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Qbank Flashcards

1
Q

One anatomical difference between pilonidal disease and perianal abscess? Suppurative hidradenitis vs pilonidal?

A

Perianal will be at the anal verge
Pilonidal will be over the coccyx superior to the anus
Suppurative hidradenitis is usually in axilla or groin not anus/coccyx

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2
Q

A patient 2 weeks post op of a partial gastrectomy presents with postprandial abdominal cramps, weakness, diaphoresis 30 minutes after eating- diagnosis and treatment?

A

Dumping syndrome- rapid emptying of stomach leads to fluid shift and autonomic reflexes
Tx is dietary changes 1st, octreotide if refractory

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3
Q

Preferred way to establish airway in patient with C spine injury?

A

Orotracheal intubation after stabilizing C spine

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4
Q

A patient presents with edema, hypoalbuminemia, and proteinuria- what does this do to the patient’s lipid profile?

A

Increased LDL, low HDL–> increased risk of accelerated atherosclerosis

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5
Q

Treatment for acute dystonic reaction?

A

Benzotropine or benadryl

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6
Q

Treatment for akathisia?

A

Propanolol

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7
Q

Treatment for Drug induced parkinsonism?

A

Amantadine or benzotropine

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8
Q

A demented patient has pneumonia 2/2 aspiration- likely pathogenesis?

A

Impaired epiglottic reflex

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9
Q

A 18 month old has atopic dermatitis, gets treatment, then has umbilicated vesicles erupt over each cheek with submandibular adenopathy- diagnosis? What virus? Tx?

A

Eczema herpeticum- occurs over healed atopic dermatitis, HSV, acyclovir

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10
Q

Isoniazid is known for causing vitamin B6 deficiency but can also cause what side effect?

A

Hepatitis- will see panlobular mononuclear infiltration and hepatic cell necrosis

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11
Q

What rash typically SPARES the diaper region in infants? Is symmetric everywhere else

A

Atopic dermatitis

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12
Q

How should you treat tachycardia with narrow QRS complexes and retrograde P waves?

A

Adenosine- tx for svt

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13
Q

A patient with TB presents with hyponatremia and hyperkalemia and normal anion gap metabolic acidosis- diagnosis?

A

Primary adrenal insufficiency- TB is a common cause in developing world

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14
Q

A patient with sickle cell presents for their 6th pain crisis hospitalization- what will be seen on peripheral smear besides sickle cells?

A

Howell Jolly bodies- at this point the patient has functional asplenia due to autoinfarction

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15
Q

A patient presents with sticking sensation in her throat accompanied by dysphagia and absent peristaltic waves in the lower 2/3 of the esophagus with decreased LES tone- diagnosis?

A

Scleroderma- no other pathology has absent peristaltic waves
Achalasia has increased LES tone
GERD has peristalsis

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16
Q

What class of medication can inhibits autonomic thermoregulation?

A

typical antipsychotics such as fluphenazine and haloperidol

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17
Q

How can blood gas differentiate COPD from CHF?

A

CHF- respiratory alkalosis

COPD- respiratory acidosis

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18
Q

What adrenergic therapy can treat hyperkalemia?

A

Albuterol and beta 2 agonists

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19
Q

A patient presents with pericarditis and BUN of 96, Cr of 5.1- next step?

A

Dialysis- this is treatment for uremic pericarditis

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20
Q

An immunocompromised patient has diffuse bilateral interstitial infiltrates on CXR- diagnosis

A

PJP

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21
Q

A patient presents with trendelenburg gait- what muscles or nerves could be injured?

A

Gluteus medius and minimus innervated by superior gluteal nerve

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22
Q

An HIV patient with esophagitis does not get better following fluconazole treatment- next step?

A

Get biopsy of ulcers showing CMV-large irregular ulcers or HSV- small, well circumscribed ulcers
CMV gets ganciclovir
HSV gets acyclovir

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23
Q

What lab abnormalities are seen with lupus anticoagulant and why is this interesting?

A

PTT will be prolonged although patient will be hypercoaguable
Russell viper venom test is specific for lupus anticoagulant and will be prolonged

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24
Q

What is a marjolin ulcer?

A

non-healing burn wound which becomes squamous cell carcinoma

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25
Q

Management of metastatic brain lesions? USMLE High Yield!

A

If solitary with stable extracranial disease- surgery

If multiple- whole brain radiation

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26
Q

What is the pathogenesis of aspirin sensitivity syndrome? USMLE High Yield!

A

Pseudo-allergic reaction due to accumulation of prostaglandins and leukotrienes

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27
Q

What is one method of preventing febrile nonhemolytic reaction after blood transfusion

A

Leukoreduction

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28
Q

A patient has hypotension and back pain after cardiac cath that mildly improves with IV fluids- next step?

A

CT of abdomen to look for retroperitoneal bleeding

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29
Q

How does a knee-to-chest position help during a child’s tet spell with TOF?

A

Increased systemic vascular resistance–> increased pulmonary blood flow

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30
Q

Murmur associated with wide pulse pressure and pounding/racing heartbeat?

A

AR

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31
Q

A patient has a bleeding espophageal varices- 4 things to do before emergent endoscopy?

A

In order- 2 large bore IVs, intubation, antibiotics (ceftriaxone), and IV octreotide to decrease blood flow

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32
Q

First step in evaluation of patient with hypercalcemia?

A

PTH, always

CXR comes after to look for malignancy

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33
Q

How does alcoholism cause impotence?

A

Cirrhosis causes hypogonadism 2/2 testicular atrophy

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34
Q

A gun shot victim has an unequivocal ultrasound for trauma- next step?

A

Go to OR for ex lap if vitals are unstable

NOTE- if BLUNT trauma- do diagnostic peritoneal lavage if FAST is unequivocal

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35
Q

A patient has symptomatic hypercalcemia- next step?

A

IV NS and calcitonin or bisphosphonate

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36
Q

Most common infection prior to orbital cellulitis? Dx test?

A

Bacterial sinusitis

CT scan to rule out abscess that would require surgery

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37
Q

What are two sequelae of mitral stenosis (arrhythmia and lung)? Why?

A

Pulmonary edema and atrial fibrillation

Due to left atrial overland/enlargement

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38
Q

What are the first two steps with a newborn with respiratory distress and scaphoid abdomen?

A

First intubate, then decompress bowel with orogastric tube

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39
Q

A patient has negative anti-tissue transglutaminase but signs suggestive of celiac’s disease including villous atrophy- why?

A

Concurrent IgA deficiency- villous atrophy is nearly diagnostic as long as no recent travel or signs of tropical sprue

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40
Q

A patient with cirrhosis has stopped drinking, is taking his medications, has been appropriately vaccinated. Next step?

A

Esophageal varices surveillance with and EGD

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41
Q

Treatment of choice for inflamed fluctuant cervical lymph node in child?

A

Dicloxacillin> cephalexin or clindamycin

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42
Q

A patient has hypotension, JVD, Kussmaul’s sign, and clear lung fields. EKG shows ST elevation in leads II, III, and aVF- diagnosis?

A

R ventricular infarction. The physical shows RV failure, the EKG shows inferior infarction

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43
Q

A patient with a high pitched systolic murmur heard at 2nd intercostal space has angina with exertion- why?

A

Aortic stenosis leads to large LV leads to increased oxygen demand during exercise leads to pain

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44
Q

3 things to lower risk of contrast induced nephropathy?

A

1) use non-ionic contrast
2) IV hydration
3) acetylcysteine

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45
Q

3 things seen with paroxysmal nocturnal hemoglobinuria?

A

unconjugated hyperbilirubinemia, thrombosis, pancytopenia

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46
Q

What does urine dipstick positive for bilirubin tell you about the hyperbilirubinemia?

A

CONJUGATED hyperbilirubinemia- rotor syndrome is one, acute fatty liver of pregnancy
Most common hyperbilirubinemia’s are unconjugated

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47
Q

4 ways to decrease ICP and mechanism?

A

Head elevation- increases venous return from head
Sedation- lowers metabolic demand
Hyperventilation- cerebral vasoconstriction
Mannitol- extracts free water

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48
Q

A 45 year old patient with no risk factors for colon cancer has mild BRBPR- next step

A

Anoscopy or proctoscopy- can diagnose hemorrhoids, anal fissure, polyps, and other common causes
FOBT is not necessary since history is positive
Colonoscopy is not first step due to age, lack of risk factors

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49
Q

First line treatment for tourette’s?

A

Antipsychotics- 2nd generations are beginning to be preferred

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50
Q

What is one complication of mono? Why?

A

Autoimmune hemolytic anemia due to cross-reactivity of EBV antibodies with RBCs and platelets

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51
Q

A bone marrow transplant patient presents with abdominal tenderness, diarrhea, dry cough, diffuse rales bilaterally. Diagnosis? Why not GVHD?

A

CMV pneumonitis and colitis

SKIN RASH must be present for GVHD

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52
Q

A child has hemolytic anemia, thrombocytopenia after diarrhea and schistocytes on peripheral smear- what must you suspect? USMLE High Yield

A

Hemolytic uremic syndrome 2/2 ecoli infection

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53
Q

What is hyposthenuria?

A

Complication of sickle cell disease that results in nocturia

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54
Q

How to differentiate Fibromyalgia from Polymyositis and Polymyalgia rheumatica?

A

Fibro- widespread pain, fatigue, point tenderness on exam
Polymyositis- elevated CK, symmetrical weakness, abnormal EMG, no tenderness
Polymylagia rheumatica- Elevated ESR, no tenderness

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55
Q

First diagnostic test, best test, and treatment for HSV encephalitis?

A

First- r/o intracranial tumor/bleed with CT–> LP
Best- HSV PCR
Tx- Acyclovir

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56
Q

Which atypical antipsychotic is least likely to cause weight gain and diabetes?

A

Aripiprazole> ziprasidone
Olanzapine is the worst
Ziprasidone causes QT prolongation

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57
Q

What does an ABG of a patient with atelectasis look like?

A

Respiratory alkalosis with hypoxemia- increased pH, decreased O2 and CO2

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58
Q

A patient has a tension pneumothorax- next step?

A

Needle thoracostomy comes before IV resuscitation

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59
Q

Can you use low molecular weight heparin in HIT?

A

No, stop all heparin products and switch to argatroban.

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60
Q

A patient has symptomatic gallstones but refuses surgery- next step? (2)

A

Counsel to avoid fatty foods and prescribe ursodeoxycholic acid

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61
Q

An immunosuppressed patient is having side effects of their medication- what side effects make you think cyclosporine vs azathioprine vs mycophenolate? High yield USMLE!

A

Cyclosporine has a long list include nephrotoxicity (most common, can lead to gout), tremors, HTN (give Ca channel blockers), glucose intolerance, hirtuism, gingival hypertrophy
Azathioprine has 3 well know side effects- diarrhea, leukopenia, hepatotoxicity
Mycophenolate is know for Marrow suppression

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62
Q

A young woman presents with chronic knee pain while climbing stairs. Otherwise healthy- diagnosis and physical exam test?

A

Patellofemoral syndrome- press on patella while extending knee to elicit pain

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63
Q

Ophtho clue- decreased vision while driving at night and reading newspaper?

A

Cataracts! Opacity of lens on exam

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64
Q

An alcoholic, chronic smoker has dilated cardiomyopathy without ischemic changes- next step?

A

Alcohol abstinence can REVERSE process

ACE inhibitors slow progression

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65
Q

Treatment for long QT syndrome?

A

Beta blockers

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66
Q

A patient with prolonged steroid use 2/2 polymyalgia now has fatigue, loss of appetite, and increased abdominal circumference- diagnosis and changes in ACTH, cortisol, aldosterone?

A

Adrenal insufficiency 2/2 steroids
Low ACTH, low cortisol
NORMAL aldosterone- ACTH does not stimulate or inhibit aldosterone- controlled by renin system

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67
Q

A patient with AVF has brisk carotid upstroke, soft systolic murmur that does not change with Valsalva, and flushed lower extremities- diagnosis?

A

High output cardiac failure
Brisk carotid is strong peripheral pulse
Murmur is a flow murmur

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68
Q

What is the key factor in development of type 2 diabetes and sequelae (HTN, HLD)? USMLE High Yield!

A

Insulin resistance

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69
Q

A baby becomes cyanotic while feeding but gets better when crying- diagnosis? Test and treatment? USMLE High Yield!

A

Choanal atresia
First- try to pass catheter from nose into oropharynx
Best- CT scan
Treatment- oral airway and lavage feeding followed by surgery

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70
Q

Where is the most common site of ulnar nerve entrapment and what will you see on exam? USMLE High Yield

A

Medial epicondylar groove

Will see decreased sensation of 4th and 5th digits and a weak grip

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71
Q

3 options for close contact prophylaxis for Neisseria meningitidis?

A

Rifampin, ciprofloxacin, ceftriaxone

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72
Q

5 indications for addition of ampicilin for empiric coverage of meningitis?

A

Covers listeria

Immunocompromised, pregnant, HIV, elderly, steroids, neonates

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73
Q

What is the most sensitive physical exam finding for acute otitis media?

A

Immobility of TM

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74
Q

Hepatitis B- first indicator to show up and last to be present to indicate risk for transmission?

A

Surface antigen

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75
Q

Hepatitis B- indicator for need for treatment and best indicator for risk of pregnant woman transmitting disease to her child?

A

e-antigen

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76
Q

A pelthoric face, splenomegaly and HCT > 50% are indicative of what?

A

Polycythemia vera

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77
Q

A child is in immense right elbow pain with no history of trauma, swelling, or deformity. She holds her hand in the pronated position. A click is heard when palpating the radial head with the elbow flexed and forearm supine and the pain goes way- diagnosis?

A

Nursemaid’s elbow- annular ligament pain

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78
Q

A patient with glactorrhea and amenorrhea has a 6mm pituitary adenoma- next step? Why no surgery?

A

Cabergoline or bromocriptine- dopamine agonists can shrink tumor
Surgery only if no response to treatment or visual disturbances due to tumor

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79
Q

A patient returns from South America with foul smelling stools, abdominal cramps and is prescribed ciprofloxacin. He returns a week later without improvement- next step?

A

Metronidazole- this is Giardia

Can get stool ova and parasite but should start treatment before results

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80
Q

A patient following blunt trauma to the abdomen has a normal CT scan. Returns one week later with abdominal pain, fever, and chills- diagnosis?

A

Pancreatic laceration or psuedocyst or abscess- not always detected with immediate CT scan

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81
Q

A patient 3 days s/p MI has a new pansystolic murmur that radiates to the axilla- why the new MR? Why not ventricular septum rupture?

A

papillary muscle rupture

Ventricular septum rupture murmur does not radiate

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82
Q

When does a COPD patient need home oxygen? SaO2? PaO2?

A

SaO2 < 88, PaO2 < 55

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83
Q

A patient with GERD and Barrett’s esophagus has a significant improvement in GERD symptoms without intervention- what happened?

A

Peptic stricture can actually improve GERD but should be biopsied for adenocarcinoma

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84
Q

A patient with GI complaints comes in a week later with eosinophilia, periorbital edema, and myositis- diagnosis?

A

Trichonellosis

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85
Q

Most common cause of myocarditis in children?

A

Viral- coxsackie

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86
Q

What procedure should be done if a patient with hemoptysis is bringing up large amounts of blood and filling the endotracheal tube with blood following intubation?

A

Bronchoscopy- can be therapeutic with electrocaudery or balloon tamponade

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87
Q

What is one cardiac finding on physical exam that would make you think angiodysplasia&raquo_space; diverticulosis for rectal bleeding?

A

Aortic stenosis

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88
Q

Most common risk factor for respiratory distress syndrome in newborn besides prematurity?

A

Maternal diabetes- delays maturation of surfactant production

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89
Q

6 scenarios for drug induced pancreatitis?

A 
Diuretics- furosemide or thiazides
IBD- sulfasalazine
Immunosuppression- azathioprine
Seizures- VPA
AIDS- didanosine
Antibiotics- metronidazole, tetracycline
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90
Q

A young patient with chronic back pain has restrictive results on pulmonary function test- diagnosis?

A

Ankylosing spondolysis- fusion of costovertebral joints leads to restricted chest wall movement

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91
Q

A patient has a rash that looks like RMSF but has generalized lymphadenopathy- diagnosis?

A

2ndary syphilis

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92
Q

Initial test for acromegaly? Best test?

A

Initial- IGF-1

Best- GH after oral glucose load

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93
Q

An infant with a heart murmur but no cyanosis presents- why not tetralogy of fallot?

A

NO CYANOSIS

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94
Q

Lumbar flexion makes what worse? What about extension?

A

Flexion makes disk herniation worse

Extension makes stenosis worse

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95
Q

Initial test for suspicion of ZE syndrome? If unequivocal next test?

A

Gastrin levels are first

Secretin stimulation test is next

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96
Q

How do the kidneys compensate for obesity hypoventilation syndrome?

A

Increase bicarb retention and decrease chloride retention

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97
Q

What swelling of the newborn scalp is limited to one bone, which one crosses sutures?

A

Cephalohematoma limited to one bone

Caput succedaneum crosses sutures

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98
Q

Delayed separation of the umbilical cord leads to defective what?

A

Leukocyte adhesion- will present as recurrent infections of skin and mucosa

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99
Q

Skin cancer found on the lips is most likely?

A

Squamous cell carcinoma

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100
Q

Treatment for thrombocytopenia following viral infection in child?

A

Reassurance

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101
Q

A patient with shortness of breath has an S3 on cardiac exam- treatment?

A

Diuretics

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102
Q

What kidney pathology is associated with hepatitis B

A

Membranous glomerulonephritis

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103
Q

What is meconium ileus diagnostic for?

A

Cystic fibrosis

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104
Q

Most common heart defect in Down’s?

A

Complete AV septal defect>VSD>ASD

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105
Q

Most common cause of post-influenza pneumonia?

A

Staph aureus

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106
Q

What is the treatment for syphilis in penicillin allergic patients?

A

Doxycycline

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107
Q

First vital sign to change with hypovolemia?

A

Pulse

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108
Q

Which one has full on mania- bipolar I or II

A

Bipolar I

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109
Q

A patient with RA is not responding to NSAIDs- next step? Second step?

A

First MTX

Try entarcept and infliximab if symptoms persist with 6 months of therapy

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110
Q

Treatment for Wolff-Parkinson-White?

A

Procainamide

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111
Q

2 ways to increase O2 levels in an intubated patient?

A

Increase FiO2 (although goal should be <60% as there are risks of O2 toxicity), add PEEP

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112
Q

A child with arthralgias, abdominal pain, and nephritis has a nonblanching rash on his lower extremities- diagnosis?

A

Henoch-Schonlein purpura

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113
Q

Kidney disease associated with HIV?

A

Focal segmental glomerulosclerosis

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114
Q

Treatment for dermatitis herpetiformis?

A

Dapsone- remember association with celiac’s disease!

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115
Q

A patient with BPH is having worsening symptoms and an increase in Cr- next step?

A

Abdominal ultrasound to assess for hydronephrosis

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116
Q

A patient presenting with acute MI can have what change on cardiac exam?

A

Fourth heart sound

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117
Q

Aortic dissection (chest pain and pain between scapula, difference in BP between arms)- initial test, best test, treatment?

A

CXR first, angiogram best, beta blockers treatment

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118
Q

Why is age important when diagnosing acute epididymis?

A

Younger patient-s think gonorrhea or chlamydia

Elderly- think gram - rods like e coli

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119
Q

A patient presents with bipolar- what labs should be drawn prior to giving lithium?

A

Cr and BUN- renal dysfunction is contraindication to lithium

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120
Q

What diagnosis should come to mind in a patient with recurrent nosebleeds and papules along his lips? What is one complication?

A

Osler-Weber-Rendu syndrome, hereditary telangiectasias

AV malformations

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121
Q

A child presents with croup that is not responding to oxygen or albuterol- next step?

A

Give epinephrine trial before going to intubation!

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122
Q

2 things that should raise suspicion a deivated trachea is not pneumothorax but rather diaphragmatic hernia?

A

normotension (or lack of hypotension)

CXR shows NG tube in the chest!

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123
Q

Treatment for Dressler’s syndrome?

A

NSAIDs

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124
Q

A patient has an inferior wall MI, 8 hours later is hypotensive while on nitroglycerin drip and has JVD with clear lungs- next step?

A

Stop nitroglycerin and give fluids- this is a RV infarct and needs fluids to increase RV stroke volume

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125
Q

Tx for hypovolemic hypernatremia?

A

Normal saline- even in infants!

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126
Q

Pulmonary auscultation- increased breath sounds, dull percussion, increased fremitus?

A

Consolidation

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127
Q

Pulmonary auscultation- decreased breath sounds, dull percussion, decreased fremitus?

A

Pleural effusion

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128
Q

Pulmonary auscultation- decreased breath sounds, hyperresonant percussion, decreased fremitus? (2)

A

COPD or pneumothorax- use history and mediastinal shift to differentiate

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129
Q

Cutoff mm for CXR after PPD test? 3 levels

A

15mm in healthy
10 mm in mild risk- endemic area, IVDU, DM, CKD
5mm in high risk- HIV, recent contact, immunosuppression

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130
Q

How does exogenous thyroid hormone abuse present differently than Graves on labs?

A

Graves- Elevated TSI

Exogenous- low serum thryoglobulin, no TSI

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131
Q

A patient has fever, diarrhea, and vomiting after cruise? bug and drug?

A

Legionella

Z pack or levofloxacin

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132
Q

Sidney Crosby gets mono- when can start playing again?

A

When physical exam normalizes- no more splenomegaly

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133
Q

Easy way to differentiate between lateral medullary vs pontine lesion?

A

CNs! diminished gag reflex or hoarseness- medulla

Weakness while chewing, diminished jaw jerk reflex- think pontine

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134
Q

Infection 6 months after knee surgery is most likely what bug?

A

Coagulase negative staph- epidermidis

S. aureus would present within 3 months

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135
Q

Pathophysiology behind cardiac tamponade? Fluid accumulation causes what?

A

Decreased LV preload due to fluid accumulation in percardial cavity

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136
Q

Bullous pemphigoid vs pemphigus vulgaris- 2 differences?

A

Bullous pemphigoid- IgG deposits at dermal epidermal junction, tense blisters
Pemphigus vulgaris- IgG deposits intracellularly in epidermis, flaccid blisters

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137
Q

A patient post MI has a cold leg- next step?

A

get echo to look for thrombus in LV

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138
Q

Is weight loss and pink diaper stains normal in a 4 day old newborn?

A

Yes- continue current feeding regimen- birth weight should be regained by 10-14 days, pink stains are uric acid crystals and normal

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139
Q

2 ways to differentiate Legg-Calve-Perthes disease and SCFE?

A

LCP- age 4-10

SCFE- ages 12-14 and OBESE

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140
Q

A patient presents with a one week history of symptoms suspicious for rheumatoid arthritis- what is another diagnosis?

A

Viral arthritis- look for symptoms to resolve in 1 month

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141
Q

What supplementation should be started in premature infants at birth who are exclusively breastfeeding?

A

Iron and Vit D

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142
Q

One part of the body methanol poisoning affects that ethylene glycol does not? One finding on urinalysis?

A

Eyes

Ethylene glycol has crystals in the urine

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143
Q

How to differentiate gonococcal from chlamydial conjunctivitis in the newborn and tx for each?

A

Gonoccocal presents at 2-5 days and is treated with erythromycin drops @ birth
Chlamydial presents 5-14 days and is treated with maternal testing and tx during pregnancy

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144
Q

A patient with a scaly, itchy rash after swimming lessons in a public pool should be treated with what?

A

Terbinafine- dx is tinea corporis

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145
Q

Complication of temporal arteritis besides blindness (cardiac)

A

Aortic aneurysms

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146
Q

When is tetanus immune globulin indicated?

A

Uncertain or lack of immunization history with a severe or dirty wound- If patient has KNOWN vaccination history even if it is > 10 years just needs toxoid booster

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147
Q

3 contraindications to metformin?

A

Renal failure, hepatic failure, sepsis- all increase risk for lactic acidosis

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148
Q

Mechanism for hypotension in pulmonary embolism- 5 steps?

A

Thrombus increases pulmonary vascular resistance–> Increase RV pressure–> RV hypokinesis and dilation–> decreased preload–> hypotension

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149
Q

What is the marker of an aplastic crisis in a sickle cell patient?

A

Very low hgb with low reticulocyte

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150
Q

Two ways to describe the gait associated with Parkinson’s

A

Shuffling or Hypokinetic

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151
Q

Two findings on light microscopy in membranous glomerulonephritis?

A

Diffuse GBM thickening, subepithelial spikes

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152
Q

Transparent or yellow papules with mild scaling plaques on the scalp, eyebrows, or nasolabial folds are characteristic of what rash?

A

Seborrheic dermatitis

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153
Q

What is genu varum? Rachitic rosary?

A

Femoral and tibial bowing, bony prominences of the costochondral junctions seen in rickets

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154
Q

Vitamin B12 deficiency can lead to increase risk of what cancer?

A

Gastric cancer if cause is pernicious anemia

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155
Q

Tea and toast diet?

A

Folic acid deficiency

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156
Q

A patient with osteoarthritis is most likely to have what kind of anemia?

A

Iron deficiency from chronic NSAID use

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157
Q

A patient with COPD has an acute exacerbation and is started on appropriate therapy- He then suffers a seizure- why?

A

Excess supplemental oxygen to correct hypoxemia stopped the respiratory drive and caused CO2 retention leading to seizure

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158
Q

An infant with low bicarb, high chloride, and failure to thrive could have what?

A

Renal tubular acidosis

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159
Q

A patient has clear lungs but prominent pulmonary arteries and an enlarged right heart border- diagnosis?

A

Primary pulmonary HTN- secondary causes- MS, MVP, LV failure, will not have clear lungs

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160
Q

What is erysipelas?

A

Strep A cellulitis which results in a well demarcated tender raised rash

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161
Q

What treatment worsens ophthalmology associated with Graves disease?

A

Radioactive iodine

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162
Q

A 16 year old breaks his clavicle- on exam there is a bruit heard beneath his clavicle. Neuro exam is normal- next step?

A

Get angiogram before using brace

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163
Q

A month old baby presents with painless bloody stools and large amounts of spit up following breastfeeding. He has normal growth so far- next step?

A

Have mom eliminate all dairy and soy from her diet and recheck in 2 weeks

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164
Q

A patient has a cystic breast mass drained and clear fluid is aspirated- next step?

A

F/u in 4 weeks- do NOT send fluid to cytology unless fluid is bloody/ foul smelling
Biopsy if mass returns in 4 weeks

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165
Q

A home birth baby with spasms and swollen erythematous umbilical cord at 2 weeks- diagnosis?

A

Tetanus

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166
Q

A 15 year old patient presents with scoliosis, foot deformities (hammer toes), dysarthria, and ataxia? diagnosis and most common cause of death? USMLE High Yield!

A

Frederich ataxia- neuro sxs, skeletal sxs, cardiomyopathy around 20 years old
Cardiomyopathy most common cause of death

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167
Q

Does impetigo need oral or topical treatment?

A

Topical erythromycin or mupirocin for local cases
Oral dicloxacillin or ampicillin for severe cases
NEVER penicillin due to s aureus

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168
Q

A patient with hepatic encephalopathy needs treatment but lactulose isn’t an option- look for what answer?

A

Correct electrolyte abnormalities or give albumin!

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169
Q

A patient returns from Florida with multiple velvety pink, pale macules on his trunk that scale upon scraping- diagnosis, confirmatory test, tx?

A

Tinea versicolor 2/2 malassezia furfur
Test- KOH prep shows spaghetti and meatball appearance
Tx- selenium sulfide lotion with ketoconazole shampoo
Hints- recent sun exposure with areas that did not tan, no scaly appearance but scale upon scraping

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170
Q

A prostitute with a high fever, malaise, skin rash on arms, and arthralgias has a negative blood culture x3- diagnosis?

A

Disseminated gonnorrhea

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171
Q

A patient with hypertension has bilateral palpable upper abdominal masses- most likely diagnosis?

A

Polycystic kidney disease

Pheochromocytoma, hyperaldosteronism do not have PALPABLE masses

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172
Q

Why do DM type 2 patients have elevated LFTs?

A

Non-alcoholic fatty liver disease 2/2 insulin resistance

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173
Q

Vitamin therapy in measles that reduces M and M?

A

Vitamin A

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174
Q

Tx for frostbite- warm water, dry heat, or infusion of warm fluids?

A

Warm water

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175
Q

A patient with prolonged atrial fibrillation has LV dilation and a low ejection fraction- next step?

A

Control rate and rhythm via medications before optimizing preload and afterload

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176
Q

A newborn had bilateral hydronephrosis and oligohydramnios on 2nd trimester ultrasound- 5 things he might be born with?

A

Pulmonary hypoplasia, skin, face, and limb deformities, posterior urethral valves

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177
Q

A 5 year old develops pertussis and is started on appropriate treatment (erythromycin for 14 days)- next step?

A

Erythromycin for 14 days for all close contacts REGARDLESS of immunization history

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178
Q

Tx for hemodynamically unstable atrial fibrillation?

A

DC cardioconversion

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179
Q

A patient presents with HTN, severe headache, motor deficits on the R, and conjugate gaze deviation to the L with nonreactive L pupil- diagnosis? Why not SAH?

A

L basal ganglia hemorrhage 2/2 HTN

Not SAH due to motor deficits and focal eye deficits

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180
Q

A boy presents with severe treatment resistant acne, pubic and axillary hair development , and normal testes- diagnosis?

A

Gonadotropin independent precocious puberty 2/2 congenital adrenal hyperplasia

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181
Q

A patient is rescued from a fire, has a seizure, and is confused- next step?

A

100% oxygen facemask to treat CO poisoning

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182
Q

4 Indications for renal/bladder US following UTI in child?

A
  • does not respond to appropriate treatment
  • family history of renal or urologic disease
  • <24 months of age
  • Recurrent febrile UTIs
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183
Q

Electrolyte abnormalities in Cushing’s? Na, K

A

Hypernatremia with hypokalemia due to crossreactivity of glucocorticoids with aldosterone receptors

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184
Q

First line treatment for osteoarthritis? (3)

A

Weight loss and moderate exercise with Acetaminophen»>NSAIDs

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185
Q

A patient has an embolus in his R femoral artery and undergoes embolectomy. 6 hours later he has severe R leg pain, swelling, and a burning sensation in his R leg- diagnosis?

A

Compartment syndrome 2/2 soft tissue swelling after reperfusion

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186
Q

3 side effects of erythropoietin therapy?

A

HTN, headaches, Flu like syndrome

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187
Q

A patient with conjunctivitis has itense itching in both eyes- likely diagnosis?

A

Allergic conjunctivitis&raquo_space; infectious

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188
Q

Tx of 3rd degree heart block?

A

Pacemaker to avoid V tach of V fib

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189
Q

A patient with hx of atherosclerosis has HTN and systolic-diastolic abdominal bruit- diagnosis?

A

Renal artery stenosis

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190
Q

12 year old boy presents with chronic back pain, bed wetting, and a palpable step off in lumbosacral area- diagnosis?

A

Spondyloisthesis

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191
Q

A child presents with hypotension, dry mouth, dilated pupils, a widened QRS on EKG after taking grandma’s amitriptyline- next step? USMLE High Yield!

A

Sodium bicarbonate for OD

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192
Q

Two ways to differentiate papillary muscle rupture vs LV aneurysm as both can present with MR murmur

A

Papillary- timeline is 2-7 days after MI, will not see EKG changes
LV aneurysm- timeline is 5 days- 3 months post MI, will see persistent ST elevation and deep Q waves

193
Q

Confounding vs effect modification?

A

Confounding- significance disappears after stratification

Effect modification- significance appears after stratification

194
Q

A baby has bilious emesis and mom did cocaine during pregnancy- likely diagnosis? Sign on X-ray?

A

Jejeunal atresia, will see triple bubble sign compared to double bubble with duodenal atresia (also duodenal atresia associated with down’s syndrome)

195
Q

A patient with a history of food allergies has acute shortness of breath and difficulty swallowing- diagnosis?

A

Laryngeal edema

196
Q

Henoch-Schonlein purpura, presenting with purpura, abdominal pain, arthalgias, +/- scrotal swelling increases risk for what sequelae?

A

Intussusception

197
Q

Treatment for anemia of chronic disease? Low iron, low TIBC

A

Treat underlying condition

198
Q

Best way to improve prognosis 1 hour after MI?

A

Restore coronary blood flow

199
Q

What should be tried before intubation during acute exacerbation of COPD?

A

Noninvasive positive pressure ventilation

200
Q

A 60 year old presents two weeks after treatment for thrombophlebitis with a DVT- next step?

A

CT of C/A/P looking for malignancy

201
Q

A patient recently started amitriptyline then presents with lower abdominal pain- next step?

A

Urinary catheterization- detrusor inactivity 2/2 amitriptyline causing urinary rentention

202
Q

A patient with CLL has anemia- treatment?

A

Prednisone to treat autoimmune hemolytic anemia

203
Q

A dentist presents with non-purulent vesicles on his finger- diagnosis? USMLE High Yield

A

Herpetic whitlow

204
Q

First step in the workup of dyspepsia?

A

H pylori testing unless dysphagia, weight loss, or persistent vomiting occurs–> straight to upper endoscopy

205
Q

Ophtho- “curtain coming down” loss of vision?

A

Retinal emboli causing amaurosis fugax

206
Q

A patient presents with fatigue and dark urine. Abdomen nontender, increased alk phos, normal AST, ALT on labs- next step?

A

Abdominal US to assess for cholestasis

207
Q

A patient has pneumomediastinum and subcutaneous emphysema after blunt chest trauma- diagnosis?

A

Tracheobronchial rupture

NOT esophageal rupture if 2/2 blunt trauma- look for Borhaave or iatrogenic

208
Q

How does chronic steroid use cause bone pain- pathophysiology?

A

Disruption of bone vasculature

209
Q

A child presents with polyuria and diaper candidiasis- must rule out what?

A

DM type I

210
Q

An HIV patient has cerebral toxoplasmosis- tx?

A

Sulfadiazine and pyrimethamine

TMP-SMX is prophylaxis NOT tx

211
Q

A patient with rheumatoid arthritis has kidney damage- diagnosis, best test?

A

Amyloidosis causing kidney damage

Renal biopsy shows apple-green birefringence under polarized light after Congo red stain

212
Q

How does valsalva affect murmurs?

A

Decreases venous return therefore decreases most murmurs except HOCM

213
Q

A patient gets nasal packing 2/2 epistaxis- 2 days later presents with fever, tachycardia, hypotension, and erythematous macules on trunk and extremities- diagnosis?

A

Toxic shock syndrome! Nasal packing or tampon can cause it

214
Q

Most common cause of death in acute MI is what arrhythmia?

A

Reentry arrhythmia

215
Q

A patient with nephrotic syndrome has low complement, rash, arthralgias- diagnosis, next test?

A

Cryglobulinemia
Get hepatitis panel
Low complement also seen with Post-strep glomerulonephritis, membranoproliferative, and lupus nephritis- differentiate based on history

216
Q

First test, best test for CLL?

A

First- CBC and peripheral smear

Best- Flow cytometry of blood

217
Q

A child has head circumference rapidly increasing across percentiles- next step?

A

CT or MRI - must get imaging

218
Q

Best test for diagnosis of Ankylosing spondylitis?

A

X ray of sacro-iliac joints

219
Q

How does iron deficiency anemia change MCHC and RDW?

A

MCHC decreased

RDW increased

220
Q

An Asian immigrant has MR- next step?

A

Pencillin prophylaxis until 21 years old

221
Q

A patient has renal stones- 4 dietary recommendations? USMLE High Yield!

A

Decrease protein and oxalate
Decrease sodium
Increase fluids
Increase dietary calcium

222
Q

A patient with HTN, hypokalemia, hyperglycemia, and weight gain has HTN because of what part of what organ?

A

Adrenal cortical disease- this is Cushing’s

223
Q

Nasopharyngeal cancer risk factor?

A

EBV

224
Q

A patient presents with symptoms of hyperthyroid, visual disturbances, but a normal TSH- most likely diagnosis?

A

TSH secreting pituitary adenoma- vision changes from mass effect

225
Q

A elderly man has urinary retention and absent Achilles reflexes- diagnosis?

A

BPH!

Cord compression would cause urinary incompetence, achilles reflex loss is normal with old age

226
Q

Treatment for Acute transplant rejection? USMLE High Yield!

A

IV steroids

227
Q

A patient presents with nephrotic syndrome and a couple of days later has severe R abdominal pain with gross hematuria. Diagnosis and most likely cause of nephrotic syndrome?

A

Dx- renal vein thrombosis due to loss of antithrombin III

Most common- membranous glomerulonephritis

228
Q

A patient has high amylase in the pleural fluid- 2 options and how to differentiate?

A

Pancreatitis- abdominal pain radiating to back, no mediastinal widening
Esophageal perforation- look for chronic alcohol use (Borhaave), widened mediastium on CXR

229
Q

Why can LP be performed immediately in infants < 1 year old when meningitis is suspected?

A

Fontanelles have not closed yet. Give Ceftriaxone/Vanc immediately after LP

230
Q 
4 most tested facts for acute leukemia:
Which one associated with DIC?
Tx for M3 AML?
Auer rods associated with?
Tx to reduce relapse in ALL?
A

DIC- M3 AML
Auer rods- M3 AML
Tx M3 AML- All-trans retinoic acid
ALL tx- intrathecal MTX

231
Q

Best test for multiple myeloma?

A

BM biopsy- > 10% plasma cells is diagnostic

First test- X-ray, next- SPEP, but best is BM biopsy NOT SPEP

232
Q

How do estrogen replacement therapy and pregnancy affect thyroid hormones?

A

Increased thyroid binding globulin leads to increased requirement for L-thyroxine dose during pregnancy and HRT

233
Q

A newborn has equinus and varus of the calcaneum and talus, varus of the midfoot, and adduction of the forefoot- diagnosis and treatment?

A

Clubfoot/ talipes equinovarus
Tx- stretching and manipulation with serial casting immediately
Surgery only if treatment fails after 3-6 months

234
Q

DO NOT MAKE DUMB MISTAKES WITH STATISTICS

A

DO NOT MAKE DUMB MISTAKES WITH STATISTICS

235
Q

Why can SaO2 change with position in pneumonia?

A

Physiologic shunting to and from the consolidation changes SaO2- lying on side of consolidation decreases SaO2

236
Q

With dehydration do you bolus solution with D5?

A

No, never in bolus only in maintenance

237
Q

A patient has crypotococcal meningitis- tx and f/u?

A

Tx- amphotericin and flucytosine

F/u HIV testing

238
Q

A patient w/ h/o prostate cancer and bony metastases has orchiectomy. Symptoms return with new bony metastases- next step?

A

Radiation therapy

239
Q

G2P1 @ 38 weeks with pre-eclampsia comes in with painful vagina bleeding. Her vital signs are stable, as are the baby’s, and the bleeding stops. Cervix is @ 3cm- next step?

A

DO NOT SEND HOME- placental abruption at term is treated with augmentation of vaginal delivery
Proceed to C section when necessary- mother/fetus becomes unstable, contraindications to delivery

240
Q

SAAG > 1.1 of alcoholic- mechanism of ascites?

A

Increased capillary hydrostatic pressure

241
Q

Crohn’s or UC- crypt abscess? Non-caseating granuloma?

A

UC- crypt abscess, but could be both

Crohn’s- Non-caseating granulomas- BEST way to differentiate

242
Q

An HIV patient has branching partially acid fast bacteria- bug and drug?

A

Norcardia- also common in transplant patients

TMP-SMX is treatment

243
Q

A patient’s pleural fluid shows protein of 5.2 vs serum protein of 6.0- mechanism?

A

Exudate (protein ratio >0.5) therefore increased capillary permeability

244
Q

Adult patient presents with obstructive lung disease and bronchodilator challenge is unequivocal- how can you tell asthma vs COPD?

A

DLCO- normal in asthma, decreased in COPD- except for chronic bronchitis (normal DLCO)

245
Q

A 35 year old man has chronic low back pain. No point tenderness, no trauma, no risk factors, pain gets better throughout the day- most oikely diagnosis?

A

Ankylosing spondylitis- causes apophyseal joint arthritis/inflammation

246
Q

Crohn’s or UC- always involves rectum?

A

UC always involves rectum

Patient who only has oral ulcers- Crohn’s

247
Q

A baby has bloody stools after being born premature- what to look for on X-ray?

A

Pneumatosis intestinalis= NEC

248
Q

A teenager presents with nonspecific symptoms- mild fever, sore throat, rhinorrhea- and normal physical exam, no PMH, stable vitals. Follow up one week later shows irritating cough that can cause vomiting. Still has normal physical exam- next step, dx, tx?

A

Next step- nasopharyngeal culture
Dx is likely pertussis
Tx- azithromycin

249
Q

A patient on phenytoin has anemia- next step? USMLE High Yield!

A

Folic acid supplementation

Other drugs interfering with folic acid are MTX, trimethoprim

250
Q

Nocardia or Actinomyces- anaerobic?

A

Actinomyces! Tx is penicillin while nocardia is tx with bactrim

251
Q

Most common cause of unilateral cervical lymphadenitis in children?

A

S. aureus

252
Q

A patient has low Ca, high P, and normal kidney function- diagnosis?

A

Primary Hypoparathyroid

253
Q

A patient following blunt abdominal trauma has delayed onset hypotension- next step?

A

CT scan- likely splenic injury

254
Q

Most common part of the spine to be affected by rheumatoid arthritis?

A

Cervical spine

255
Q

A patient has a history of anorexia- 5 things she is at risk for? USMLE High Yield

A 
Osteoporosis
Arrhythmias
Anovulation
If pregnant- IUGR
Postpartum depression
256
Q

What abdominal anatomical problem in children can present with periodic abdominal pain followed by vomiting, no pain between these episodes, and positive FOBT? Diagnosis, Test, Treatment?

A

Intussusception
Abdominal US
Air enema

257
Q

Dermatology- stuck on waxy appearance in elderly patient?

A

Seborrheic keratosis

258
Q

A patient with blunt chest trauma has decreased breath sounds and dullness on the L with tracheal deviation to the R- diagnosis?

A

Hemothorax!

Pneumothorax is hyperresonant

259
Q

A patient has LLQ pain, hematochezia, and ulcerations on colonoscopy after a surgical repair of a large abdominal aortic aneurysm- diagnosis?

A

Ischemic colitis

260
Q

A 2 month old has a white relfex on eye exam- next step? USMLE High Yield

A

Ophtho consult to rule out retinoblastoma

261
Q

Test and treatment for disseminated histoplasmosis?

A

Test- urine antigen

Tx- itraconazole

262
Q

Polymyositis vs Myasthenia Gravis- ptosis and diplopia?

A

MG

263
Q

New diagnosis of HTN needs what 4 tests?

A

UA, CMP, Lipid profile, EKG

264
Q

Strongest modifiable risk factor for predicting aortic aneurysm expansion?

A

Smoking

265
Q

Tx of Lyme disease during pregnancy?

A

Amoxicillin»»Azithromycin

266
Q

An old lady lifts an box then has acute severe back pain- fracture vs lumbosacral strain?

A

Fracture- more rapid, dramatic onset with spinal tenderness, look for osteoporosis risk factors
Strain- paravertebral muscle tenderness

267
Q

A child has isolated hemihyperplasia, macroglossia, and macrosomia. Next step?

A

Abdominal ultrasound for wilms tumor or hepatoblastoma

268
Q

Why would an obese lady with normal FSH and LH have amenorrhea?

A

Anovulation

269
Q

A 3 week old has a leg-length discrepancy- next step?

A

Perform ortolani and barlow maneuvers- if palpable click–> orthopedics
If negative- hip ultrasound

270
Q

A patient with ulcerative colitis has fatigue and increased Alk Phos- diagnosis?

A

Primary sclerosing cholangitis

271
Q

A patient has a pulsatile mass in the right groin area, right thigh pain that is worse with walking- diagnosis?

A

femoral artery aneurysms

272
Q

First line therapy for mild acne?

A

Topical retinoids

273
Q

What rash spreads cranio-caudally and spares the palms and soles?

A

Rubella

274
Q

A patient who recently underwent chemotherapy develops a rapidly progressing bulla on his foot that ruptures leaving a painless ulcer with a black center- diagnosis?

A

Psuedomonas causing erythema gangrenosum

275
Q

Syncope with prodromal dizziness and blurred vision?

A

Orthostasis

276
Q

A patient has thready pulses in the radial arteries that disappears with inspiration- what sign?

A

Pulsus paradoxus- possibly cardiac tamponade

277
Q

CSF findings in HSV encephalitis- RBC, WBC, % neutrophils, protein, glucose?

A

RBC elevated
WBC elevated with low neutrophils
protein elevated
Glucose normal

278
Q

A patient presents with shortness of breath. PFTs show FEV1 65% and FEV1/FVC ratio of 85%- what’s the answer?

A

Whatever mentions fibrosis!

279
Q

Empyema vs TB as cause of pleural effusion?

A

Empyema- will have frank pus aspirated, low glucose, more PMNs
TB- high protein, more lymphocytes, not frank pus

280
Q

A patient with recent diagnosis of small cell lung cancer has diffuse headaches that worsen when he leans forward and prominent neck veins on exam- diagnosis? Tx?

A

SVC syndrome

Tx is radiation

281
Q

Treatment for wide complex tachycardia?

A

Amiodarone

282
Q

Post-gastric bypass patients prophylaxis?

A

Ursodeoxycholic acid for 6 months to prevent gallstones

283
Q

Pain seen with peritoneal irritation 2/2 perforation?

A

Somatic

Visceral is more diffuse- seen with SBO

284
Q

Most common cause of aortic stenosis in elderly?

A

Calcifications of aortic valve leaflets

285
Q

Prognostic factor for astrocytomas?

A

Degree of anaplasia

286
Q

A patient with pancreatic cancer has severe itching. He has multiple metastasis- next step?

A

Stent placement in common bile duct

287
Q

A sickle cell patient has diffuse thigh and back pain- avascular necrosis or microvascular occlusion?

A

Microvascular occlusion- look for high LDH value

288
Q

Mechanism of renal failure in multiple myeloma?

A

toxic effect of light chain casts on renal tubules

289
Q

A patient with rheumatoid arthritis has a low grade fever and monoarticular swelling and tenderness of right second MCP- diagnosis?

A

Septic athritis- monoarticular does not occur with RA

290
Q

What is the anemia associated with DIC caused by?

A

Microangiopathic hemolytic anemia

291
Q

What is a common complication of thoracentesis that can result in decreased breath sounds and dullness to percussion on the same side of the procedure? How can it affect LV?

A

Hemothorax causing decreased LV preload

292
Q

What physical exam finding is absent in testicular torsion?

A

Cremasteric reflex

Pain relief with elevation of testes= epididymitis

293
Q

A young male with worsening diarrhea, loud bowel sounds, anemia, and a history of R wrist fracture likely has what diagnosis?

A

Celiac’s disease leading to malabsorption

294
Q

A child has pharyngitis without lymphadenopathy- next step?

A

Nothing!

No lymphadenopathy means not GAS and penicillin not necessary

295
Q

A patient has an EKG with flattened P waves and prolonged QRS- next step?

A

Check K levels- if high give Ca gluconate

296
Q

Pheochromocytoma associated with what part of adrenals?

A

Medulla

297
Q

A patient develops a fever 1 week after blood transfusion and chemotherapy. Has confusion and altered mental status- diagnosis?

A

Bacterial infection, possibly sepsis. Signs can be less in chemo patient due to less WBCs

298
Q

A diabetic ulcer without erythema or purulent drainage does not involve the bone- next step?

A

Debride the necrotic tissue

299
Q

Mechanism of ketone production in DKA?

A

Fatty acid breakdown in the liver

300
Q

HIV drug causing vivid dreams?

A

Efavirenz

301
Q

Initial treatment for urge incontinence?

A

Frequent voluntary voiding, bladder training

302
Q

A patient with psychosis has tachycardia, restless leg syndrome, dilated pupils- best treatment?

A

Group therapy- he has cocaine intoxication

303
Q

A patient has sclera above her iris on downward gaze- what is this seen with?

A

Lid lag seen with hyperthyroidism

304
Q

An iatrogenic cause of thrombocytosis?

A

Splenectomy

305
Q

A patient on sotalol for atrial fibrillation has two episodes of syncope without warning- what arrhthymia could be causing symptoms and treatment?

A

Torsade’s

Tx is mag sulfate

306
Q

Adrenergic drugs used for tocolysis?

A

Beta agonists- terbutaline

307
Q

Treatment for familial hypertriglyceridemia?

A

Fibrates

308
Q

A child with febrile seizures has pharyngitis and macules on his chest and abdomen- diagnosis?

A

HHV-6- typical rash and common cause of febrile seizures

309
Q

What can present with ipsilateral ataxia- weak L side, falls to the L, sways to the L while getting up from chair?

A

Cerebellar tumor- also can see nystagmus and tremor

310
Q

Tx for fibromyalgia?

A

Exercise program

311
Q

A newborn has anemia, hepatosplenomegaly, hyperbilirubinemia, rhinorrhea, and ulcerative lesions on his feet- diagnosis?

A

Syphilis- can also see x ray abnormalities (metaphyseal dystrophy)

312
Q

Mutation that causes osteogenesis imperfecta? USMLE High Yield!

A

Collagen type 1

313
Q

A patient with recent diabetes diagnosis has arthralgias, hepatomegaly, testicular atrophy. He also has high iron levels. What cardiac abnormality can be seen?

A

Conduction abnormalities

314
Q

A patient has gastinoma- what other tumors could be seen?

A

MEN 1- parathyroid, pituitary, pancreatic

315
Q

What causes zenker’s diverticulum and what is treatment? USMLE High Yield

A

Cause- motor dysfunction

Treatment- myotomy

316
Q

Which knee injury has a palpable snap on exam with knee flexion and tibial torsion?

A

Medial meniscus tear

317
Q

Treatment of first episode of acute bronchitis?

A

Reassurance

318
Q

A patient with a normal PCWP but high right heart pressures and high pulmonary artery pressures could have what?

A

Pulmonary Embolism

319
Q

Pronator drift is a physical exam finding seen with what?

A

Upper motor neuron lesion

320
Q

A COPD patient has acute worsening of respiratory symptoms with L chest pain. 2 things to suspect?

A

Spontaneous pneumothorax- hyperresonant

PE- look for risk factors

321
Q

How does raising the head of the bed help prevent atelectasis?

A

Increases FRC

322
Q

Reyes syndrome causes what morphologic changes in liver?

A

Extensive fatty vacuolization

323
Q

Which is used first for treatment of enuresis after behavior modifications fail- desmopressin or imipramine?

A

Desmopressin first, then imipramine if no improvement

324
Q

Most common cause of abnormal hemostasis in patients with chronic renal failure? USMLE High Yield!

A

Platelet dysfunction- treat with DDVAP if necessary

325
Q

Subarachnoid hemorrhage leads to what electrolye abnormality?

A

Hyponatremia- cerebral salt wasting syndrome

326
Q

Treatment for central retinal artery occlusion?

A

High flow oxygen and ocular massage

327
Q

Child presents with low grade fever, tender lymphadenopathy, maculopapular rash that started on the face and spread to trunk quickly. Also has conjunctivitis. Vaccination history unclear

A

Rubella

Measles- higher fever, cough, coryza

328
Q

Post exposure prophylaxis to varicella in children?

A

Give vaccine if no history of vaccine

If hx of vaccination- observe

329
Q

A patient s/p car accident w/ femur fracture has normal PCWP but bilateral opacities on CXR, and continued chest pain with shortness of breath- diagnosis?

A

Pulmonary contusion

Not Fat embolism- will see petechiae and have latent period of 12-72 hours after accident

330
Q

A patient with septic shock after aspiration pneumonia has elevated AST and ALT (in the 1000s) the next day- diagnosis?

A

Ischemic hepatic injury

331
Q

Ophtho- sudden onset of floaters and a curtain coming down over her eyes?

A

Retinal detachment

332
Q

What is electrical alternans?

A

Varying amplitude in QRS seen with cardiac tamponade?

333
Q

A patient with SLE has proteinuria and increased Cr- next step?

A

Get biopsy- outcomes and treatment vary depending on class of lupus nephritis

334
Q

A patient with IBD has signs of sepsis- next step?

A

Abdominal X ray to r/o toxic megacolon

335
Q

HNPCC increases risk for which cancer other than colon cancer?

A

Endometrial cancer

336
Q

Most serious side effect of hydroxychloroquine?

A

Retinopathy

337
Q

A patient with asthma has new onset tremors, weakness- next step?

A

Get electrolytes- hypokalemia 2/2 beta agonists

338
Q

A G1P0 @ 28 weeks has PROM. US shows bilateral renal agenesis- next step?

A

Allow spontaneous vaginal delivery- incompatible with life so no need for steroids

339
Q

Common OTC drug that decreases warfarin metabolism?

A

Tylenol, also NSAIDs

340
Q

Other name for Osgood-Schlatters disease?

A

Traction apophysitis

341
Q

A 58 year old with Parkinson’s has new headache, blurred vision, constipation, and vomiting- most likely?

A

Anticholinergic toxicity

342
Q

Paroxysmal supraventricular tachycardia (HR >160) has conduction through what anatomic structure?

A

AV node

343
Q

Treatment for amniotic fluid embolism?

A

Intubation or respiratory support as necessary

344
Q

A patient has spinal metastases- next step?

A

Steroids ans MRI

345
Q

A patient on long term steroids is having new onset hip pain without trauma- next step?

A

MRI for avascular necrosis

346
Q

Pigment granules in hepatocytes- rotor’s or dubin-johnson?

A

Dubin-Johnson

347
Q

A patient with metabolic acidosis has a high CO2 and lethargy- why?

A

Not compensating appropriately leading to hypercarbia

348
Q

What physical exam finding is often associated with an increased BNP (cardiac exam)

A

S3

349
Q

Most common cause of brain abscess 2/2 sinusitis?

A

Anaerobic bacteria- streptococci or bacteroides

350
Q

6 indications for pneumococcal vaccine before 65?

A 
Chronic liver disease
Asplenia
DM
COPD/asthma
CV disease
Alcoholism
351
Q

Treatment for stroke 2/2 sickle cell disease?

A

Exchange transfusion

NOT fibrinolytic or thrombolytic therapy

352
Q

Patient with head trauma and lucid interval?

A

Epidural hematoma- ruptured middle meningial artery

353
Q

How to prevent post-op pneumonia? Incentive spirometry or post-op antibiotics?

A

Incentive spirometry»»»antibiotics

354
Q

Quantitative pilocarpine iontophoresis is better known as what?

A

Chloride sweat test for CF

355
Q

Although known for pseudomonal infections, CF patients are at risk for what other infection in childhood?

A

S. aureus

356
Q

GVHD is caused by activation of what cells?

A

Donor T cells

357
Q

Most common cause of B12 deficiency in US?

A

Pernicious anemia- look for glossitis, vitiligo

358
Q

Metabolic side effects of thiazides? USMLE High Yield!

A

Hyperglycemia, hypokalemia, hypercalcemia, increased LDL, increased TGs

359
Q

A patient has dense intra-basement membrane deposits that are C3 not Igs- diagnosis?

A

membranoproliferative glomerulonephritis

360
Q

Most likely cause of meningitis in 18 month old with petechial rash on trunk and extremities?

A

Neisseria

361
Q

A patient who has been on TPN for 2 years has cholecystitis- why?

A

Gallbladder stasis

362
Q

A patient presents with signs of cholecystitis, PUD, possible perforation- first step?

A

EKG to rule on MI

363
Q

Ehrlichiosis- diagnosis and treatment?

A

Clinical- tick bite from southeast without rash, leukopenia and thrombocytopenia

364
Q

A COPD patient has SaO2 of 88- best treatment to increase survival?

A

Oxygen- actually better benefit than pneumococcal and influenza vaccine, although patient should receive these too

365
Q

Best way to monitor for respiratory failure with Guillain-Barre? USMLE High Yield!

A

Vital capacity

366
Q

First step in work up of a patient with hypertension and hypokalemia?

A

Plasma renin-aldosterone ratio before any imaging

367
Q

Mechanism of thrombocytopenia in SLE?

A

Auto-immune destruction

368
Q

Classic triad of congenital rubella?

A

Deafness, PDA, cataracts

369
Q

Healthcare worker exposed to HIV- next step?

A

Testing immediately, 6 weeks, 3 months, 6 months

3 ART treatment

370
Q

Values of Ca, P, K, and Uric acid in tumor lysis syndrome?

A

Ca and P- decreased

Uric acid and K- increased

371
Q

A patient with PPROM @ 34 weeks should get what treatment?

A

Penicillin due to unknown GBS

372
Q

Medication to avoid in acute coronary syndrome?

A

Ca channel blockers due to worsening cardiac ischemia

373
Q

Treatment for polymyalgia rheumatica- presents with neck, shoulder and pelvic pain, one hour of morning stiffness, and elevated ESR?

A

Low dose prednisone

374
Q

A positive urinary cyanide nitroprusside test is used as screening for what? USMLE High Yield!

A

Cystinuria- inherited cause of uric acid stones due to amino acid transport abnormaility

375
Q

What is the classic triad of splenic abscess and what is the most common risk factor?

A

fever/chills, LUQ pain, and splenic fluid collection

Most common risk factor- infective endocarditis

376
Q

4 steps to treat ascites?

A

Na and H2O restriction–>Spironolactone–>loop diuretics–>Frequent paracentesis

377
Q

A known alcoholic has mental status changes on day 2 of hospitalization but normal vital signs. Has asterixis as well- treatment?

A

Lactulose

378
Q

A patient with COPD has new onset clubbing- cause?

A

Cancer is the most common

379
Q

Patient presents with fever, chills, urinary frequency, and tender, boggy prostate. UA positive for leukocyte esterase, next step?

A

Midstream urine culture to guide antibiotic therapy

380
Q

A patient with recurrent intussusception should be evaluated for what? What vaccine is contraindicated with intussusception?

A

Meckel’s diverticulum

Rotavirus

381
Q

Treatment for acute popliteal occlusion 4 days s/p MI?

A

Embolectomy via interventional radiology

382
Q

A patient with post-op oliguria has an inconclusive bladder scan- next step?

A

Insert foley to see if symptoms improve–> no improvement give consider fluid bolus if pre-renal

383
Q

A patient from Mississippi has a asymptomatic pulmonary nodule on exam. He is healthy, non-smoker, 33 years old. Diagnosis?

A

Histoplasmosis

384
Q

A patient with acute liver failure is Hep B positive with viral DNA @ 80,000. Next step (hint, 4 indications to treat Hep B, and first line therapy)

A

Treat! Liver failure, cirrhosis, DNA > 20,000, and HBV reactivation prophylaxis during chemo are indications to treat
Tenofivir and Entecavir are first line

385
Q

Infective endocarditis can present with nonspecific symptoms such as polyarthritis, dark urine, shortness of breath, heart murmur, fingertip pain, macules on palms and soles, hemorrhagic lesions on retina

A

KNOW THIS- have gotten many questions wrong

386
Q

A baby has inspiratory stridor that worsens when lying down, crying, or feeding and gets better in prone position- diagnostic test and treatment?

A

Laryngomalacia
Dx- laryngoscopy
Tx- reassurance

387
Q

Eccentric lytic lesion of bone on x-ray is better known as what buzzword?

A

Soap bubble appearance- think giant cell tumor

388
Q

2 vaccines that should be given to pregnant Hep C positive patient? USMLE High Yield!

A

Hep A and B- should be given to all Hep C carriers even if pregnant!

389
Q

A patient presents with severe pain in the back of his neck that began suddenly. He has HTN, PUD, and vitals show tachycardia with elevated BP- diagnosis?

A

Aortic dissection- can present with sharp pain in back of neck!

390
Q

Most common cause of asymptomatic elevation of alk phos in elderly?

A

Paget’s disease

391
Q

Definitive treatment for best long-term outcome for Graves disease?

A

Radioactive iodine therapy

392
Q

An elderly lady comes in with complaints of memory loss. Also has weight gain, fatigue, constipation and hoarseness- diagnosis?

A

Hypothyroid

393
Q

Abnormal D-xylose test?

A

Celiac’s disease

394
Q

Moderate pustular acne with erythema but no scarring should get what treatment?

A

Topical antibiotics

Oral antibiotics are reserved for large nodular or cystic acne

395
Q

An elderly lady with severe back pain, elevated ESR, and excessive urination has constipation- why?

A

Hypercalcemia 2/2 multiple myeloma

396
Q

A mobile cavitary lung lesion with intermittent hemoptysis is indicative of what?

A

Aspergilloma

397
Q

A patient has rapidly progressing bilateral cellulitis of the submandibular space with subcutaneous emphysema- where did infection start?

A

Teeth- this is ludwig angina

398
Q

A 2 week old infant has conjunctivitis- dx and tx?

A

Chlamydial, treat is ORAL erythromycin

Topical erythromycin at birth is gonococcal prophylaxis!

399
Q

A tachycardic afebrile patient has an exudative pleural effusion- diagnosis?

A

Pulmonary embolism

400
Q

A patient with HTN has a potassium of 3.5 and undetectable renin level- diagnosis?

A

Primary hyperaldosteronism

401
Q

What is the most important risk factor for strokes- USMLE High Yield!

A

HTN

402
Q

Fastest way to correct hyperkalemia?

A

Insulin and glucose

403
Q

4 things associated with osteogenesis imperfecta?

A

Blue sclera, hearing loss, recurrent fractures, opalescent teeth

404
Q

Single most important test to assess liver function during acute hepatitis?

A

PT- increasing in PT means progression to fulminant liver failure

405
Q

2 risks for untreated hyperthyroid?

A

Atrial fibrillation, rapid bone loss

406
Q

An elderly patient sees vertical lines as bent and wavy- diagnosis?

A

Macular degeneration

407
Q

EKG shows flat broad T waves and premature ventricular beats- diagnosis?

A

Hypokalemia

408
Q

Confirmatory test for ALL?

A

Bone marrow biopsy

409
Q

HOCM has what inheritance pattern?

A

Autosomal dominant

410
Q

An 8 year old girl has dark axillary hair but no pubic hair and no breast development- diagnosis and next step? USMLE High Yield

A

Diagnosis is adrenarche and next step is reassurance

ANY breast or pubic hair means premature pubarche and needs investigation

411
Q

Drug induced esophagitis not caused by bisphosphonates?

A

Potassium chloride

412
Q

3 risk factors for pancreatic cancer?

A

Chronic pancreatitis, smoking, obesity

413
Q

A patient breastfeeding has amenorrhea- why?

A

Prolactin suppresses GnRH

414
Q

An HIV patient with esophagitis- what is a major clue it will be candida?

A

Oral thrush- without thrush most likely diagnosis is HSV»CMV

415
Q

Pathophysiology of ARDS? (2)

A

Decreased lung compliance and impaired gas exchange

416
Q

HIV patient has painful loss of vision- diagnosis?

A

HSV

CMV retinitis is painLESS

417
Q

A patient with diffuse severe abdominal pain has not passed gas or had BM for 3 days. ABG shows acidosis. X ray shows multiple air fluid levels- next step?

A

Surgery- fever, leukocytosis, acidosis mean impending strangulation
peritoneal signs mean necrosis

418
Q

Penile fracture treatment? (2)

A

Retrogreade urethrogram then surgery

419
Q

A patient has flushed skin and telangiectasias, papules, and pustules that worsen when she drinks hot drinks or tans- diagnosis?

A

rosacea- look for 30-50 year old lady

420
Q

Treatment for acute otitis media?

A

Amoxicillin

Do NOT observe unless > 2 years old with mild unilateral symptoms

421
Q

A patient with severe coughing paroxysms has subcutaneous emphysema over the chest- next step?

A

CXR- must rule out pneumothorax

Although possibly has pertussis, cultures still come after CXR

422
Q

Respiratory alkalosis leads to hypocalcemia how?

A

Increases Ca bound to albumin thus decreasing ionized Ca

423
Q

What comes first in infective endocarditis- TEE or culture?

A

Cultures!

424
Q

A diabetic patient wants viagra- what counseling is necessary? (think medication)

A

Nitrates (contraindicated) or alpha blockers (wait 4 hours)should not be used with viagra
Note- controlling diabetes has not been shown to improve ED

425
Q

What is a factorial design study?

A

3 different interventions looking at > 2 variables

426
Q

A young otherwise healthy patient with symptomatic HTN and evidence of LVH on EKG should be assessed for what?

A

Coarction of the aorta with BPs in both arms and legs- high in arms compared to legs

427
Q

Most frequent origin for ectopic foci of atrial fibrillation?

A

Pulmonary veins

428
Q

An HIV patient with multiple intrahepatic lesions begins to bleed when biopsy is attempted- diagnosis?

A

Bartonella causing bacillary angiomatosis

429
Q

Poor prognostic factor in CLL?

A

Thrombocytopenia

430
Q

Most important risk factor for cerebral palsy?

A

PREMATURITY

NOT hypoxia

431
Q

An infant with ambiguous genitalia, hyponatremia, and hyperkalemia is most likely to have what steroid elevated?

A

17-hydroxyprogesterone via 21-alpha hydroxylase deficiency
Other causes of CAH present around puberty with HTN and hypogonadism (17 alpha hydroxylase deficiency) or HTN and virilization (11 beta hydroxylase deficiency)

432
Q

An IVDU with new conduction abnormality and diastolic murmur has what complication?

A

Perivalvular abscess

Remember, tricuspid regurg will be systolic murmur

433
Q

Confirmatory test for amyloidosis?

A

Fat pad biopsy

434
Q

A patient who has to travel for business has fear of flying, tried friends BZDs and they worked. Next step

A

Behavioral therapy is first line treatment

435
Q

2 criteria for tocolysis when no extreme risks to mother or fetus are present?

A

Cervical changes and 4 contractions in 20 minutes

Typically should give steroids too!

436
Q

A patient with chronic kidney failure presents with liekly aortic disection- first test after ECG?

A

TEE»»aortography is NEVER right

If no kidney failure TEE or CT scan

437
Q

Most common cause of firm hard cervical lymphadenopathy in elderly smoker?

A

Squamous cell carcinoma

438
Q

A 5 year old has regressed from milestones after meningitis- why? LP, meningitis, or medication side effect?

A

Sequelae of meningitis

439
Q

Ruptured submucosal arteries of distal esophagus or proximal stomach is the pathophysiology behind what?

A

Mallory-Weiss tears

Dilated veins are esophageal varices

440
Q

Variable decelerations can be treated with what, most of the time? What would be next?

A

Oxygen administration and change in maternal position

Amnioinfusion

441
Q

A patient with traumatic cord spinal injury has his airway secured and is hemodynamically stabilized- next step?

A

Urinary catheter to assess for retention and prevent bladder injury

442
Q

An 18th month old who had a seizure following his 6 month vaccinations is here for his 4th dose of dTaP- should it be given?

A

Yes- only contraindications are allergies to ingredients, or uncontrolled epilepsy, or encephalopathy within one week of prior vaccine

443
Q

Uncomplicated UTI in non-pregnant lady- nitrofurantoin or levofloxacin?

A

Nitrofurantoin

Levo saved for complicated cases (diabetes, obstruction, indwelling catheter)

444
Q

What does TMP-SMX do to potassium levels?

A

Causes hyperkalemia

445
Q

A patient with hirsutism and amenorrhea has elevated 17-hydroxyprogesterone- PCOD or CAH?

A

CAH- elevated 17-hydroxyprogesterone not seen with PCOD

446
Q

A 31 year old comes in with swollen tender R knee. He is afebrile but has 10,000 WBCs in synovial fluid. Also has recently treated for urethral discharge and has R heel pain, mouth ulcers, low back pain? Tx?

A

Reactive arthritis- NOT Gonococcla arthritis
Clues- enthesitis- heel pain, mouth ulcers, low back pain, afebrile
Tx is NSAIDS

447
Q

Lidocaine decreases risk of what, but increases risk of what else?

A

Decreases risk of V fib

Increases risk of Asystole

448
Q

Diagnosis for unilateral varicocele that fails to empty when the patient is recumbent?

A

Tumor- Renal Cell Carcinoma

449
Q

A hypertensive patient presents with ataxia, vomiting, gaze palsy, occipital headaches and facial weakness- where is the brain bleed?

A

Cerebellar

Putamen would have hemiparesis usually

450
Q

Maintenance treatment for Bruton’s?

A

IVIG

451
Q

A patient on risperidone has elevated prolactin and low TSH- diagnosis?

A

Pituitary adenoma- signs of hypopituitarism

452
Q

A patient from Cambodia has hemoptysis, irregular heart beats, palpitations, and acute onset of left sided weakness- underlying diagnosis?

A

Rheumatic fever leading to mitral stenosis–> atrial fibrillation–> thrombus causing stroke

453
Q

A 2 week old infant has conjugated hyperbilirubinemia- biliary atresia or breast milk jaundice?

A

biliary atresia

Breast milk jaundice is unconjugated

454
Q

A patient with cholesterol emboli can have what interesting finding on CBC with differential?

A

Eosinophils

455
Q

A patient with pharyngitis is given amoxicillin and develops a rash and urticaria 30 minutes later- next step?

A

Anti-histamines

This is not EBV- that rash develops at least 24 hours after amoxicillin

456
Q

A 45 year old diabetic patient has a 30 pack year history and an LDL of 70- next step

A

start statins- basically all diabetic patients over 40 need a statin regardless of LDL

457
Q

A patient on TB therapy has microcytic anemia with increased iron and low TIBC- next step?

A

Give pyridoxine for sideroblastic anemia 2/2 isoniazid

458
Q

Management of cocaine induced chest pain?

A

BZDs or nitroglycerin

459
Q

What lab value should be followed to document HBV clearance that is NOT in the hepatitis panel?

A

ALT should be followed every 3 months w/ HbeAg

460
Q

Most common cause of thyrotoxicosis with reduced radioactive iodine uptake diffusely?

A

Thyroiditis

461
Q

A patient on PTU has a fever and sore throat one week after starting treatment- next step?

A

Stop PTU- agranulocytosis!

462
Q

Best long term treatment for PUD? If refractory?

A

Antibiotics and pantoprazole–> if refractory then proceed to vagotomy

463
Q

Lactose intolerance labs- stool pH, stool osmotic gap, hydrogen breath test?

A

Stool pH low, stool osmotic gap high, positive hydrogen breath test

464
Q

A patient with DiGeorge syndrome has fever, seizures, and R sided weakness- why seizures?

A

Brain abscesses 2/2 sinusitis

Not hypocalcemia because of R sided weakness and fever

465
Q

Treatment for SIADH 2/2 lung cancer? What if severely symptomatic hyponatremia?

A

Fluid restriction first

If severe or symptomatic–> hypertonic saline

466
Q 
Name the disease associated with the renal casts? USMLE High Yield!
Muddy brown-
RBC-
WBC
Fatty-
Broad and Waxy-
A 
Muddy brown- ATN
RBC- Glomerulonephritis
WBC- Pyelonephritis
Fatty- Nephrotic
Broad and Waxy- Chronic Renal Failure
467
Q

A patient with MGUS has normal UPEP, no proteinuria, and normal calcium- next step?

A

X rays to look for lytic lesions to r/o multiple myeloma

468
Q

Most common cause of folate deficiency in USA?

A

Alcohol- if question is just alcoholic with megaloblastic anemia choose folate»B12 unless methylmalonic acid or neuro sxs are given

469
Q

What fluoroquinolone should a patient be started on with pneumonia? Cipro or Levo?

A

Levo because cipro does not have streptococcal coverage

470
Q

Most common predisposing factor for acute bacterial sinusitis?

A

Viral URI

471
Q

What is the initial treatment for symptomatic relief for hyperthyroid? USMLE High Yield!

A

Propanolol until underlying cause is identified

472
Q

Pyridostigmine can be used to treat what?

A

MG

473
Q

How does heroin affect pupils, HR, and BP?

A

Miosis, bradycardia, hypotension

474
Q

A patient comes in 3 days after starting cipro for UTI with no improvement. Bacteria is susceptible to cipro. Next step?

A

Ultrasound

475
Q

2 tests before lithium treatment?

A

Cr and thyroid function tests

476
Q

Guidelines for colon cancer screening in ulcerative colitis?

A

Colonoscopy 8 years after diagnosis with f/u colonoscopy every 1-2 years after

477
Q

Diagnosis of shoulder pain if pain with lifting the arm ceases after lidocaine injection?

A

Rotator cuff impingement

478
Q

a 27 year old lady, not obese, only taking OCPs has 3 visits with BP > 140/90- next step?

A

Stop OCPs to see if HTN disappears before starting thiazides

479
Q

A patient has symmetric lower extremity symptoms- GBS or compression?

A

Look for UMN signs or sensory deficits–> would be compression and get MRI
If no

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