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Usmle3 > Qbank > Flashcards

Qbank Flashcards

1
Q

TSH is elevated low free T4 positive anti-thyroid peroxidase antibodies that is very very high. What is the diagnosis

A

Hashimoto’s thyroiditis

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2
Q

What is the primary risk of development of thyroid lymphoma?

A

Pre-existing Hashimoto’s thyroiditis due to chronic lymphocytic infiltration of the thyroid gland

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3
Q

Patient has history of Hashimoto’s rapidly progressive enlargement of thyroid gland, as well as obstructive symptoms. What is the diagnosis?

A

Thyroid lymphoma

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4
Q

adolescent girls with goiter normal thyroid function, test and negative anti-thyroid antibodies. What is the diagnosis?

A

Colloid goiter

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5
Q

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

A

Medullary thyroid cancer

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6
Q

Treatment options for uncomplicated UTI, non-pregnant women

A

Macrobid
Trimethoprim-sulfamethoxazole
Fosfomycin (single-dose )
Floraquinolones (only if previous options cannot be used)

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7
Q

For uncomplicated UTI, do you need a urine culture?

A

Only if initial treatment fails

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8
Q

Complicated UTI and non-pregnant women outpatient options

A

Floroquinolones

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9
Q

Inpatient abx treatment for complicated, UTI, and non-pregnant women

A

Ceftriaxone
Zosyn
Imipenem


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10
Q

For complicated UTIs, what would be needed prior to treatment in a non-pregnant woman

A

Urine culture obtained prior to therapy with adjustment of antibiotic as needed

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11
Q

What prep is used to evaluate causes of vaginitis?

A

Wet mount microscopy with potassium hydroxide

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12
Q

Thick colored, white or gray copious vaginal discharge with KOH positive is indicative of what infection

A

Bacterial vaginosis

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13
Q

Why is use of cipro avoided during pregnancy?

A

Ciprofloxacin cross the placenta and are toxic to developing Cartlidge

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14
Q

Why is gentamicin avoided during pregnancy?

A

irreversible congenital deafness

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15
Q

Trimethoprim sulfamethoxazole used in the first trimester is associated with what birth defects

A

Neural tube defects
cardiac defects
cleft palate

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16
Q

Trimethoprim sulfamethoxazole used in the late third trimester is associated with what 

A

Neonatal kernicterus

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17
Q

First-line therapy for vaso-occlusive chest syndrome in sickle cell patient with fever, hypoxemia and chest pain or respiratory distress

A

Rocephin

azithromycin

cefotaxime


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18
Q

When would you give blood transfusion in acute chest syndrome?

A

If PO2 is less than 92%, significant anemia, or worsening symptoms, despite initial treatment

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19
Q

With tension pneumothorax which side does the trachea deviate to

A

Toward the unaffected side 

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20
Q

Treatment for tension, pneumothorax 

A

Needle thoracostomy

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21
Q

Outpatient treatment for acute Pyelonephritis 

A

Seven days of ciprofloxacin 

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22
Q

CSF with 0 to 5, WBC, 40 to 70 glucose and protein less than 40

A

Normal CSF fluid

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23
Q

CSF fluid analysis,
WBC greater than 1000 glucose less than 40 proteins greater than 250

A

Bacterial meningitis

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24
Q

CSF fluid 100 - 500 WBC
less than 45 glucose and protein 100 and 500 diagnosis?

A

Tuberculosis meningitis

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25
Q

CSF fluid 10 to 500 wbc’s glucose 40 to 70
protein less than 150 indicates diagnosis?

A

Viral meningitis

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26
Q

CSF fluid with 0 to 5 wbc’s 40 to 70 glucose
42,000 protein would indicate what diagnosis

A

Guillain-Barré syndrome 

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27
Q

Cell count 20 to 200 and mononuclear cell predominant

A

Cryptococcal meningitis

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28
Q

Sensitivity of cryptococcal antigen test

A

93 to 100%

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29
Q

Mechanism of action, TPA

A

Activation of plasminogen, to plasmin , increase fibrin degradation 

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30
Q

Mechanism of action with warfarin

A

Decreases production of vitamin K dependent clotting factors 

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31
Q

Reversal agent for TPA

A

Cryoprecipitate antifibrinolytic agents (tranexamic acid aminocaproic acid 

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32
Q

What does prothrombin complex concentrate contain?

A

Vitamin K dependent clotting factors

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33
Q

Mechanism of action heparin what is the reversal agent

A

Increases activity of antithrombin III
Protamine sulfate

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34
Q

Reversal agent for warfarin

A

Vitamin K and prothrombin complex concentrate

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35
Q

Mechanism of action factor Xa inhibitors, like Xarelto or Eliquis 

A

Direct inhibition of factor Xa

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36
Q

Reversal agent for factor Xa inhibitors 

A

PCC and recumbent modified factor Xa
(andexanet)

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37
Q

This drug is a direct inhibitor of clot, bound and free thrombin

A

Dabigatran
(Pradaxa)

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38
Q

What is the reversal agent for Dabigatran

A

PCC or Idarucizumab 

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39
Q

Clinical presentation early, disseminated, lymes, disease

A

Multiple erythema migrans,
unilateral or bilateral cranial nerve palsy, (cranial nerve eight)
meningitis
carditis
migratory arthralgia

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40
Q

Late manifestations of limes disease, months to years after infection

A

Arthritis,
encephalitis
peripheral neuropathy

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41
Q

Used for diagnosing, lymes disease

A

Enzyme, linked immunosorbent, assay and western blot analysis 

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42
Q

Timeframe for adjustment disorder to develop

A

3 months of stressor 

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43
Q

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 

A

Illness, anxiety disorder 

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44
Q

Etiology of viral, meningoencephalitis 

A

Enteroviruses:
coxsackievirus
herpes virus arboviruses(west nile)

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45
Q

Empiric treatment of CF, patients with acute exacerbation:

A

Vancomycin for MRSA coverage and two drug coverage for pseudomonas

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46
Q

4 Cluster B (dramatic) personality disorder

A

borderline, histrionic, antisocial, narcissistic

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47
Q

cluster A (odd/eccentric)

A

schizoid, schizotypal, paranoid

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48
Q

mental disorder characterized by unstable moods
Impulsive
Self destructive

A

Borderline personality disorder

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49
Q

Pervasive
Lifelong patterns of suspiciousness and mistrust

A

Paranoid, personality disorder

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50
Q

What differentiates paranoid personality disorder from psychotic disorder

A

Absence of persistent psychotic symptoms, and the nonspecific nature of distress generalize to every interpersonal interaction 

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51
Q

High grade squamous intraepithelial lesion on pap what is next step in management 

A

Immediate colposcopy

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52
Q

2 dgs
Chronic maintenance therapy in patients with relapsing remitting MS 

A

Beta-interferon
Glatiramer acetate

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53
Q

Criteria for bipolar II

A

Hypomania lasting > or equal to 4 days
And
Depressive episodes, lasting >or equal to two weeks

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54
Q

Submissive and clingy 

A

Dependent personality disorder

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55
Q

Purposeful falsification of symptoms to assume the sick roll

A

Factitious disorder 

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56
Q

What disease

Ash-leaf spots
Angiofibromas of malar region
Shagreen patches

A

Tuberous sclerosis complex

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57
Q

Definitive diagnosis of west Nile virus

A

Detection of West Nile I GM antibody in the CSF

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58
Q

CNS infection that occurs almost exclusively in HIV infected patients with aids or post transplant patients

A

Cytomegalovirus 

59
Q

Injury to what nerve Leads to unilateral vocal cord paralysis

A

Recurrent laryngeal nerve

60
Q

Most important treatable risk factor for cva

A

Hypertension

61
Q

Parasite found in cat feces
Undercooked meat
Contaminated soil

A

Toxoplasmosis

62
Q

Mosquito borne virus causes high fever
Severe bilateral polyarthralgia

A

Chikungunya

63
Q

Why Ketamine dg of choice for awake intubation 3 actions

A

dissociation, amnesia, analgesic 

64
Q

Preferred method of intubation for difficult airway 

A

Awake, intubation

65
Q

Difference between RSI vs awake intubation

A

Patient independently maintains upper airway, tone and spontaneous ventilation 

66
Q

Set an intermittent abdominal pain and vomiting sausage shaped mass in the right abdomen, currant, jelly, stools, lethargy, or altered mental status

A

Intussusception 

67
Q

Imaging to diagnose intussusception

A

Ultrasound: target sign

68
Q

Treatment for intussusception

A

Air or saline enema surgical intervention for failed enema, reduction, or signs of peritonitis 

69
Q

Two malabsorption syndromes with +lactose breath test

A

SIBO
Lactose intolerance

70
Q

Watery diarrhea with fecal urgency, and nocturnal diarrhea is characteristic of what G.I. illness

A

Collagenous colitis 

71
Q

Collagenous colitis what is found on biopsy

A

Thick, subepithelial, collagen band 

72
Q

What disease, large volume foul-smelling stools excessive flatulence, weight loss, and microcytic anemia 

A

Celiac disease 

73
Q

Vilas atrophy loss of normal Vilas architecture, intraepithelial, lymphocytic, infiltrates, and crypt hyperplasia what disease

A

 Celiac disease

74
Q

Most common and most aggressive pathogen, causing septic arthritis in children of all ages

A

Staphylococcus aureus, followed by streptococcus pneumoniae and streptococcus pyogenes 

75
Q

Drug of choice that is required for any child of any age with suspected septic arthritis, 

A

gram-positive coverage with vancomycin

76
Q

Findings of what is nearly always due to a lower G.I. bleed

A

Bright red blood from rectum

77
Q

Most common cause of brisk painless hematochezia in an elderly patient

A

Diverticulosis

78
Q

Treatment of choice in patients with severe graves, exopthalmos
Periorbital edema
Vision changes
(prior to definitive treatment with surgery or RAI)

A

Steroids

79
Q

Why is TSH not routinely helpful to assess thyroid function once patient is asymptomatic and after thyroid treatment

A

TSH may remain suppressed for several months after initiation of therapy, and does not accurately reflect thyroid functional status 

80
Q

What labs to check for assessing thyroid function after patient is treated with ATD and asymptomatic

A

Total T3 and free T4

81
Q

Potential adverse side effect of propylthiouracil

A

Hepatotoxicity

82
Q

Labs to assess thyroid function during treatment with anti-thyroid drugs

A

Total T3, and free T4 levels 

83
Q

First-line therapy for toxic shock syndrome (anti-staphylococcal antibiotic therapy)

A

Vancomycin, clindamycin and cefepime 

84
Q

Mechanism of action clindamycin for TSS

A

Inhibits the bacterial ribosome leading to a drastic reduction in exotoxin production 

85
Q

Post exposure prophylaxis rabies

A

Active immunization with rabies vaccination 4doses
AND
Passive immunization with rabies immunoglobulin 

86
Q

First line imaging modality for evaluation of a palpable breast mass in a woman less than 30 

A

Ultrasonography 

87
Q

Patient with Peri oral, tingling, incoordination, weakness, paralysis are common after poisoning with what fish

A

Puffer fish poisoning 

88
Q

Pathogens that cause in utero infection

A

Toxoplasmosis
Listeria
Parvovirus

89
Q

2 illnesses
associated with allergic bronco pulmonary aspergillosis

A

Asthma
CF

90
Q

Chest image findings with allergic bronchopulmonary aspergillosis

A

Recurrent fleeting infiltrates
Bronchiectasis

91
Q

3 things needed for the
Diagnosis of allergic bronchopulmonary aspergillosis 

A

Positive aspergillus, skin test, and/or IGE 
Elevated serum I GE
Eosinophilia

92
Q

Clinical features of nonclassical congenital adrenal hyperplasia

A

pubic/axillary hair
Severe acne
Hirsutism
oligomenorrhea
Increase growth velocity, bone age
Increase 17 hydroxyprogesterone level 

93
Q

Inheritance pattern/pathophysiology for nonclassical, congenital, adrenal hyperplasia 

A

Autosomal recessive
Decr 21 hydroxylase
Normal glucocorticoids/ mineralocorticoids
Incr androgens 

94
Q

Treatment of nonclassical congenital, adrenal hyperplasia

A

Hydro Cortizone

95
Q

Type of gastritis associated with pernicious anemia

A

Autoimmune metaplastic atrophic gastritis 

96
Q

Cellular targets: the cause of autoimmune, aplastic atrophic gastritis

A

immune response against
oxyntic cells, intrinsic factor 

97
Q

Findings on gastric, endoscopy, pernicious, anemia

A

Absent rugae in the fundus

98
Q

Low variance, dimorphic fungus found in soil and decaying plant matter describes what diagnosis

A

Sporothrix schenckii

99
Q

Treatment of choice for
Sporotrichosis

A

Prolong course of
Itraconazole

100
Q

Treatment of aspergillosis

A

IV voriconazole

101
Q

This drug is used to treat invasive candidiasis

A

Caspofungin 

102
Q

Treatment of rhino orbital cerebral mucormycosis

A

Liposomal amphotericin B 

103
Q

Umbilical cord inflammation with abcess like foci of necrosis suggest what illness

A

Congenital syphilis
Spirochete infection with treponema Pallidium 

104
Q

A rare idiosyncratic reaction to dopamine antagonist

A

Neuroleptic malignant syndrome 

105
Q

What is the difference between neuroleptic malignant syndrome and serotonin syndrome?

A

Neuroleptic malignant syndrome does not involve neuromuscular hyperactivity like tremor, hyperreflexia or clonus 

106
Q

Characteristics of neuroleptic malignant syndrome

A

Bradykinesia and
generalized lead pipe muscular rigidity 

107
Q

A disease characterized by fever, mental status, changes, clonus, and hyper reflexia 2/2 combination of ssri + maoi


A

Serotonin syndrome 

108
Q

Autosomal dominant disorder, characterized by multiple café au lait macules plus axillary or inguinal freckling

A

Neurofibromatosis type I

109
Q

Anthracycline can cause dose dependent, decline EF leading to what diagnosis

A

Dilated cardiomyopathy 

110
Q

Treatment of
Cryptococcal meningeoencephalitis
In pts with HIV

A

> 2 wks amphotericin B and flucytosine 

111
Q

Most common cause of bacterial meningitis in adults

A

Streptococcus pneumoniae and neisseria meningitidis 

112
Q

Treatment of cytomegalovirus encephalitis

A

Ganciclovir plus foscarnet 

113
Q

Drug that treats, severe candida and aspergillus infections

A

Caspofungin 

114
Q

Clinical manifestation in a patient with aids who develops cryptococcal meningitis

A

Headache, vomiting, visual changes, papilledema, and cranial nerve palsy’s 

115
Q

Three stages of treatment for cryptococcal meningitis

A

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 

116
Q

Tumor associated with adenomatosis polyposis
(Gardeners syndrome)

A

Desmoid tumor

117
Q

Anaphylactic transfusion reaction
Onset
Cause
Features 

A

Within seconds -mins

Recipient anti-IGA antibodies against donor blood IGA

Angioedema hypotension wheezing respiratory distress shock
IGA deficient recipient

118
Q

Benign proliferation of fibroblast that usually occur after trauma or insect bite, can also be idiopathic firm, hyper pigmentation nodule on lower extremities

A

Dermatofibroma

119
Q

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

A

Epidermoid cyst

120
Q

Immunologic blood transfusion reactions

Acute hemolytic
Timeframe:
Cause:
Key features:

A

1 hr

ABO incompatibility

agitation, nausea/vomiting, dyspnea, fever, flushing, hypotension, tachycardia, and hemoglobinuria

121
Q

Immunologic blood transfusion reactions
Febrile, non-hemolytic
Time frame:
Cause:
Key features:

A

1-6 hr

Cytokines accumulation during blood storage

Fever and chills

122
Q

Immunologic blood transfusion reactions
Urticarial
Timeframe:
Cause:
Key features :
Treatment: antihistamine

A

2-3hr
Recipient IgE against blood products
Urticaria

123
Q

Immunologic blood transfusion reactions
Timeframe:
Cause:
Key features :
Transfusion related acute lung injury

A

Within 6hours
Donor anti-leukocyte ab
Respiratory distress, non-cardiogenic, pulmonary edema with bilateral pulmonary infiltrates

124
Q

Immunologic blood transfusion reactions
Timeframe:
Cause:
Key features :
Graft versus host

A

Within weeks
Donor T lymphocytes
Rash, fever, G.I. symptoms, pancytopenia 

125
Q

Prenatal testing
High sensitivity and specificity for aneuploidy

A

Cell free fetal DNA test

126
Q

Prenatal testing:
Definitive karyotypic diagnosis

A

Chorionic villus sampling

127
Q

Prenatal testing:
Screens for neural tube defects and aneuploidy

A

Second trimester quadruple screen

128
Q

syphilis
Primary
• Secondary
• Early latent (<12
months of infection)

A

Benzathine penicillin G,
2.4 million units IM
as a single dose

129
Q

• Late latent (> 12
months of infection)
• Unknown duration
• Gummatous/CV
syphilis

A

Benzathine penicillin G,
2.4 million units IM weekly
for 3 weeks

130
Q

Neurosyphilis treatment

A

Aqueous penicillin G,
3-4 million units IV
every 4 hours for 10-14
days

131
Q

Congenital syphilis

A

Aqueous penicillin G,
50,000 units/kg/dose IV
- every 8-12 hours for 10
days

132
Q

an infective suppurative portal vein thrombosis, is a rare but devastating complication of intraabdominal infections, including appendicitis.

A

Pylephlebitis

133
Q

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.

A

Gottron’s papules

134
Q

Test used when there are 2 or more independent groups being evaluated

A

ANOVA

135
Q

Calculated by dividing the number of deaths by the total population size.

A

Crude mortality rate

136
Q

Calculated by dividing the number of deaths from a particular disease by the total population size.

A

Cause-specific mortality rate

137
Q

Calculated by dividing the number of deaths from a specific disease by the number of people affected by the disease.

A

Case fatality rate

138
Q

Calculated by dividing the observed number of deaths by the expected number of deaths. This measure is used sometimes in occupational epidemiology.

A

Standardized, mortality, ratio

139
Q

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 

A

Attack rate

140
Q

Calculated by dividing the number of maternal deaths by the number of live births

A

Maternal mortality rate

141
Q

Defined as the number of live births divided by the total population size

A

Crude birth rate

142
Q

Drug of choice second gen antipsychotic for treatment resistant schizophrenia (2 or more failed antipsychotic trials)

A

Clozapine

143
Q

cleaves prothrombin to generate thrombin

A

Factor Xa

Usmle3 (3 decks)

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