Qbank Flashcards
TSH is elevated low free T4 positive anti-thyroid peroxidase antibodies that is very very high. What is the diagnosis
Hashimoto’s thyroiditis
What is the primary risk of development of thyroid lymphoma?
Pre-existing Hashimoto’s thyroiditis due to chronic lymphocytic infiltration of the thyroid gland
Patient has history of Hashimoto’s rapidly progressive enlargement of thyroid gland, as well as obstructive symptoms. What is the diagnosis?
Thyroid lymphoma
adolescent girls with goiter normal thyroid function, test and negative anti-thyroid antibodies. What is the diagnosis?
Colloid goiter
This disease usually presents as thyroid nodule sometimes in the presence of MEN syndrome it is a neoplasm of the thyroid gland C cells and typically has an elevated calcitonin level
Medullary thyroid cancer
Treatment options for uncomplicated UTI, non-pregnant women
Macrobid
Trimethoprim-sulfamethoxazole
Fosfomycin (single-dose )
Floraquinolones (only if previous options cannot be used)
For uncomplicated UTI, do you need a urine culture?
Only if initial treatment fails
Complicated UTI and non-pregnant women outpatient options
Floroquinolones
Inpatient abx treatment for complicated, UTI, and non-pregnant women
Ceftriaxone
Zosyn
Imipenem

For complicated UTIs, what would be needed prior to treatment in a non-pregnant woman
Urine culture obtained prior to therapy with adjustment of antibiotic as needed
What prep is used to evaluate causes of vaginitis?
Wet mount microscopy with potassium hydroxide
Thick colored, white or gray copious vaginal discharge with KOH positive is indicative of what infection
Bacterial vaginosis
Why is use of cipro avoided during pregnancy?
Ciprofloxacin cross the placenta and are toxic to developing Cartlidge
Why is gentamicin avoided during pregnancy?
irreversible congenital deafness
Trimethoprim sulfamethoxazole used in the first trimester is associated with what birth defects
Neural tube defects
cardiac defects
cleft palate
Trimethoprim sulfamethoxazole used in the late third trimester is associated with what 
Neonatal kernicterus
First-line therapy for vaso-occlusive chest syndrome in sickle cell patient with fever, hypoxemia and chest pain or respiratory distress
Rocephin
azithromycin
cefotaxime

When would you give blood transfusion in acute chest syndrome?
If PO2 is less than 92%, significant anemia, or worsening symptoms, despite initial treatment
With tension pneumothorax which side does the trachea deviate to
Toward the unaffected side 
Treatment for tension, pneumothorax 
Needle thoracostomy
Outpatient treatment for acute Pyelonephritis 
Seven days of ciprofloxacin 
CSF with 0 to 5, WBC, 40 to 70 glucose and protein less than 40
Normal CSF fluid
CSF fluid analysis,
WBC greater than 1000 glucose less than 40 proteins greater than 250
Bacterial meningitis
CSF fluid 100 - 500 WBC
less than 45 glucose and protein 100 and 500 diagnosis?
Tuberculosis meningitis
CSF fluid 10 to 500 wbc’s glucose 40 to 70
protein less than 150 indicates diagnosis?
Viral meningitis
CSF fluid with 0 to 5 wbc’s 40 to 70 glucose
42,000 protein would indicate what diagnosis
Guillain-Barré syndrome 
Cell count 20 to 200 and mononuclear cell predominant
Cryptococcal meningitis
Sensitivity of cryptococcal antigen test
93 to 100%
Mechanism of action, TPA
Activation of plasminogen, to plasmin , increase fibrin degradation 
Mechanism of action with warfarin
Decreases production of vitamin K dependent clotting factors 
Reversal agent for TPA
Cryoprecipitate antifibrinolytic agents (tranexamic acid aminocaproic acid 
What does prothrombin complex concentrate contain?
Vitamin K dependent clotting factors
Mechanism of action heparin what is the reversal agent
Increases activity of antithrombin III
Protamine sulfate
Reversal agent for warfarin
Vitamin K and prothrombin complex concentrate
Mechanism of action factor Xa inhibitors, like Xarelto or Eliquis 
Direct inhibition of factor Xa
Reversal agent for factor Xa inhibitors 
PCC and recumbent modified factor Xa
(andexanet)
This drug is a direct inhibitor of clot, bound and free thrombin
Dabigatran
(Pradaxa)
What is the reversal agent for Dabigatran
PCC or Idarucizumab 
Clinical presentation early, disseminated, lymes, disease
Multiple erythema migrans,
unilateral or bilateral cranial nerve palsy, (cranial nerve eight)
meningitis
carditis
migratory arthralgia
Late manifestations of limes disease, months to years after infection
Arthritis,
encephalitis
peripheral neuropathy
Used for diagnosing, lymes disease
Enzyme, linked immunosorbent, assay and western blot analysis 
Timeframe for adjustment disorder to develop
3 months of stressor 
Somatic symptom disorder characterized by excessive concern about having or developing a serious undiagnosed general medical disease persisting for greater than or equal to six months 
Illness, anxiety disorder 
Etiology of viral, meningoencephalitis 
Enteroviruses:
coxsackievirus
herpes virus arboviruses(west nile)
Empiric treatment of CF, patients with acute exacerbation:
Vancomycin for MRSA coverage and two drug coverage for pseudomonas
4 Cluster B (dramatic) personality disorder
borderline, histrionic, antisocial, narcissistic
cluster A (odd/eccentric)
schizoid, schizotypal, paranoid
mental disorder characterized by unstable moods
Impulsive
Self destructive
Borderline personality disorder
Pervasive
Lifelong patterns of suspiciousness and mistrust
Paranoid, personality disorder
What differentiates paranoid personality disorder from psychotic disorder
Absence of persistent psychotic symptoms, and the nonspecific nature of distress generalize to every interpersonal interaction 
High grade squamous intraepithelial lesion on pap what is next step in management 
Immediate colposcopy
2 dgs
Chronic maintenance therapy in patients with relapsing remitting MS 
Beta-interferon
Glatiramer acetate
Criteria for bipolar II
Hypomania lasting > or equal to 4 days
And
Depressive episodes, lasting >or equal to two weeks
Submissive and clingy 
Dependent personality disorder
Purposeful falsification of symptoms to assume the sick roll
Factitious disorder 
What disease
Ash-leaf spots
Angiofibromas of malar region
Shagreen patches
Tuberous sclerosis complex
Definitive diagnosis of west Nile virus
Detection of West Nile I GM antibody in the CSF
CNS infection that occurs almost exclusively in HIV infected patients with aids or post transplant patients
Cytomegalovirus 
Injury to what nerve Leads to unilateral vocal cord paralysis
Recurrent laryngeal nerve
Most important treatable risk factor for cva
Hypertension
Parasite found in cat feces
Undercooked meat
Contaminated soil
Toxoplasmosis
Mosquito borne virus causes high fever
Severe bilateral polyarthralgia
Chikungunya
Why Ketamine dg of choice for awake intubation 3 actions
dissociation, amnesia, analgesic 
Preferred method of intubation for difficult airway 
Awake, intubation
Difference between RSI vs awake intubation
Patient independently maintains upper airway, tone and spontaneous ventilation 
Set an intermittent abdominal pain and vomiting sausage shaped mass in the right abdomen, currant, jelly, stools, lethargy, or altered mental status
Intussusception 
Imaging to diagnose intussusception
Ultrasound: target sign
Treatment for intussusception
Air or saline enema surgical intervention for failed enema, reduction, or signs of peritonitis 
Two malabsorption syndromes with +lactose breath test
SIBO
Lactose intolerance
Watery diarrhea with fecal urgency, and nocturnal diarrhea is characteristic of what G.I. illness
Collagenous colitis 
Collagenous colitis what is found on biopsy
Thick, subepithelial, collagen band 
What disease, large volume foul-smelling stools excessive flatulence, weight loss, and microcytic anemia 
Celiac disease 
Vilas atrophy loss of normal Vilas architecture, intraepithelial, lymphocytic, infiltrates, and crypt hyperplasia what disease
 Celiac disease
Most common and most aggressive pathogen, causing septic arthritis in children of all ages
Staphylococcus aureus, followed by streptococcus pneumoniae and streptococcus pyogenes 
Drug of choice that is required for any child of any age with suspected septic arthritis, 
gram-positive coverage with vancomycin
Findings of what is nearly always due to a lower G.I. bleed
Bright red blood from rectum
Most common cause of brisk painless hematochezia in an elderly patient
Diverticulosis
Treatment of choice in patients with severe graves, exopthalmos
Periorbital edema
Vision changes
(prior to definitive treatment with surgery or RAI)
Steroids
Why is TSH not routinely helpful to assess thyroid function once patient is asymptomatic and after thyroid treatment
TSH may remain suppressed for several months after initiation of therapy, and does not accurately reflect thyroid functional status 
What labs to check for assessing thyroid function after patient is treated with ATD and asymptomatic
Total T3 and free T4
Potential adverse side effect of propylthiouracil
Hepatotoxicity
Labs to assess thyroid function during treatment with anti-thyroid drugs
Total T3, and free T4 levels 
First-line therapy for toxic shock syndrome (anti-staphylococcal antibiotic therapy)
Vancomycin, clindamycin and cefepime 
Mechanism of action clindamycin for TSS
Inhibits the bacterial ribosome leading to a drastic reduction in exotoxin production 
Post exposure prophylaxis rabies
Active immunization with rabies vaccination 4doses
AND
Passive immunization with rabies immunoglobulin 
First line imaging modality for evaluation of a palpable breast mass in a woman less than 30 
Ultrasonography 
Patient with Peri oral, tingling, incoordination, weakness, paralysis are common after poisoning with what fish
Puffer fish poisoning 
Pathogens that cause in utero infection
Toxoplasmosis
Listeria
Parvovirus
2 illnesses
associated with allergic bronco pulmonary aspergillosis
Asthma
CF
Chest image findings with allergic bronchopulmonary aspergillosis
Recurrent fleeting infiltrates
Bronchiectasis
3 things needed for the
Diagnosis of allergic bronchopulmonary aspergillosis 
Positive aspergillus, skin test, and/or IGE 
Elevated serum I GE
Eosinophilia
Clinical features of nonclassical congenital adrenal hyperplasia
pubic/axillary hair
Severe acne
Hirsutism
oligomenorrhea
Increase growth velocity, bone age
Increase 17 hydroxyprogesterone level 
Inheritance pattern/pathophysiology for nonclassical, congenital, adrenal hyperplasia 
Autosomal recessive
Decr 21 hydroxylase
Normal glucocorticoids/ mineralocorticoids
Incr androgens 
Treatment of nonclassical congenital, adrenal hyperplasia
Hydro Cortizone
Type of gastritis associated with pernicious anemia
Autoimmune metaplastic atrophic gastritis 
Cellular targets: the cause of autoimmune, aplastic atrophic gastritis
immune response against
oxyntic cells, intrinsic factor 
Findings on gastric, endoscopy, pernicious, anemia
Absent rugae in the fundus
Low variance, dimorphic fungus found in soil and decaying plant matter describes what diagnosis
Sporothrix schenckii
Treatment of choice for
Sporotrichosis
Prolong course of
Itraconazole
Treatment of aspergillosis
IV voriconazole
This drug is used to treat invasive candidiasis
Caspofungin 
Treatment of rhino orbital cerebral mucormycosis
Liposomal amphotericin B 
Umbilical cord inflammation with abcess like foci of necrosis suggest what illness
Congenital syphilis
Spirochete infection with treponema Pallidium 
A rare idiosyncratic reaction to dopamine antagonist
Neuroleptic malignant syndrome 
What is the difference between neuroleptic malignant syndrome and serotonin syndrome?
Neuroleptic malignant syndrome does not involve neuromuscular hyperactivity like tremor, hyperreflexia or clonus 
Characteristics of neuroleptic malignant syndrome
Bradykinesia and
generalized lead pipe muscular rigidity 
A disease characterized by fever, mental status, changes, clonus, and hyper reflexia 2/2 combination of ssri + maoi

Serotonin syndrome 
Autosomal dominant disorder, characterized by multiple café au lait macules plus axillary or inguinal freckling
Neurofibromatosis type I
Anthracycline can cause dose dependent, decline EF leading to what diagnosis
Dilated cardiomyopathy 
Treatment of
Cryptococcal meningeoencephalitis
In pts with HIV
> 2 wks amphotericin B and flucytosine 
Most common cause of bacterial meningitis in adults
Streptococcus pneumoniae and neisseria meningitidis 
Treatment of cytomegalovirus encephalitis
Ganciclovir plus foscarnet 
Drug that treats, severe candida and aspergillus infections
Caspofungin 
Clinical manifestation in a patient with aids who develops cryptococcal meningitis
Headache, vomiting, visual changes, papilledema, and cranial nerve palsy’s 
Three stages of treatment for cryptococcal meningitis
Induction:2 wk amphotericin B until symptoms abait, and CSF is sterilized
Consolidation: 8wks high dose, oral fluconazole
Maintenance: 1 yr or more lower dose, oral fluconazole prevent recurrence 
Tumor associated with adenomatosis polyposis
(Gardeners syndrome)
Desmoid tumor
Anaphylactic transfusion reaction
Onset
Cause
Features 
Within seconds -mins
Recipient anti-IGA antibodies against donor blood IGA
Angioedema hypotension wheezing respiratory distress shock
IGA deficient recipient
Benign proliferation of fibroblast that usually occur after trauma or insect bite, can also be idiopathic firm, hyper pigmentation nodule on lower extremities
Dermatofibroma
A discrete module that is usually located on the skin secondary to normal epidermal keratin becoming lodged in the dermis can be seen in Gardner syndrome, usually on the extremities resolve spontaneously
Epidermoid cyst
Immunologic blood transfusion reactions
Acute hemolytic
Timeframe:
Cause:
Key features:
1 hr
ABO incompatibility
agitation, nausea/vomiting, dyspnea, fever, flushing, hypotension, tachycardia, and hemoglobinuria
Immunologic blood transfusion reactions
Febrile, non-hemolytic
Time frame:
Cause:
Key features:
1-6 hr
Cytokines accumulation during blood storage
Fever and chills
Immunologic blood transfusion reactions
Urticarial
Timeframe:
Cause:
Key features :
Treatment: antihistamine
2-3hr
Recipient IgE against blood products
Urticaria
Immunologic blood transfusion reactions
Timeframe:
Cause:
Key features :
Transfusion related acute lung injury
Within 6hours
Donor anti-leukocyte ab
Respiratory distress, non-cardiogenic, pulmonary edema with bilateral pulmonary infiltrates
Immunologic blood transfusion reactions
Timeframe:
Cause:
Key features :
Graft versus host
Within weeks
Donor T lymphocytes
Rash, fever, G.I. symptoms, pancytopenia 
Prenatal testing
High sensitivity and specificity for aneuploidy
Cell free fetal DNA test
Prenatal testing:
Definitive karyotypic diagnosis
Chorionic villus sampling
Prenatal testing:
Screens for neural tube defects and aneuploidy
Second trimester quadruple screen
syphilis
Primary
• Secondary
• Early latent (<12
months of infection)
Benzathine penicillin G,
2.4 million units IM
as a single dose
• Late latent (> 12
months of infection)
• Unknown duration
• Gummatous/CV
syphilis
Benzathine penicillin G,
2.4 million units IM weekly
for 3 weeks
Neurosyphilis treatment
Aqueous penicillin G,
3-4 million units IV
every 4 hours for 10-14
days
Congenital syphilis
Aqueous penicillin G,
50,000 units/kg/dose IV
- every 8-12 hours for 10
days
an infective suppurative portal vein thrombosis, is a rare but devastating complication of intraabdominal infections, including appendicitis.
Pylephlebitis
red/purple papules or plaques associated with dermatomyositis. These typically involve the dorsal and radial surfaces of the metacarpophalangeal joints, proximal interphalangeal joints, and proximal phalanx.
Gottron’s papules
Test used when there are 2 or more independent groups being evaluated
ANOVA
Calculated by dividing the number of deaths by the total population size.
Crude mortality rate
Calculated by dividing the number of deaths from a particular disease by the total population size.
Cause-specific mortality rate
Calculated by dividing the number of deaths from a specific disease by the number of people affected by the disease.
Case fatality rate
Calculated by dividing the observed number of deaths by the expected number of deaths. This measure is used sometimes in occupational epidemiology.
Standardized, mortality, ratio
An incidence measure typically used in infectious disease epidemiology it is calculated by dividing the number of patients with disease by the total population at risk 
Attack rate
Calculated by dividing the number of maternal deaths by the number of live births
Maternal mortality rate
Defined as the number of live births divided by the total population size
Crude birth rate
Drug of choice second gen antipsychotic for treatment resistant schizophrenia (2 or more failed antipsychotic trials)
Clozapine
cleaves prothrombin to generate thrombin
Factor Xa
