

Psoas syndrome

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76
Q

What is the only muscle that opens the vocal cords?

A

Posterior cricoarytenoid muscle

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77
Q

LP in GBS shows what?

A

Increased protein, NORMAL cell count

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78
Q

What is Waddell sign indicate?

A

Malingering

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81
Q

Pt w/widespread skin rashes/discoloration that glows red fluorescent when exposed to UV light has what?

Treat how?

How else?

A

Erythrasma

PO erythromycin

Topical clindamycin if localized

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82
Q

What herbal supplement can render OCPs ineffective?

A

St John’s wort

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83
Q

What causes failure of bone resorption that leads to thickened, dense bones that are prone to fracture?

Lab values of Ca?
PO4?
ALP?

Xray shows what?

A

Osteopetrosis

ALL normal

Erlenmeyer flask deformity

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83
Q

What is acute Cholecystitis?

A

Inflammation of the GB that results from OBSTRUCTION of the cystic duct from gallstones

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84
Q

What is the formula for filtration fraction?

A

GFR / RPF

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85
Q

What is defined as the intentional act on the part of the caregiver to fail to respect a pt’s advance directive?

A

Battery

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86
Q

What is the MC outcome in a pt w/ADPKD?

A

Hemodialysis

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87
Q

Age group for Berger disease?
When do symptoms present?

PSGN?
When do symptoms present?

A

10-30 y/o
Within a day of an uri

3-14 y/o
2 weeks after infection

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88
Q

Which molar pregnancy has fetal tissue?

A

Partial

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88
Q

Patient with Addison’s disease, what are the levels of renin like?

Aldosterone?

A

Inc

Dec

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89
Q

What presents w/elevated IgM, anemia, and blurry vision with Raynaud phenomenon?

How to treat?

A

Waldenstrom macroglobulinemia

Plasmapharesis

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89
Q

Pt presents with 3rd trimester bleeding w/out contractions or fetal distress, what is the most likely Dx?

D/t what?

A

Placenta previa

Previous C section

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89
Q

Murphy’s sign tests for what?

A

Acute cholecystitis

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90
Q

What is a common occurrence in athletes who perform overhead activities repeatedly and have a + Neer’s and Hawkins test?

D/t what?

A

Impingement syndrome

Compression of supraspinatus and associated bursa in the subacromial space

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91
Q

Woman in her 30s that presents with ascites, jaundice, and abdominal pain and was recently pregnant likely has what?

A

Budd-Chiari

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94
Q

How do ACE-i’s effect FF, GFR, and RPF?

A

They dec AgII which leads to an increase in RPF, no change in GFR and therefore a DECREASE in FF

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95
Q

What is Beck’s syndrome?

What symptoms?

A

Anterior spinal artery syndrome

B/L loss of pain/temp and spastic paresis below the lesion w/b/L flaccid paralysis at level of lesion

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96
Q

How long should a child be in a rear facing car seat in a car?

A

< 2 years old

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97
Q

What is a KEY feature of central pontine myelinolysis?

How do you prevent this condition?

A

Horizontal gaze palsy

Correct w/NS (NOT fluid restriction) at a rate no > than 10 mmol/L/24 hours or .5 mEq/L/hr

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98
Q

What does tertiary adrenal insufficiency result from?

A

20mg or more of prednisone per day for more than 3 weeks

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99
Q

Acceptable BPs in pts > 60 years old is what?

A

Less than 150/90

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100
Q

MOA of salmonella typhimurium?

A

Elicits a host immune response that upregulates intracellular cAMP

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101
Q

Hemophilia A is what?

Describe the PT?
PTT?
Bleeding time?
Plt count?

A

Factor 8 deficiency

All normal except the PTT is increased

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102
Q

Loop diuretic use is associated w/what acid-base disturbance?

How/why?

A

Metabolic alkalosis

Loss of Na w/loss of HCO3, dec renal perfusion leading to elevated Angiotensin and Aldosterone levels

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103
Q

Child that develops tremors and renal insufficiency with mental status changes, muscle weakness in extremities has what?

A

Mercury poisoning

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103
Q

ITP lab values are what in the following:

PT
PTT
Bleeding time
Plt count

A

Normal
Normal
Inc
Dec

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103
Q

How do NSAIDs effect filtration fraction?

A

No effect bc they decrease RPF and GFR

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104
Q

What presents in neonates as a bulging blue domed, translucent membrane at the level of the vaginal introitus and can lead to urinary obstruction?

Best way to image?

A

Imperforate hymen

US

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105
Q

When is Persantine and regadenoson testing indicated?

When is it contraindicated?

If contraindicated, use what instead?

A

Baseline ECK is uninterpretable - LBB or paced rhythm

COPD

Dobutamine

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106
Q

What Grade of a study means that it is harmful without benefits for pts?

A

D

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106
Q

When can children sit in the front seat?

A

Older than 13

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106
Q

Leg length discrepancies of what value may be treated with an in-sole shoe lift?

A

< 2 cm

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107
Q

What is panax ginseng (Asian ginseng root) used to treat?

MC SE?

A

ED/sexual dysfunction, T2DM, fatigue

Inability to sleep

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108
Q

A pt is scheduled to undergo an appendectomy, during the procedure a previously unknown ovarian mass is noted and removed, what is this called?

A

Battery

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108
Q

What is more common, lateral or medial meniscus tears?

A

Medial by 3x as much

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109
Q

What is the MC type of vulvar cancer?

Presents in whom?

A

SCC

Post-menopausal women

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109
Q

Pt w/FUO, what are the most likely causes?

A

Collagen vascular disease (22%)
Chronic infection (16%)
Malignancy (7%)

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109
Q

What is the MC cause of jaundice w/in the first 24 hours of delivery?

What is the rule for total bilirubin levels?

A

ABO incompatibility

5 mg/dL per 24 hours

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109
Q

Saw palmetto is used to treat what?

SE’s?

A

BPH

Mild - HA, nausea, dizziness

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109
Q

What bacteria is a lactose-negative, hydrogen sulfide-producing g(-) bacteria?

Which similar bacteria does NOT produce hydrogen sulfide?

A

Salmonella enterica typhimurium

Shigella dysenteriae

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111
Q

Pt with preeclampsia before 20 weeks, uterine enlargement, disproportional fundal height indicate what?

Treat how?

A

Molar pregnancy

Dilation and evacuation

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112
Q

What is the indication for a carotid endarterectomy?

A

Carotid stenosis of 70-99%

If 100% occluded, NO benefit

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113
Q

What is the CSF like in FUNGAL meningitis?

Cell count?
Cell type?
Pressure?
Glucose?
Protein?
A 
10-100s cell count
Lymphocyte predom
Inc pressure
Dec glucose
Inc protein
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114
Q

What will the ristocetin assay be in vWF pts?

Bernard-Soulier?

A

Low

Normal

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115
Q

How do you treat bacterial meningitis d/t Grp B strep in a 5 day old infant?

A

Ampicillin + gentamicin
OR
Ampicillin + cefotaxime

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116
Q

After a fracture of the scaphoid has been treated, what is the best imaging to verify osseous union?

A

CT

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117
Q

Multiple myeloma can cause what type of RTA?

What specific features?

What effect on bicarbonate?

A

Type II - proximal

Hypokalemia and acidic urine (< 5.5)

Dec reapportion by the prox tubule

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118
Q

What is the MC allergen in the summer?

Fall/winter?

A

Grass (rose fever) or trees

Ragweed (hay fever)

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119
Q

What causes restrictive cardiomyopathy that is a result of eosinophil degranulation leading to cardiac necrosis and fibrosis?

A

Loaf flyer endocarditis

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120
Q

In 5-alpha-reductase deficiency what is the testosterone to DHT level?

Present how?

A

Elevated testosterone
DHT is reduced

Ambiguous genitalia at birth

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121
Q

What is the treatment for tension pneumothorax?

A

Immediate needle decompression followed by tube thoracostomy

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122
Q

Lactulose MOA?

A

Broken down by ABD flora into lactic acid and organic acids

Lactic acid lowers fecal pH which promotes the diffusion of ammonium into ammonia (NH3) into the lumen

Also reduce amount of bacteria in colon

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123
Q

How to control ascites in alcoholics?

A

Diuretics and Na restriction

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124
Q

Pt has a confirmed osteosarcoma, what imaging should take place next?

A

CT chest —> 80% go to lungs

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125
Q

What is the non-surgical conservative treatment for Achilles’ tendon rupture?

A

Long-leg cast w/20 degrees of plantarflexion for 2 weeks, followed by progressive weight bearing and therapy

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126
Q

Physicians acting as Good Samaritans have immunity to what?

A

Ordinary negligence

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127
Q

What stool osmotic gap indicates a secretory diarrhea?

A

< 50

Think: 5 looks like a S, therefore —> secretory

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128
Q

Pt that has hematuria, polyuria, and BPH may have what?

Further testing how?

A

Urinary bladder diverticulitis

VCUG

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129
Q

What causes a progressive, systemic CT disorder that affects striated muscle fibers and affects pts bw ages of 50-70 and is more common among females than males?

Describe the labs

A

polymyositis

Inc CK, Inc aldolase, + anti-Jo-1 Ab

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130
Q

How to treat hyperthyroidism in pregnant pt in 1st trimester?

2nd and 3rd?

A

PTU

Methimazole

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131
Q

Pt that is bit by a cat has fatigue and generalized body aches, what bug is it?

Describe it (g+, g-, shape, etc)

What is the normal treatment?

A

Pateurella

G(-) bacillus

Augmentin

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132
Q

What is the MC cause of IE?

A

Staph aureus

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133
Q

What is complex regional pain syndrome?

How many stages?

A

Disorder of extremities characterized by pain, swelling, limited ROM, vasomotor instability, skin changes, patchy bone demineralization

3

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134
Q

What test is described by passively flexing the pt’s shoulder to 90 degrees then IR the shoulder?

Specific for what?

A

O’Brien’s test

Superior labral anterior to posterior tear

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135
Q

What is subclinical hyperthyroidism?

Associated w/what risks?

A

Low TSH
Normal T4
Normal total/free T3

AFib, dec bone mineral density

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136
Q

Hyperthyroid symptoms with hoarseness indicates what?

Why?

A

Graves

Goiter irritates RLN

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137
Q

Pt with hyperthyroid symptoms d/t post-viral inflammatory process has what?

What happens later?

A

Subacute [graulomatous] thyroiditis (de Quervain’s)

Becomes hypothyroid

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138
Q

What thyroid problems may occur 2-6 months postpartum?

What else can cause it?

A

Thyrotoxicosis

Infection, malignancy, hyperythyroidism

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139
Q

What is Plummer’s disease known as?

Prevalence biggest in whom?

What is seen on thyroid scan?

A

Toxic multi nodular goiter

Older people w/decreased iodine

Patchy uptake

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140
Q

Chapman point at the TP of T2 indicates what?

A

Thyroid pathology

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141
Q

Chapman point at proximal right thigh indicates what?

A

Crohn’s

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142
Q

Pt is taking prednisone long term for some health problems. He wants to do an elective GB removal. What should be done prior to surgery?

Why?

A

Increase prednisone dose

Pts on long-term steroids are at risk for Adrenal Insufficiency during times of stress (surgery)

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143
Q

What level evidence is the strongest? What kind of study has this evidence?

Weakest? What kind of study?

A

1, randomized, controlled, double-blind

3, case report and case series

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144
Q

What is another name for smudge cells?

Seen in what?

A

Ruptured cells

CLL

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145
Q

Auer rods are seen in what?

A

AML

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146
Q

What presents MC in men > 55 w/Asx leukocytosis w/WBC > 50,000, HSM, anemia?

A

CLL

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147
Q

What is the DeBakey type 1?

A

Ascending aorta, arch, and descending thoracic aorta

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148
Q

What is the DeBakey type 2?

A

Ascending aorta ONLY

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149
Q

What is the DeBakey type 3a?

A

Descending thoracic aorta distal to Left subclavian artery and proximal to celiac artery

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150
Q

What is the DeBakey type 3b?

A

Thoracic and ABD aorta distal to left subclavian artery

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151
Q

Hemodynamically stable pt w/sustained VTach gets what?

A

Amiodarone

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152
Q

Pt w/hemodynamically stable SVT, what is 1st line treatment?

If unstable?

A

Vagal maneuver, then adenosine

synchronized cardioversion

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153
Q

Generally speaking, what is the order of treatment when there are multiple SD’s?

A

Correct thoracic vertebral SD 1st bc it can improve other dysfx

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154
Q

Varying degrees of microcytosis with abnormally large central pallor?

A

Fe def anemia

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155
Q

Erythrocyte with a central color spot in the area of pallor is what?

Seen in what condition

A

Target cell

Alpha-thalassemia

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156
Q

What conditions can cause acquired sideroblastic anemia?

A

Lead
Drugs - INH, EtOH, chloramphenicol
collagen vascular disease
Neoplasm

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157
Q

What rbcs have a regular outline and lack central pallor?

Can be seen in what condition?

A

Spherocytes

AIHA

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158
Q

Within the carotid sheath, where does the IJV lie anatomically?

A

Lateral to the common carotid

Anterior to the vagus n.

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159
Q

How does a child w/mild dehydration present?

How much approx volume loss?

Best 1st treatment?

A

Slight dry mucous membranes

3-5%

PO rehydration

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160
Q

How does moderate dehydration present in children?

Approx how much volume loss?

A

Tachycardia, deep respirations, reduced skin turgor, irritability, sunken fontanelle, dec urine output

6-9%

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161
Q

How does severe dehydration present in children?

Approx how much volume loss?

A

HoTN, cap refill > 3s, cool skin, lethargy, tachypnea

> 10%

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162
Q

What causes normal exercise tolerance with ST segment elevation w/out evidence of MI seen on echo?

What is the pathophysiology?

A

Prinzmetal aka variant angina

Coronary artery vasospasm

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163
Q

Transient, monocular loss of vision lasting a few minutes followed by complete recovery is called what?

Most often d/t what?

A

Amaurosis fugax

Retinal emboli dislodged from i/L carotid a.

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164
Q

Pt that has kidney stones, what is V. Important that they do as an outpt?

A

Filter urine to analyze the stone

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165
Q

How do you set up the pt for reciprocal inhibition ME treatment?

A

Put the pt into their DIRECT barrier

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166
Q

Fall backward onto hand results in what SD?

Fall forwards?

A

Anterior radial head

Posterior radial head

It is REVERSED

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167
Q

What tendons are irritated in DeQuervain’s tenosynovitis?

A

APL

EPB

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168
Q

Pt that is presenting with a large bowel obstruction, what is the MC cause?

A

Neoplasm

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169
Q

What is the best initial step in w/u of normal pressure hydrocephalus?

A

Non-Con CT

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170
Q

Young girl that presents w/precocious puberty that has a negative LH response on leuprolide stimulation test indicates what?

Therefore need to do what to w/u?

A

Peripheral cause

US ovaries and adrenals

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171
Q

Lithium use during pregnancy can cause what?

A

Ebstein anomaly - tricuspid leaflets do not close properly, leads to enlarged heart
Tricuspid atresia

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172
Q

Pt has subacromial bursitis, what is the preferred treatment?

Why?

A

Subacromial steroid injection over intra-articular

Less bursal inflammation

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173
Q

What may present with pain over the acromion, that is poorly localized, and can be exacerbated by overhead activities and has a positive Neer’s and Hawkin’s test?

A

Subacromial bursitis

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174
Q

MC causes of duodenal ulcer?

A

H. Pylori infection

NSAID use

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175
Q

What is the best test used to diagnose CTS?

A

Phalen’s

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176
Q

Hypospadias is associated with what else?

A

1 - chordee: ventral curvature of the penis

Also, cryptorchidism and inguinal hernias

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177
Q

What is 1st line treatment for stable angina?

Adjunct treatment?

A

Beta blockers

CCBs

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178
Q

What is a congenital abnormality in a newborn that is a mass and is edematous, dark in color, and is covered by a gelatinous matrix of greenish material?

Where is it located?

A

Gastrochisis

LATERAL to midline

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179
Q

What child condition causes exopthalamos, macroglossia, gigantism, hyperinsulinemia, and hypoglycemia?

What is else is associated with it?
What is seen in utero?

A

Beckwith-Weidmann

Omphalocele
Polyhydramnios

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180
Q

What causes diarrhea and inability to extend the wrist in an adult pt?

Treat with what?

A

Pb poisoning

EDTA or dimercaptosuccinic acid

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181
Q

Young female that comes to the ED for passing out after standing for 2 hours and felt lightheaded, sweaty, and anxious is caused by what?

A

Vasovagal

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182
Q

What is another name for the Patrick test?

Used for what?

A

FABERE

Sacroilitis or OA of the hip

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183
Q

What is a result of severe hypothyroidism leading to AMS, hypothermia, respiratory depression, bradycardia, HoTN, hyponatremia, and hypoglycemia?

Need to check what else?

Treat how?

A

Myxedema coma

Serum cortisol to check for co-existing A.I.

IV thyroxine (T4) and hydrocortisone

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184
Q

What is a sclerosing lesion of the breast that may mimic malignancy on mammography?

A

Radial scar

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185
Q

What is a hereditary form of glomerularnephritis that shows BM splitting on electron microscopy?

Presents w/how much proteinuria a day?

A

Alport syndrome

< 3.5 g/day as with ALL nephritic syndrome

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186
Q

Malignant hyperthermia is d/t what drug?

What mechanism?

A

Succinylcholine

Massive influx of intracellular Ca levels and a hypermetabolic state

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187
Q

What is the MC compulsion in OCD?

A

Repetitive washing (60%)

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188
Q

Pt that has SVT and is unconscious and unstable, treat how?

A

Synchronized cardioversion withOUT sedation

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189
Q

What type of Salter-Harris fracture is described through the growth plate (physis)?

Also called what?

What is spared?

A

Type 3

Tillaux fracture

Metaphysis

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190
Q

What is the mneomnic for Salter-Harris fractures?

Describe each 1

A

SALTR - slipped, above, lower, through, ruined
1 - slipped (growth plate)
2 - fracture extends ABOVE the physeal plate, involves the metaphysis
3 - through the growth plate and epiphysis, spares metaphysis
4 - through growth plate (physis), metaphysis, and epiphysis
5 - complete crush injury of all 3

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191
Q

What is the MC site of vaginal injury in a sexual assault victim?

A

Posterior fourchette

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192
Q

Pt in asystole is given epinephrine and is check 3 minutes later, what should be given this time?

A

1 mg of Epi every 3-5 minutes

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193
Q

What special fracture involves fractures of the maxilla, nasal bones, and medial aspects of the orbits?

A

Le Fort II

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194
Q

What special fracture involves only the maxilla at the level of the nasal fossa d/t direct blow or impact?

A

Le Fort I

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195
Q

What is a complete craniofacial disjunction that involves the maxilla, zygoma, nasal bones and bones fo the cranial base, midface will be “floating”?

A

Le Fort III

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196
Q

What is the most important criteria to monitor for determining replacement fluids in burn victims?

What is the goal?

A

Urine output

.5 mL/kg/hour

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197
Q

Pt that has Right-sided torticollis will present how?

Why?

A

SB to right > SB to left
Rotation Left > Rotation Right

SCM SBs towards, Rotates AWAY
Spasm of Right SCM will SB towards more and rotate away more

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198
Q

What is the parkland formula?

A

%BSA x weight (kg) x 4 = mL fluid over 24 hours

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199
Q

Hypotonia, decreased activity, macroglossia, and umbilical hernia indicate what?

Can lead to what?

A

Hypothyroidism

Mental retard

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200
Q

How does supination of the foot cause the fibular head to move?

A

Posteriorly

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201
Q

How do you treat an anterior fibular head with HVLA?

A

Thenar eminence placed over anterior aspect of proximal fibula, Thrust anterior to posterior

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202
Q

What is an osteochondral defect in the 2nd metatarsal head?

A

Frieberg’s infraction

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203
Q

What involves osteonecrosis of the tarsal navicular, presents in childhood?

A

Kohler’s disease

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204
Q

What involves osteochondrosis of the capitellum, common in little league baseballers?

A

Panner’s disease

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205
Q

What involves osteochondrosis at the insertion of the Achilles’ tendon on the calcaneal tuberosity, seen during rapid growth in the young?

A

Sever’s disease

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206
Q

What involves AVN and collapse of the lunate, common with repetitive compressive loading of wrist?

A

Kienbock’s disease

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207
Q

What can be taken to prevent uric acid stone formation?

MOA?

A

Potassium citrate

Alkalinzes the urine

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208
Q

What is the preferrred treatment for cutaneous larva migrans?

A

Thiabendazole

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209
Q

Young smoker w/“asthma attack” and family history of liver disease has what?

A

Alpha 1 anti-trypsin

210
Q

What has broad staph, strep and enterococcus coverage?

A

Cephalexin

211
Q

How do you set up a pt for Spuhrling’s maneuver?

A

SB and extend towards the affected side

212
Q

30 year old woman that complains of pelvic pain, pain with intercourse, and pain during menses that radiates to her rectum has what?

A

Endometriosis

213
Q

What is the treatment for chancroid?

A 
1 PD dose azithromycin 
1 IM dose cetriaxone
1 week of erythromycin 
OR
3 days of Cipro
214
Q

What is Chadwick’s sign?

What is Goodell’s sign?

Ladin’s sign?

A

Blue discoloration of cervix and vagina —> pregnancy

Softening of vaginal portion of cervix

Softening at junction of cervix and uterus

215
Q

What is characterized by a rigid thoracic kyphosis, vertebral wedging, and degenerative end plates?

Treat how?

A

Scheuermann disease

PT and OMT

216
Q

What does genu recurvatum mean?

A

Hyperextension of the knee PAST 0 degrees

217
Q

Normal Q angle is what?

Greater than normal indicates what?

A

14-17 degrees

Genu Valgum

218
Q

How much weight should a underweight pregnant pt gain? What BMI is underweight?

Normal weight? What BMI?

Overweight? What BMI

Obese? What BMI?

A

28-40 lbs, < 18.5

25-35 lbs, 18.5 to 24.9

15-25 lbs, 25-29.9

11-20 lbs, > 30

219
Q

What lab value is commonly elevated in pts with HIV and PCJ infection?

A

LDH

220
Q

What nerves innervate the hamstring muscles?

A

Common fibular (short head of biceps femoris ONLY) and tibial branches of the sciatic nerve

221
Q

Ankle plantarflexion effects the fibular head how?

A

Posterior fibular head

Occurs w/supination of foot

222
Q

How are Anterior tenderpoints treated with counterstrain?

Posterior?

A

Flexion, SB towards lesion

Extension, SB away from lesion

223
Q

What medicine can cause hypomagnesemia?

What are KEY symptoms to make a diagnosis?

A

Mycophenolate
Loops
Thiazides
PPIs

Vomiting and diarrhea

224
Q

How can you treat hypomagnesemia?

Treatment based on what?

A

IV magnesium sulfate or PO magnesium oxide

Severity of symptoms like tetany, seizure, cardiac abnormalities, hemodynamic instability

225
Q

Pt with coffee ground emesis has an EGD that shows multiple duodenal ulcers, what must you rule out?

If Gastric ulcers?

A

H pylori and NSAID use

Cancer

226
Q

Pt presents w/neutropenic fever and possible source of infection, what drugs to use?

If it has been 3-5 days add what?

A

Vanc and Ceftazidime (or cefepime)

Antifungals - fluconazole

227
Q

What are the 2 MC sources of infection in neutropenic fever?

What organisms?

A

G+ skin flora and G- enteric flora

Staph epidermidis

228
Q

Where is the high ilium tenderpoint?

How to treat with counterstrain?

A

1.5 inches lateral to PSIS

Pt prone, dr on side of dysfx, Hip extended and leg ER

229
Q

What is a well-defined Hypoechoic mass on US in the scrotum of young male?

What lab value?

A

Seminoma - germ cell tumor

High hCG (in the 100’s)

230
Q

What presents as a Non-homogeneous testicular mass w/calcifications, cystic areas, and insisting margins?

What lab value?

A

Choriocarcinoma

hCG in the 1000s

231
Q

What Chapman point is located on the left proximal femur?

A

Sigmoid colon

232
Q

Pt that has a posterior urethral injury that cannot void and has lower ABD pain should be managed how?

A

Placement of suprapubic catheter

Fix the injury weeks to months after stabilization

233
Q

What is the treatment for a black widow spider bite?

A

Anti venom

Apparently calcium gluconate is no longer used?

234
Q

Pt that has difficulty carrying out ADLs and path exam shows has brain clusters of round, dense cells w/eosinophilia core surrounded by a clear halo has what?

A

Lewy body dementia

235
Q

Leukoaraiosis is another term for what?

Seen in what disease?

A

White matter disease

Vascular dementia

236
Q

Well-defined solid mass of the breast in a woman 15-35 indicates what?

Need to do what?

Can appear during what?

A

Fibroadenoma

Core needle biopsy

Pregnancy

237
Q

How to decrease intensity of HOCM?

A

Beta blocker

238
Q

How do you treat anatomical short leg with heel lift in an old pt?
How to increase, what is the goal?

Young pt?
What is the goal?

A

1.5mm (1/16’’)
Increase q2 weeks by 1.5mm until full distance reached

3.2mm (1/8’’)
Increase by 3.2mm until 1/2 to 3/4 distance reached

239
Q

When is daytime incontinence achieved in children?

A

85% at 30 months

98% at 36 months

240
Q

What is vitamin B2?

Symptoms of deficiency?

A

Riboflavin

Corneal vascularization and cheilosis

241
Q

B1 deficiency occurs MC in whom?

Causes what sx?

A

Alcoholics and those malnourished (refugees)

Wernicke-Korsakoff, dry beriberi (muscle wasting and neuritis), wet beriberi (dilated cardiomyopathy and edema)

242
Q

What does wet beriberi cause?

D/t what?

A

Dilated cardiomyopathy and edema

B1 def

243
Q

What does Dry beriberi cause?

D/t what?

A

Muscle wasting and neuritis

B1 def

244
Q

Encephalopathy, ophthalmoplegia and ataxia indicate what?

D/t what

A

Wernicke’s encephalopathy

B1 - thiamine deficiency

245
Q

Pt with pain in the shoulder after being kicked in the chest has referred pain from what?

A

Phrenic nerve

246
Q

Infant born w/respiratory distress and CXR that shows b/L patchy opacities has what?

What is a RF?

Baby at risk for what?

A

Meconium aspiration syndrome

Post term pregnancy

Persistent pulmonary HTN

247
Q

Maternal HTN carries what risks for baby?

A

Placental abruption

IUGR

248
Q

6 week pregnant pt is exposed to lumbar xray, what is the risk to the fetus?

A

Low to No risk

249
Q

What Cobb angle indicates scoliosis?

What Cobb angle should OMT/PT be used?

A

> 10 degrees

10-20 degrees

250
Q

When should spinal bracing be used for scoliosis pts?

Surgery?

A

20-45 degrees

> 45 degrees

251
Q

Decreased pulmonary VC may develop in pts w/Cobb angle greater than what?

A

60 degrees

252
Q

What are the MC etiologies of SAH?

A

Rupture of berry aneurysm

AV malformation

253
Q

What are the MC cause of pyogenic liver abscesses?

A

Polymicrobial - mixed enteric facultative and anaerobic species

254
Q

Pt that is anxious and on multiple meds that presents w/ataxia, vertigo, fatigue, HA, insomnia, irritability, nausea, tremor, vomiting has what?

A

Discontinuation syndrome from SSRI —> look for paroxetine

255
Q

Pt with elevated LFTs appearing 8 weeks following exposure to HepB is in what stage?

What are his HepB serology markers?

A

Active infection

HBsAg + HBeAg + anti-HBc (IgM)

256
Q

What is the HepB serology of a pt w/chronic infection and a high circulating viral load?

A

HBsAg + anti-HBc (IgG)

257
Q

What is the HepB serology of a pt in the window period?

How long is the window period?

A

Anti-HBc (IgM) ONLY

6 months

258
Q

How do you diagnose DDH in baby?

A

Under 2 weeks wait until 2 weeks or older
2 weeks - 4 months: US of hip
After 4-6 months - plan xray

259
Q

Alpha angle < 60 degrees indicates what?

A

DDH in baby, find out in US

260
Q

Inversion ankle sprain causes what kind of cuboid dysfunction?

Treat with HVLA how?

A

IR (dropped) cuboid

ER

261
Q

How does handgrip effect the intensity of MR?

A

Increases

262
Q

Shaken baby syndrome presents w/what eye symptoms?

A

Vitreous/retinal hemorrhages

263
Q

What is the best study to order if you suspect child abuse?

A

Skeletal survey

264
Q

Gout has what kind of aspirate (watery or purulent)?

Birefringence? Shape?

Wbc?

A

Watery

Negatively, needle-shaped

Wbc < 50,000

265
Q

PseudoGout has what kind of aspirate (watery or purulent)

Birefringence? Shape?

Wbc?

A

Watery

Positively, rhomboid-shaped

< 50,000

266
Q

Septic arthritis has what kind of aspirate (watery or purulent)

Birefringence? Shape?

Wbc?

A

Purulent

No crystals

> 50,000

267
Q

Elderly male that presents w/symptoms of urinary outlet obstruction, PSA > 10 and/or abnormal prostate exam should have what?

A

TRUS - transrectal ultrasound guided biopsy

268
Q

What is the treatment for Fe def anemia?

Where will it be absorbed?

A

PO ferrous iron

DMT-1 in the duodenum

269
Q

Injecting a steroid into the subacromial space via what method?

A

Inferior to posterolateral edge of the acromion and direct it medially

270
Q

How do you inject a steroid into the AC joint?

A

Insert needle superior to Anterolateral edge of the acromion, angled perpendicularly to junction of acromion and distal clavicle

271
Q

Which vein in the LE has the highest potential for embolism to cause a PE?

A

Femoral

Most proximal have highest probability

272
Q

Pts w/neutropenic fever must be covered for what organism?

If fever persists for several days to even week, what must be done?

A

Pseudomonas

Add broad spectrum anti-fungal - amphotericin B

273
Q

Rai staging used for what?

What is stage 0?

1?

2?

A

CLL

Lymphcytosis >15 x 10^9

Lymphocytosis + LAD

Lymphocytosis + SM

274
Q

Rai stage 3 means what?

4?

A

lymphocytosis + anemia

Lymphocytosis + low platelets

275
Q

Giant cells w/bilobular nuclei and eosinophilic nucleoli are what?

Seen in what?

A

RS cells

Hodgkin’s disease

276
Q

Plasma cells w/fried egg appearance indicates what?

PAS staining IgM deposits around nucleus of plasma cells means what?

A

Multiple myeloma

Dutcher bodies - seen in Waldenstrom’s

277
Q

What are the attachment sites of the dura?

A

Foramen magnum
C2, C3
S2

278
Q

Any medical device failure or malfunction needs to be reported to whom?

A

FDA

279
Q

Hypoechoic findings on US mean what?

A

Dark area - suspicious for malignancy

280
Q

What is the Apprehension test?

Tests for what?

A

Shoulder goes into Extension, ABduction, External rotation

Shoulder dislocation

281
Q

Baby has trouble latching, what CN should treatment be directed at?

A

CN 12

282
Q

PTT that is prolonged but corrects w/mixing study means what?

Describe mixing study

A

Hemophilia A

Add clotting factors to the blood and then it works

283
Q

Ankylosing spondylitis will show what on xray?

What are they?

A

Syndesmophytes

Calcifications/heterotopic ossification in the interspinal ligaments or annulus fibrosis

284
Q

What is described by an encapsulated, well circumscribed mass w/central necrosis and calcifications on CT in a pt w/RUQ pain?

Assoc w/what?

A

Hepatic adenoma

OCPs and anabolic steroids

285
Q

What bones form the pterion?

A 
TPSF
Temporal
Parietal
Sphenoid 
Frontal
286
Q

V-spread technique is OMT used to treat what?

A

Compression or misalignment of cranial suture

287
Q

According to D.O.’s, what is the pathophyisology behind Migraines?

A

Trigeminovascular system

No longer vasoconstriction

288
Q

What meds can prophlyactically treat migraines?

A 
Propanolol
Verapamil
Amitriptyline
Valproic acid 
Venlafaxine
Topiramate
289
Q

What do you do if you think a pt would be a good organ donor candidate?

A

Contact the organ donor network regarding the situation

290
Q

What is the MC organism responsible for necrotizing fasciitis?

A

Grp A Strep (strep pyogenes)

291
Q

Lateral strain pattern occurs on what axis?

A

2 vertical axis

292
Q

Torsional strain pattern occurs on what axis?

A

A-P

293
Q

27 year old woman awoke 1 morning and found peripheral vision decreased, 2 days later she has blurry vision, fundoscopic exam shows pale optic discs bilaterally, diagnosis?

Treatment?

A

Optic neuritis

Admit and start IV methyl Prednisonolone

294
Q

USPSTF recommends all women ages 15-45 take what supplement no matter what?

A

Folic acid

295
Q

+ anti-smooth muscle antibodies indicates what?

A

Autoimmune hepatitis

296
Q

T10-T11 has VS reflexes?

A

Ovaries, testes

Right colon

297
Q

What is the VS reflex levels for a pt w/endometriosis?

A

T10-11

Bc it is the ovaries

298
Q

Pt that has trouble falling asleep, what drugs are 1st line?

Pt that cannot stay asleep after falling asleep, what med to use?

A

Zolpidem
Zaleplon
Triazolam

Benzo

299
Q

What do the iron studies show in alpha thalassemia?

A

Normal to high ferritin

Normal to low TIBC

300
Q

Premature ovarian failure has what values of:
FSH?
LH?
FSH to LH ratio?

A

inc
Inc
FSH > LH

301
Q

Where do carcinoid tumors arise from?

A

Neuroendocrine cells from the appendix and terminal ileum (small intestine)

302
Q

What is the main difference between dermatomyositis and polymyositis?

A

Dermatomyositis has Grottron papules and Heliotrope rash

It has SKIN manifestation
Dermatomyositis involves the DERMIS

303
Q

Unilateral Sacral flexion dysfunction, what will the sacral sulcus be on the involved side?

ILA?

A

Deep

Inferior

304
Q

Unilateral Sacral extension dysfunction, what will the sacral sulcus be on the involved side?

ILA?

A

Shallow

Superior

305
Q

Left u/L sacral flexion dysfunction, describe how you move

What findings for the sacral sulci?
ILA?

A

SB to the left
Then look/flex to your RIGHT —> it is OPPOSITE

Right sulci will be shallow
Left ILA will be shallow

306
Q

Right u/L sacral flexion dysfunction, describe how you move

What findings for the sacral sulci?
ILA?

A

SB Right, then Look/turn to the LEFT —> IT is OPPOSITE!!!

Left sacral sulci will be shallow
right ILA shallow

307
Q

Premature ovarian failure, what are the levels of FSH and LH usually?

A

FSH > 40

LH > 25

308
Q

Dermatomyositis is associated w/what lab values?

What other thing is it associated with?

A

Inc CPK, aldolase, LDH
Anti-Jo1, anti-Mi2

15% inc in MALIGNANCY

309
Q

Pt has AC joint pain. When pt shrugs his shoulders the proximal clavicle remains cephalad, this indicates what dysfunction?

A

ADDuction dysfunction

Prox clavicle moves caudad when shrugging (ABducting) and moves cephalad when ADDucting

310
Q

Pt w/bacterial meningitis gets treated with what if they over 50?

A

Ampicillin for Listeria

Also steroids help in general

311
Q

How do you treat fibromyalgia with OMT?

A

Counterstrain

312
Q

What is the treatment for Sjogren syndrome?

A

Pilocarpine

313
Q

Pt w/anteriomedial tibial knee pain and plays soccer has what?

A

Pes anserine bursitis

314
Q

What is the preprandial glucose goal?

Postprandial?

A

90-130

< 180

315
Q

1 hour GTT greater than what needs 3 hour test?

3 hour test values of what indicate Gestational diabetes?
1st line therapy?

A

> 140

Any 2 of the following: Fasting > 95, 1 hour > 180, 2 hour > 155, 3 hour > 140
Diet and exercise

316
Q

What presents with intracranial calcifications, hydrocephaly, chorioretinitis in a baby?

A

Toxo

317
Q

What muscles insert at the anteromedial aspect of the tibia?

Pain at this location is called what?

A

Gracilis, sartorius, semitendinosus

Pes anserine bursitis

318
Q

Pain on single-leg hop and when a tuning fork is placed over the leg in the distal 1/3 of the tibia indicates what?

A

Medial tibial stress syndrome - shin splints

319
Q

What is the most effective treatment of post-rural puncture HAs?

A

Epidural blood patches - slows CSF leak

320
Q

Pt that takes multiple medications for COPD and then develops Cushing’s like syndrome, what is the reason?

A

NOT smoking apparently

Most likely iatrogenic - from prednisone use

321
Q

How do you treat a posterior radial head with HVLA?

A

Arm in extension, supination, Anterior thrust

322
Q

Anterior radial head dysfunction, what is the set up for HVLA?

A

Pronate arm, flex it and push anterior to POSTERIOR on radial head

24:55 on Elbow/wrist/hand tx OS2

323
Q

Wermer syndrome is what?

A

MEN I

324
Q

Pt that eats a normal balanced diet but vomits or skips meals when they feel fat has what?

A

Other specified feeding and eating disorder

325
Q

Pt w/PMHx of a ventral hernia that is hemodynamically stable with several week history of possible bowel obstruction has what?

A

Chronically incarcerated ventral hernia

NOT an EMERGENCY

326
Q

Pt that has a supracervical hysterectomy needs what kind of Cervical cancer screening?

A

Women aged 30-65 Need:
HPV + cytology q5 years
Or
Cytology alone q3 years

327
Q

Symptomatic hemorrhoids are 1st treated with what?

If it doesn’t work then what?

A

Rubber band ligation - nonsurgical

Hemorrhoidectomy

328
Q

CEA tumor marker elevated in what?

CA-125?

A

Colon cancer

Ovarian

329
Q

What is the initial test for M.G.?

A

ACh-R antibody test

330
Q

What is the only established risk factor for the development of Acne?

A

Family history

331
Q

Acne with comedones that does not respond to benzoyl peroxide, what is the next step up in treatment?

If that doesn’t work then what?

Finally what?

A

Topical retinoids

PO Abx

PO isotretinoin

332
Q

What is the translocation for Burkett Lymphoma?

A

8;14 c-myc

333
Q

Tenderpoint for psoas syndrome located where?

How to treat with counterstrain?

A

Medial to ASIS

Hip flexed, External rotation

334
Q

What qualifies as Severe pre-eclampsia?

A

BP > 160/110

Proteinuria > 5 g

335
Q

What qualifies as mild preeclampsia?

A

BP > 140/90

Proteinuria > 300 mg

336
Q

9 year old presents w/HA, fever, blanching rash and trace pedal edema after a summer camping trip has what?

A

RMSF

337
Q

Which test is the most sensitive for diagnosis of DMD?

A

Serum CK

338
Q

Distributive shock is a term used to describe which shock states?

A

Septic
Anaphylactic
Neurogenic

339
Q

Pt that has bitter almond smelling breath has what poisoning?

Treated how?

A

Cyanide

Thiosulfate + amyl nitrate

340
Q

What labs do you order in the initial evaluation of HTN?

A 
EKG
BMP
CBC
UA
Lipid panel
341
Q

What parts of the body drain to the right lymphatic duct?

The right lymphatic duct then drains to where?

A

R side of H+N, R UE, heart, and portion of the lungs

Junction of R IJV and R subclavian vein

342
Q

Pt in DKA needs IV NS + KCl in what conditions?

A

K+ level is < 5.3

343
Q

Renal biopsy that shows segmental solidification of the glomerular capillary tufts, particularly in the perihilar regions indicates what?

Part of what renal syndrome?

If present in a child, what are they at higher risk for?

What should they get?

A

FSGS

Nephrotic syndrome

Encapsulated organism infection - S pneumo infections

PPV23 vaccine

344
Q

What is Burnett syndrome? Caused by what?

What changes can it cause on EKG?

A

Milk-alkali syndrome
Too much Calcium intake

QT interval shortening, J wave

345
Q

How do you treat Severe Milk-alkali Syndrome with Ca levels > 14?

A

Intranasal calcitonin

Bisphosphonates

346
Q

Pt w/opioid dependence in pregnancy should be treated how?

A

Methadone

347
Q

What measurements can be used by US to assess a gestational age?

A

Biparietal diameter
ABD circumference
Crown-rump length
Femur length

348
Q

In menopause, what is increased more, FSH or LH?

A

FSH

349
Q

What is the most useful INITIAL method for detecting semen in a sexual assault victim?

A

Wood’s lamp

350
Q

What kind of STEMI presents w/ST depression and R-waves in leads V1-V3?

A

Posterior

351
Q

Posterior MI presents how?

A

ST Depression (reciprocal ST elevation) and R waves (reciprocal Q waves) in leads V1-V3

352
Q

Infarction of what artery causes posterior MI?

Comes off what?

A

Posterior descending coronary a.

RCA

353
Q

Occlusion of which artery causes an inferior MI?

A

RCA

354
Q

Occlusion of the RCA will produce infarction where?

A

RV
inferior wall
Posterior wall

355
Q

Lateral or posterior infarction is d/t occlusion of which artery?

Is a branch off what?

A

Circumflex

Left main coronary

356
Q

What tender point is located inferior or inferolateral tip of C2 spinous process?

Treatment position?

A

PC3 inion

F SARA —> Maverickk point

357
Q

What presents as a painless nodule near the MCP joint and can cause locking or catching of the digits?

A

Trigger finger

358
Q

What gestational age can the uterine fundus be palpated at the level of the umbilicus?

Halfway bw pubic symphysis and umbilicus?

A

20 weeks

16 weeks

359
Q

What defines severe sepsis?

A

Sepsis + organ dysfunction (elevated BUN/Cr), hypoperfusion or HoTN

360
Q

Elevated PO4 levels can lead to what?

What can happen?

A

Decreased Ca levels bc PO4- binds to phosphate

Fracture d/t inc PTH secretion which causes inc bone resorption by osteoclasts in an effort to increase Ca

361
Q

What is the SALTR mnemonic?

A

Slipped growth plate
Above - fracture above plate to involve Metaphysis
Lower - fracture extends lower to involve epiphysis
Through - through the metaphysis, physis, epiphysis
Ruined - complete crush

362
Q

Lateral epicondyltitis occurs d/t microscopic tearing of what muscle?

A

Extensor Carpi radialis brevis

363
Q

JNC says pts 60 years and older is what?

A

< 150/90

364
Q

Pt that has symptoms of heart failure with very little physical activity is what NYHA class?

A

3

365
Q

what is the rule of 9s for kids?

A

Front of head is 9%, back is 9% for total of 18% (normal for adults is the TOTAL head = 9%)

Each leg is 7% in front and back vs normal 9% for adults

366
Q

Tetany, hyperreflexia, and cardiac dysrhythmias indicate what electrolyte abnormality?

A

Hypomagnesemia

367
Q

What are the mechanics of the AO joint?

A

SB and rotation are always OPPOSITE

368
Q

Dull aching scrotal pain w/dec fertility, a sensation of scrotal fullness,and palpable testicular mass that does not trans illuminate indicates what?

A

Varicocele

369
Q

What presents w/normal TSH, elevated total T4, normal free T3?

A

Euthyroid hyperthyroxinemia

370
Q

What presents w/low TSH, normal free T4 and normal T3?

A

Subclinical hyperthyroidism

371
Q

What is the 1st step in management when you cannot visualize the string of an IUD?

What is next?

A

US

Flat plate ABD xray

372
Q

What is a fracture at the base of the thumb or 1st metacarpal extending into the intra-articulate space called?

A

Bennet’s fracture

373
Q

What is the Pap smear guidelines for women 21-29?

30-65?

A

Q3 years

Q3 years w/cytology or q5 years w/cytology and HPV

374
Q

Adverse reaction to a vaccine would occur when?

If there is one, where do you report it?

A

Within 7 days from vaccination

Vaccine Adverse event reporting system

375
Q

Which kidney has a longer renal vein?

A

Left

376
Q

What lab values correlate with disease severity in SLE?

A

Decrease in complement

377
Q

How should a thoracic aortic aneurysm be followed if it is 4-5cm?

A

Q6 months w/contrast CT

378
Q

What entity holds information about physician malpractice, licensure and negative actions against drs?

A

National Practioner Data Bank

379
Q

What is the MC neurologic deficit of untreated bacterial meningitis?

A

Hearing loss

380
Q

What is the best initial treatment of Legg-Calve-Perthes disease?

A

Bracing w/partial weight-bearing

If that fails then surgery

381
Q

Pt has received 1.5 L over 3 hours in the ER and the Pt is 60kg and has 45% of his body burned, how much total fluid should he receive in 24 hours?

How much of that volume should be given in the 1st 8 hours?

How much in the next 16?
How much in the next 16 hours?

A

10,800 mL

5,400: but he already got 1,500 so he needs 3,900 more over 5 hours which is 780!!

5,400 mL / 16 = 337 mL/hr

382
Q

Pt w/sickle cell and suspected acute chest syndrome, what is the 1st step in workup?

What normally causes ACS?

A

CXR

Fat or bone marrow embolus

383
Q

What is the most accurate test to diagnose cholecystitis?

A

HIDA scan

384
Q

What is the best initial treatment for symptomatic hypocalcemia?

A

IV calcium gluconate

385
Q

1st line prophylaxis for traveler’s diarrhea is what?

A

Ciprofloxacin

386
Q

VS level of adrenals?

Uterus?

Prostate?

A

T8-10

T12-L2

T12-L2

387
Q

Pt that has decreased mentation, delirium, HA, weakness and slurred speech w/hypothermia, dilated pupils, and reduced RR has what?

A

Benzo overdose

388
Q

At what level does Hyponatremia causes seizures?

Symptomatic when?

A

< 115

< 125

389
Q

What is a benign, self-limited derm condition that presents as an itchy papular rash over the trunk, often triggered by sun exposure, MC seen in middle aged men?

A

Grover disease aka transient acantholytic dermatosis

390
Q

What is an AD disease that presents w/vesicular lesions and crusting erythematous plaques over intertriginous areas like the genitals, inguinal area, neck, axilla, etc?

A

Familial benign pemphigus (Hailey-Hailey disease)

391
Q

PCT is d/t def of what enzyme?

A

Uroporphyrinogen decarboxylase

392
Q

What congenital brain malformation presents w/absent or dysplastic cerebellar vermis and cystic dilation of the 4th ventricle?

A

Dandy Walker

393
Q

Sjogren’s has what Abs?

A

Anti-Ro/SSA

Anti-La/SSB

394
Q

Describe an inevitable abortion

A

Dilated os
NO expelled products
NO rupture of membranes

395
Q

What is the most accurate test for ZE syndrome?

A

Secretin stim test

396
Q

How do you diagnose DM with a 2 hour GTT?

A

> 200 with or without symptoms

397
Q

Severe c diff should be treated how?

What indicates severe?

A

PO Vanc

Age > 60, temp > 38.3, albumin < 2.5
ICU admin, pseudomembranous colitis

398
Q

Pt is having inferior wall MI as evidenced by EKG, what is the next best step?

A

Put EKG leads on right side…LOL

399
Q

HIV pt w/odynophagia and multiple linear, shallow to deep ulcers has what?

A

CMV

400
Q

How is status epilepticus treated initially?

If this fails then what?

3rd line treatment?

If after 30 minutes still nothing?

A

Benzo

2nd round of Benzo

Fosphenytoin

Propofol or midazolam and incubate

Finally phenobarbital

401
Q

How do you treat tenderpoints w/counterstrain if they are all EQUALLY tender?

A

Treat the 1 in the middle 1st and work proximally to distally

402
Q

Pts w/ADHD are increased risk of developing what as an adult?

A

Antisocial personality disorder

403
Q

What kind of HIV esophagitis presents w/round and ovoid ulcers w/vesicles?

A

HSV

404
Q

In DKA management, when do you switch to subQ insulin?

A

AG closed, 2 hours before insulin drip is stopped

405
Q

Episodic tachycaria, HA, diaphoresis and HTN is what?

A

Pheochromocytoma

406
Q

What presents w/ABD pain, irritability, wrist/ankle drop and dense metaphyseal lines on joints?

A

Lead poisoning

407
Q

What lab should be ordered in suspected lead poisoning?

A

Free erythrocytes protoporhyrin level or serum blood level

408
Q

What EKG findings for print metal angina?

A

Transient ST elevation - d/t vasospasm

409
Q

Posterior costal tender points are associated w/what kind of somatic dysfunction?

A

Inhalation (elevated ribs)

410
Q

What presents in a 40 y/o male w/sudden death and EKG shows ST elevation in V1-V3 w/RBBB, and terminal S waves in the lateral leads?

Look for what in the history?

A

Brugada syndrome

ASIAN man

411
Q

Pt w/unprovoked VTE w/unknown secondary cause should be on anticoagulation for how long?

If d/t surgery or trauma or immobility?

A

INDEFINITELY

3-6 months

412
Q

What presents as an allergy to a drug w/asthma, chronic rhinosinusitus, congestion, b/L nasal polyps?

A

ASA allergy

413
Q

Herniation bw L4 and L5 what nerve root is compressed?

A

L5

414
Q

Herniation bw L5 and S1 what nerve root is compressed?

A

S1

415
Q

Herniation bw L3 and L4 what nerve root is compressed?

A

L4

416
Q

Ribs 1-5 exhalation Dysfunction presents how?

A

Narrowing of the intercostal space below the dysfunction ANTERIORLY

417
Q

Innominate rotation occurs which sacral axis?

A

Inferior transverse

418
Q

What muscle group is used in the treatment of anterior inominate rotation?

A

Hamstrings

419
Q

What muscle group is used in the treatment of posterior inominate rotation?

A

Quads

420
Q

Pt has a 1st degree relative that got colon cancer at age 46, when should he get a colonoscopy?

How often after that?

A

Age 36

Q5 years

421
Q

ICU pt that is having RUQ pain and US shows bile sludge, pericholecystic fluid and thickened gallbladder walls has what?

A

Acalculous cholecystitis

422
Q

Bishop score of what level or higher indicates a favorable delivery?

Highest score possible?

A

9

13

423
Q

Bishop score of 5-9 indicates what?

Should do what?

A

10% chance of failure

Augment w/oxytocin

424
Q

How does viral conjuctivitis present?

A

Preauricular LAD w/red watery eyes

425
Q

When is a bronchodilator challenge diagnostic?

If it is not, next step?

A

FEV1 increases by 200 mL or 12%

Methacholine challenge

426
Q

Age 2 months what should a baby do?

A

Lift their head when prone, coo, track sounds, smile

427
Q

Baby comes in for a visit, it can roll front to back, grasp a rattle and orient to voice and laugh, how old?

A

4 months

428
Q

What does a DEEP posterior transverse process on the left mean?

A

Pt is rotated RIGHT

Bc there is a hard end feel on the right

429
Q

Make sure to look at what the question is asking —> “where the patient is CONTRACTING towards”

A

That’s it

430
Q

What is classified as elevated BP?

A

120-129 / 80-89

431
Q

What viruses MC cause onset of T1DM DKA?

A 
#1 Coxsackie B
But also rotavirus, mumps, CMV
432
Q

What is a collection of blood in the anterior chamber of the eye?

Occurs MC in what?

A

Hyphema

Blunt trauma to the eye

433
Q

What occurs d/t rupture of a small ocular vessel in the eye?

Resolves when?

A

Subconjuctival hemorrhage

7-10 days w/no treatment

434
Q

GFR lower than what level is an ABSOLUTE contraindication to using metformin for T2DM pts?

A

< 30

435
Q

Pt that has cocaine-induced chest pain, what is 1st line treatment?

What is CONTRAINDICATED?

A

Benzos

BBlockers

436
Q

Brochiolitis occurs in what age group?

A

Under 2 years old

RSV —> NO stridor

437
Q

What will you see on xray in a pt w/croup?

A

Steeple sign aka SUBglottic narrowing

438
Q

1st line choice for priapism?

A

Intracavernosal phenylephrine

439
Q

Large giant cells w/a multinucleated or bilobed nucleus are what?

A

Reed Sternberg cells

440
Q

ARDS mainly has what clinical feature?

A

Pulmonary edema

441
Q

Washed out appearance to bone and cortical thinning mean what?

Seen in what?

A

Dec bone mineral density

Osteopenia/osteoporosis

442
Q

Chondromalacia is seen in what?

A

Overuse, degeneration of articular cartilage in the knee joint

443
Q

What is Cushing Triad?

Physiologic response to what?

Can imply what?

A

Systolic HTN, bradycardia, Irregular respirations

Increased ICP

Impending brain herniation

444
Q

Pt w/multiple myeloma can develop what heart problem?

Manifests how physiologically?

A

Cardiac amyloidosis

Restrictive cardiomyopathy causing constrictive HF —> dec SV

445
Q

What test is the best to assess fetal limb development and cardiac function?

A

Level II US

446
Q

Pt has psoas syndrome, how will the upper lumbar SDs appear?

What muscle does it commonly cause SD to on the opposite side?

A

Flexed, SB, rotated to side of hypertonic psoas

Piriformis muscle

447
Q

Pt that has a stroke of the ACA will have what symptoms?

A

c/L LE weakness, incontinence and personality changes

448
Q

ADHD is commonly associated with what other disorders?

A

Conduct
Tourette’s
Oppositional defiant disorder

449
Q

Rash that starts on the face and moves downwards w/cold symptoms = ?

What can decrease mortality?

A

Rubeola aka measles

Vit A

450
Q

Describe roseola

A

Fever for 4 days, then a rash that SPARES the face in kids 6mo - 2 years

451
Q

Pt that has scoliosis on the right, what does the T-spine do to compensate?

A

Rotation to the right and SB to the left

452
Q

How long of a washout period do you need to go from MAOI to SSRI?

A

14 days

453
Q

Pt w/ESRD that is having parenthesis, muscle cramps and weakness but no EKG changes still needs what treatment?

A

Calcium gluconate

454
Q

What is the empiric treatment of CAP in the outpt setting in a healthy person?

A

Macrolide or Doxycycline

455
Q

Pt is 17 w/no period, US shows a uterus, FSH is high, what is next step?

If FSH is low?

A

Karyotype

TSH, prolactin

456
Q

How to tell the difference bw EBV pharyngitis and gonococcal?

A

EBV has TENDER cervical LAD

457
Q

What is the rule of 3s for SP?

A 
T1-3 SP at level of corr vert
T4-6 1/2 below
T7-9 1 level below
T10 1 level below
T11 1/2
T12 at level
458
Q

What is Homan’s sign?

A

Pain w/Dorsiflexion of the foot

459
Q

What must be done to terminate a relationship with a pt?

A

Certified letter in the mail, has to have reason and effective date (30 days), list interim care providers and closest ER

460
Q

Apley scratch test used to evaluate what?

A

Rotator cuff muscles

461
Q

What nerve root is the biceps?

What sensation aka dermatome structure?

A

C5

Deltoid

462
Q

What nerve root is the bracioradialis reflex?

What dermatome?

A

C6

Lateral forearm, 1st 2 digits

463
Q

Pt w/FUO for over a week, HA and visual disturbances w/failure to make a Dx has what?

A

Temporal arteritis

464
Q

What nerve supplies supraspinatus muscle?

A

Suprascapular

465
Q

HIV pt w/fever, watery diarrhea, RUQ pain, fatigue, weight loss and clear lungs has what?

A

Disseminated MAC

466
Q

What is Preh’s sign?

+ sign indicates what?

A

Pain relief when lifting the affected testicle

Epididymitis

467
Q

Tightness of the calf muscle results in what SD?

A

Dorsiflexion restriction at the ankle

468
Q

How do you treat pubic lice?

A

Permethrin

469
Q

Pt is 10 weeks pregnant and stable and has an IUD in place, what is the best next step?

A

Pull out it in the office

If over 12 weeks leave it in

470
Q

DLCO in pts w/COPD is what?

Asthma?

A

Decreased

Normal/increased

471
Q

Central cyanosis and respiratory distress in a 3 month old baby w/Down syndrome is d/t what?

A

VSD causing Eisenmenger’s syndrome

R —> L shunting of blood

472
Q

Preterm labor risk can be assessed w/what test when a woman is 22-34 weeks gestation?

A

Fetal fibronectin

473
Q

What is 1st line treatment for tinea versicolor?

A

Ketoconazole 2% cream

474
Q

Mammography that presents w/a smooth, large, polylobulated mass is what?

Treat how?

A

Phyllodes tumor

Wide local excision

475
Q

Fryette’s principle states that concavity of the curve is what?

A

On the side of Side-bending

476
Q

How do you treat hot flashes (vasomotor sx)?

A

HRT - estrogen and progesterone

477
Q

MC SE of SERMs?

A

Hot flashes

478
Q

What is ethacrynic acid?

Used for what?

A

Loop

BP control in pt w/sulfa allergy

479
Q

Pt w/vWD will have what abnormal lab value?

Why?

A

Inc PTT

vWF protects Factor 8 from degradation

480
Q

Pt has posterior inominate rotation, what muscle is isometrically contracted to treat this?

A

Rectus femoris

Just think about it. If you have tight hamstrings they will pull the inominate back into a posterior rotation. To treat this, activate the front muscles (quads)

481
Q

Classic symptoms of polymyalgia rheumatica?

Lab values?

A

Pain and stiffness in shoulder and pelvic girdle

Inc ESR

482
Q

What does cryoprecipitate contain?

Used for what?

A

Factor 8, 13, vWF, fibrinogen

Needs FFP but volume overloaded or fibrinogen < 1

483
Q

PAS staining IgM deposits around the nucleus of plasma cells are consistent w/what?

A

Waldenstrom’s

484
Q

Pt w/diaper rash has what?

Treat how?

A

Candidal dermatitis

Nyastatin ointment

485
Q

What is minoxidil?

What is an adverse SE?

A

Anti-hypertensive that causes vasodilation

Excessive hair growth (hypertrichosis)

486
Q

LP that shows IgG antibodies to NMDA-R and pt presents w/a seizure, w/CT that is normal, what does the pt have?

High assoc w/what?

A

NMDAR encephalitis

Ovarian teratoma - get ABD/Pelvis CT

487
Q

What med SE causes blue halos?

Green halos?

A

Sildenafil

Amiodarone

488
Q

Dirty wound and don’t know how many tetanus shots they got, what do you treat with?

A

TIG and Tdap

489
Q

When do you transfuse platelets?

A

Under 50,000 and bleeding
Or
Under 10,000

490
Q

What is the test to diagnose exercise induced bronchoconstriction?

A

Bronchial provocation testing aka methacholine challenge

491
Q

Pt has a left MCA stroke w/right-sided paralysis. Visual field testing will reveal what?

A

Right homonymous hemianopsia

Both the weakness and visual defects occur OPPOSITE side of stroke

492
Q

What is a fear of public places an can result in a panic attack and then you are afraid of having another one so you avoid situations?

A

Agoraphobia

493
Q

Child that is sweating and turning blue during feeding has what?

A

ToF

494
Q

What is a dermatosis characterized by scaly, erythematous rash patches on photosensitive areas w/+ Anti-Ro/SSA ab?

A

Subacute cutaneous lupus erythematous

495
Q

Where is the Chapman point for the pancreas?

A

7th Right ICS

496
Q

How do you do Adson’s test?

Tests for what?

A

Monitor pulse, extend arm, extend shoulder, ER and slightly ABduct, pt turns head TOWARDS effected shoulder

Thoracic outlet syndrome

497
Q

How to treat lichen sclerosis if topical corticosteroids do not work?

A

Topical calcineurin inhibitors like tacrolimus

498
Q

MC causes of death in kids 1-4 is what?

A

Drowning > MVA > homicide > burn/fire > suffocation

499
Q

Ulnar nerve entrapment w/NO problems flexing the digit means entrapment where?

A

At the wrist —> Guyon’s canal

If entrapped at the cubital tunnel, then you cannot flex the 4th and 5th DIPs

500
Q

When do you cardiovert in AFib?

What else may you need to do?

A

Pt must be SYMPTOMATIC despite adequate rate control
AFib present for < 48 hours

TEE 1st if longer than 48 hours to assess for thrombus OR anticoagulation for 3 weeks prior to cardioversion

501
Q

Young female w/b/L conductive hearing loss w/+ FHx of hearing loss has what?

Inheritance?

A

Otosclerosis - loss of stapedial reflux

AD

502
Q

What VS level is lower ureter?

A

L1-L2

503
Q

Pt that has diabetic foot ulcer and then leg pain may have developed what?

A

Osteomyelitis via direct spread

504
Q

Erysipelas vs cellulitis, how do you tell them apart?

A

Erysipelas develops RAPIDLY and is more serious, involves only the dermis

Will see the buzz word “streaking”
Caused MC be GrpA strep

505
Q

What is the ME treatment position for Ant. Inominate rotation?

A

Pt supine, pt flex knee up to chest and activate downwards

506
Q

What is the ME treatment position for Post. Inominate rotation?

A

Pt supine, leg drops off table, pt activates up against dr pushing leg down to the ground

507
Q

Negative Romberg test could indicate a lesion where?

Also will be an anterior Chapman point on the coracoid process

A

Cerebellum

508
Q

What is saw palmetto used to treat?

Common SE?

A

BPH

Bleeding when taken w/Warfarin

509
Q

What is an anatomical cause of recurrent heavy epistaxis?

A

AVM

510
Q

Cob angle > what should warrant investigation of pulmonary function?

A

60

511
Q

Pt w/asbestos lung biopsy will show what?

A

+ for Prussian blue

512
Q

Lung biopsy showing diffuse alveolar damage d/t what?

A

RDS

513
Q

How to treat anterior TPs T1-T6 w/counterstrain?

A

Flexion and arms Internally rotated

514
Q

AT 7-9 c/s treatment position?

A

F, STRA

515
Q

How does cerebral palsy present?

MC d/t what?

RF?

A

Developmental delay and hypertonic

Perinatal neurologic insult

Prematurity

516
Q

What medicine that people take can qualify your PPD + if it is > 5mm?

A

Glucorticoids use

517
Q

MOA of Riluzole?

A

Glutamate antagonist

518
Q

PO Isotretinoin can cause what SE?

A

Suicidal ideation

519
Q

Pt has L1-5 Rotated right, what will the sacrum do?

A

Sacrum will be Left on Left

Sacrum is always rotated OPPOSITE the lumbar rotation
L1-5 means Neutral and that means the sacrum will be FORWARD

520
Q

L5 is flexed or extended, what is the sacrum doing?

A

Sacrum will be backward

521
Q

Rib hump on the right T5 means what SD?

A

PTP on right

T5 N RRSL

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