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
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
3
Q
Preferred way to establish airway in patient with C spine injury?
A
Orotracheal intubation after stabilizing C spine
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
5
Q
Treatment for acute dystonic reaction?
A
Benzotropine or benadryl
6
Q
Treatment for akathisia?
A
Propanolol
7
Q
Treatment for Drug induced parkinsonism?
A
Amantadine or benzotropine
8
Q
A demented patient has pneumonia 2/2 aspiration- likely pathogenesis?
A
Impaired epiglottic reflex
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
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
11
Q
What rash typically SPARES the diaper region in infants? Is symmetric everywhere else
A
Atopic dermatitis
12
Q
How should you treat tachycardia with narrow QRS complexes and retrograde P waves?
A
Adenosine- tx for svt
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
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
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
16
Q
What class of medication can inhibits autonomic thermoregulation?
A
typical antipsychotics such as fluphenazine and haloperidol
17
Q
How can blood gas differentiate COPD from CHF?
A
CHF- respiratory alkalosis
COPD- respiratory acidosis
18
Q
What adrenergic therapy can treat hyperkalemia?
A
Albuterol and beta 2 agonists
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
20
Q
An immunocompromised patient has diffuse bilateral interstitial infiltrates on CXR- diagnosis
A
PJP
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
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
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
24
Q
What is a marjolin ulcer?
A
non-healing burn wound which becomes squamous cell carcinoma
25
Management of metastatic brain lesions? USMLE High Yield!
If solitary with stable extracranial disease- surgery
| If multiple- whole brain radiation
26
What is the pathogenesis of aspirin sensitivity syndrome? USMLE High Yield!
Pseudo-allergic reaction due to accumulation of prostaglandins and leukotrienes
27
What is one method of preventing febrile nonhemolytic reaction after blood transfusion
Leukoreduction
28
A patient has hypotension and back pain after cardiac cath that mildly improves with IV fluids- next step?
CT of abdomen to look for retroperitoneal bleeding
29
How does a knee-to-chest position help during a child's tet spell with TOF?
Increased systemic vascular resistance--> increased pulmonary blood flow
30
Murmur associated with wide pulse pressure and pounding/racing heartbeat?
AR
31
A patient has a bleeding espophageal varices- 4 things to do before emergent endoscopy?
In order- 2 large bore IVs, intubation, antibiotics (ceftriaxone), and IV octreotide to decrease blood flow
32
First step in evaluation of patient with hypercalcemia?
PTH, always
| CXR comes after to look for malignancy
33
How does alcoholism cause impotence?
Cirrhosis causes hypogonadism 2/2 testicular atrophy
34
A gun shot victim has an unequivocal ultrasound for trauma- next step?
Go to OR for ex lap if vitals are unstable
| NOTE- if BLUNT trauma- do diagnostic peritoneal lavage if FAST is unequivocal
35
A patient has symptomatic hypercalcemia- next step?
IV NS and calcitonin or bisphosphonate
36
Most common infection prior to orbital cellulitis? Dx test?
Bacterial sinusitis
| CT scan to rule out abscess that would require surgery
37
What are two sequelae of mitral stenosis (arrhythmia and lung)? Why?
Pulmonary edema and atrial fibrillation
| Due to left atrial overland/enlargement
38
What are the first two steps with a newborn with respiratory distress and scaphoid abdomen?
First intubate, then decompress bowel with orogastric tube
39
A patient has negative anti-tissue transglutaminase but signs suggestive of celiac's disease including villous atrophy- why?
Concurrent IgA deficiency- villous atrophy is nearly diagnostic as long as no recent travel or signs of tropical sprue
40
A patient with cirrhosis has stopped drinking, is taking his medications, has been appropriately vaccinated. Next step?
Esophageal varices surveillance with and EGD
41
Treatment of choice for inflamed fluctuant cervical lymph node in child?
Dicloxacillin> cephalexin or clindamycin
42
A patient has hypotension, JVD, Kussmaul's sign, and clear lung fields. EKG shows ST elevation in leads II, III, and aVF- diagnosis?
R ventricular infarction. The physical shows RV failure, the EKG shows inferior infarction
43
A patient with a high pitched systolic murmur heard at 2nd intercostal space has angina with exertion- why?
Aortic stenosis leads to large LV leads to increased oxygen demand during exercise leads to pain
44
3 things to lower risk of contrast induced nephropathy?
1) use non-ionic contrast
2) IV hydration
3) acetylcysteine
45
3 things seen with paroxysmal nocturnal hemoglobinuria?
unconjugated hyperbilirubinemia, thrombosis, pancytopenia
46
What does urine dipstick positive for bilirubin tell you about the hyperbilirubinemia?
CONJUGATED hyperbilirubinemia- rotor syndrome is one, acute fatty liver of pregnancy
Most common hyperbilirubinemia's are unconjugated
47
4 ways to decrease ICP and mechanism?
Head elevation- increases venous return from head
Sedation- lowers metabolic demand
Hyperventilation- cerebral vasoconstriction
Mannitol- extracts free water
48
A 45 year old patient with no risk factors for colon cancer has mild BRBPR- next step
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
49
First line treatment for tourette's?
Antipsychotics- 2nd generations are beginning to be preferred
50
What is one complication of mono? Why?
Autoimmune hemolytic anemia due to cross-reactivity of EBV antibodies with RBCs and platelets
51
A bone marrow transplant patient presents with abdominal tenderness, diarrhea, dry cough, diffuse rales bilaterally. Diagnosis? Why not GVHD?
CMV pneumonitis and colitis
| SKIN RASH must be present for GVHD
52
A child has hemolytic anemia, thrombocytopenia after diarrhea and schistocytes on peripheral smear- what must you suspect? USMLE High Yield
Hemolytic uremic syndrome 2/2 ecoli infection
53
What is hyposthenuria?
Complication of sickle cell disease that results in nocturia
54
How to differentiate Fibromyalgia from Polymyositis and Polymyalgia rheumatica?
Fibro- widespread pain, fatigue, point tenderness on exam
Polymyositis- elevated CK, symmetrical weakness, abnormal EMG, no tenderness
Polymylagia rheumatica- Elevated ESR, no tenderness
55
First diagnostic test, best test, and treatment for HSV encephalitis?
First- r/o intracranial tumor/bleed with CT--> LP
Best- HSV PCR
Tx- Acyclovir
56
Which atypical antipsychotic is least likely to cause weight gain and diabetes?
Aripiprazole> ziprasidone
Olanzapine is the worst
Ziprasidone causes QT prolongation
57
What does an ABG of a patient with atelectasis look like?
Respiratory alkalosis with hypoxemia- increased pH, decreased O2 and CO2
58
A patient has a tension pneumothorax- next step?
Needle thoracostomy comes before IV resuscitation
59
Can you use low molecular weight heparin in HIT?
No, stop all heparin products and switch to argatroban.
60
A patient has symptomatic gallstones but refuses surgery- next step? (2)
Counsel to avoid fatty foods and prescribe ursodeoxycholic acid
61
An immunosuppressed patient is having side effects of their medication- what side effects make you think cyclosporine vs azathioprine vs mycophenolate? High yield USMLE!
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
62
A young woman presents with chronic knee pain while climbing stairs. Otherwise healthy- diagnosis and physical exam test?
Patellofemoral syndrome- press on patella while extending knee to elicit pain
63
Ophtho clue- decreased vision while driving at night and reading newspaper?
Cataracts! Opacity of lens on exam
64
An alcoholic, chronic smoker has dilated cardiomyopathy without ischemic changes- next step?
Alcohol abstinence can REVERSE process
| ACE inhibitors slow progression
65
Treatment for long QT syndrome?
Beta blockers
66
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?
Adrenal insufficiency 2/2 steroids
Low ACTH, low cortisol
NORMAL aldosterone- ACTH does not stimulate or inhibit aldosterone- controlled by renin system
67
A patient with AVF has brisk carotid upstroke, soft systolic murmur that does not change with Valsalva, and flushed lower extremities- diagnosis?
High output cardiac failure
Brisk carotid is strong peripheral pulse
Murmur is a flow murmur
68
What is the key factor in development of type 2 diabetes and sequelae (HTN, HLD)? USMLE High Yield!
Insulin resistance
69
A baby becomes cyanotic while feeding but gets better when crying- diagnosis? Test and treatment? USMLE High Yield!
Choanal atresia
First- try to pass catheter from nose into oropharynx
Best- CT scan
Treatment- oral airway and lavage feeding followed by surgery
70
Where is the most common site of ulnar nerve entrapment and what will you see on exam? USMLE High Yield
Medial epicondylar groove
| Will see decreased sensation of 4th and 5th digits and a weak grip
71
3 options for close contact prophylaxis for Neisseria meningitidis?
Rifampin, ciprofloxacin, ceftriaxone
72
5 indications for addition of ampicilin for empiric coverage of meningitis?
Covers listeria
| Immunocompromised, pregnant, HIV, elderly, steroids, neonates
73
What is the most sensitive physical exam finding for acute otitis media?
Immobility of TM
74
Hepatitis B- first indicator to show up and last to be present to indicate risk for transmission?
Surface antigen
75
Hepatitis B- indicator for need for treatment and best indicator for risk of pregnant woman transmitting disease to her child?
e-antigen
76
A pelthoric face, splenomegaly and HCT > 50% are indicative of what?
Polycythemia vera
77
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?
Nursemaid's elbow- annular ligament pain
78
A patient with glactorrhea and amenorrhea has a 6mm pituitary adenoma- next step? Why no surgery?
Cabergoline or bromocriptine- dopamine agonists can shrink tumor
Surgery only if no response to treatment or visual disturbances due to tumor
79
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?
Metronidazole- this is Giardia
| Can get stool ova and parasite but should start treatment before results
80
A patient following blunt trauma to the abdomen has a normal CT scan. Returns one week later with abdominal pain, fever, and chills- diagnosis?
Pancreatic laceration or psuedocyst or abscess- not always detected with immediate CT scan
81
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?
papillary muscle rupture
| Ventricular septum rupture murmur does not radiate
82
When does a COPD patient need home oxygen? SaO2? PaO2?
SaO2 < 88, PaO2 < 55
83
A patient with GERD and Barrett's esophagus has a significant improvement in GERD symptoms without intervention- what happened?
Peptic stricture can actually improve GERD but should be biopsied for adenocarcinoma
84
A patient with GI complaints comes in a week later with eosinophilia, periorbital edema, and myositis- diagnosis?
Trichonellosis
85
Most common cause of myocarditis in children?
Viral- coxsackie
86
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?
Bronchoscopy- can be therapeutic with electrocaudery or balloon tamponade
87
What is one cardiac finding on physical exam that would make you think angiodysplasia >> diverticulosis for rectal bleeding?
Aortic stenosis
88
Most common risk factor for respiratory distress syndrome in newborn besides prematurity?
Maternal diabetes- delays maturation of surfactant production
89
6 scenarios for drug induced pancreatitis?
```
Diuretics- furosemide or thiazides
IBD- sulfasalazine
Immunosuppression- azathioprine
Seizures- VPA
AIDS- didanosine
Antibiotics- metronidazole, tetracycline
```
90
A young patient with chronic back pain has restrictive results on pulmonary function test- diagnosis?
Ankylosing spondolysis- fusion of costovertebral joints leads to restricted chest wall movement
91
A patient has a rash that looks like RMSF but has generalized lymphadenopathy- diagnosis?
2ndary syphilis
92
Initial test for acromegaly? Best test?
Initial- IGF-1
| Best- GH after oral glucose load
93
An infant with a heart murmur but no cyanosis presents- why not tetralogy of fallot?
NO CYANOSIS
94
Lumbar flexion makes what worse? What about extension?
Flexion makes disk herniation worse
| Extension makes stenosis worse
95
Initial test for suspicion of ZE syndrome? If unequivocal next test?
Gastrin levels are first
| Secretin stimulation test is next
96
How do the kidneys compensate for obesity hypoventilation syndrome?
Increase bicarb retention and decrease chloride retention
97
What swelling of the newborn scalp is limited to one bone, which one crosses sutures?
Cephalohematoma limited to one bone
| Caput succedaneum crosses sutures
98
Delayed separation of the umbilical cord leads to defective what?
Leukocyte adhesion- will present as recurrent infections of skin and mucosa
99
Skin cancer found on the lips is most likely?
Squamous cell carcinoma
100
Treatment for thrombocytopenia following viral infection in child?
Reassurance
101
A patient with shortness of breath has an S3 on cardiac exam- treatment?
Diuretics
102
What kidney pathology is associated with hepatitis B
Membranous glomerulonephritis
103
What is meconium ileus diagnostic for?
Cystic fibrosis
104
Most common heart defect in Down's?
Complete AV septal defect>VSD>ASD
105
Most common cause of post-influenza pneumonia?
Staph aureus
106
What is the treatment for syphilis in penicillin allergic patients?
Doxycycline
107
First vital sign to change with hypovolemia?
Pulse
108
Which one has full on mania- bipolar I or II
Bipolar I
109
A patient with RA is not responding to NSAIDs- next step? Second step?
First MTX
| Try entarcept and infliximab if symptoms persist with 6 months of therapy
110
Treatment for Wolff-Parkinson-White?
Procainamide
111
2 ways to increase O2 levels in an intubated patient?
Increase FiO2 (although goal should be <60% as there are risks of O2 toxicity), add PEEP
112
A child with arthralgias, abdominal pain, and nephritis has a nonblanching rash on his lower extremities- diagnosis?
Henoch-Schonlein purpura
113
Kidney disease associated with HIV?
Focal segmental glomerulosclerosis
114
Treatment for dermatitis herpetiformis?
Dapsone- remember association with celiac's disease!
115
A patient with BPH is having worsening symptoms and an increase in Cr- next step?
Abdominal ultrasound to assess for hydronephrosis
116
A patient presenting with acute MI can have what change on cardiac exam?
Fourth heart sound
117
Aortic dissection (chest pain and pain between scapula, difference in BP between arms)- initial test, best test, treatment?
CXR first, angiogram best, beta blockers treatment
118
Why is age important when diagnosing acute epididymis?
Younger patient-s think gonorrhea or chlamydia
| Elderly- think gram - rods like e coli
119
A patient presents with bipolar- what labs should be drawn prior to giving lithium?
Cr and BUN- renal dysfunction is contraindication to lithium
120
What diagnosis should come to mind in a patient with recurrent nosebleeds and papules along his lips? What is one complication?
Osler-Weber-Rendu syndrome, hereditary telangiectasias
| AV malformations
121
A child presents with croup that is not responding to oxygen or albuterol- next step?
Give epinephrine trial before going to intubation!
122
2 things that should raise suspicion a deivated trachea is not pneumothorax but rather diaphragmatic hernia?
normotension (or lack of hypotension)
| CXR shows NG tube in the chest!
123
Treatment for Dressler's syndrome?
NSAIDs
124
A patient has an inferior wall MI, 8 hours later is hypotensive while on nitroglycerin drip and has JVD with clear lungs- next step?
Stop nitroglycerin and give fluids- this is a RV infarct and needs fluids to increase RV stroke volume
125
Tx for hypovolemic hypernatremia?
Normal saline- even in infants!
126
Pulmonary auscultation- increased breath sounds, dull percussion, increased fremitus?
Consolidation
127
Pulmonary auscultation- decreased breath sounds, dull percussion, decreased fremitus?
Pleural effusion
128
Pulmonary auscultation- decreased breath sounds, hyperresonant percussion, decreased fremitus? (2)
COPD or pneumothorax- use history and mediastinal shift to differentiate
129
Cutoff mm for CXR after PPD test? 3 levels
15mm in healthy
10 mm in mild risk- endemic area, IVDU, DM, CKD
5mm in high risk- HIV, recent contact, immunosuppression
130
How does exogenous thyroid hormone abuse present differently than Graves on labs?
Graves- Elevated TSI
| Exogenous- low serum thryoglobulin, no TSI
131
A patient has fever, diarrhea, and vomiting after cruise? bug and drug?
Legionella
| Z pack or levofloxacin
132
Sidney Crosby gets mono- when can start playing again?
When physical exam normalizes- no more splenomegaly
133
Easy way to differentiate between lateral medullary vs pontine lesion?
CNs! diminished gag reflex or hoarseness- medulla
| Weakness while chewing, diminished jaw jerk reflex- think pontine
134
Infection 6 months after knee surgery is most likely what bug?
Coagulase negative staph- epidermidis
| S. aureus would present within 3 months
135
Pathophysiology behind cardiac tamponade? Fluid accumulation causes what?
Decreased LV preload due to fluid accumulation in percardial cavity
136
Bullous pemphigoid vs pemphigus vulgaris- 2 differences?
Bullous pemphigoid- IgG deposits at dermal epidermal junction, tense blisters
Pemphigus vulgaris- IgG deposits intracellularly in epidermis, flaccid blisters
137
A patient post MI has a cold leg- next step?
get echo to look for thrombus in LV
138
Is weight loss and pink diaper stains normal in a 4 day old newborn?
Yes- continue current feeding regimen- birth weight should be regained by 10-14 days, pink stains are uric acid crystals and normal
139
2 ways to differentiate Legg-Calve-Perthes disease and SCFE?
LCP- age 4-10
| SCFE- ages 12-14 and OBESE
140
A patient presents with a one week history of symptoms suspicious for rheumatoid arthritis- what is another diagnosis?
Viral arthritis- look for symptoms to resolve in 1 month
141
What supplementation should be started in premature infants at birth who are exclusively breastfeeding?
Iron and Vit D
142
One part of the body methanol poisoning affects that ethylene glycol does not? One finding on urinalysis?
Eyes
| Ethylene glycol has crystals in the urine
143
How to differentiate gonococcal from chlamydial conjunctivitis in the newborn and tx for each?
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
144
A patient with a scaly, itchy rash after swimming lessons in a public pool should be treated with what?
Terbinafine- dx is tinea corporis
145
Complication of temporal arteritis besides blindness (cardiac)
Aortic aneurysms
146
When is tetanus immune globulin indicated?
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
147
3 contraindications to metformin?
Renal failure, hepatic failure, sepsis- all increase risk for lactic acidosis
148
Mechanism for hypotension in pulmonary embolism- 5 steps?
Thrombus increases pulmonary vascular resistance--> Increase RV pressure--> RV hypokinesis and dilation--> decreased preload--> hypotension
149
What is the marker of an aplastic crisis in a sickle cell patient?
Very low hgb with low reticulocyte
150
Two ways to describe the gait associated with Parkinson's
Shuffling or Hypokinetic
151
Two findings on light microscopy in membranous glomerulonephritis?
Diffuse GBM thickening, subepithelial spikes
152
Transparent or yellow papules with mild scaling plaques on the scalp, eyebrows, or nasolabial folds are characteristic of what rash?
Seborrheic dermatitis
153
What is genu varum? Rachitic rosary?
Femoral and tibial bowing, bony prominences of the costochondral junctions seen in rickets
154
Vitamin B12 deficiency can lead to increase risk of what cancer?
Gastric cancer if cause is pernicious anemia
155
Tea and toast diet?
Folic acid deficiency
156
A patient with osteoarthritis is most likely to have what kind of anemia?
Iron deficiency from chronic NSAID use
157
A patient with COPD has an acute exacerbation and is started on appropriate therapy- He then suffers a seizure- why?
Excess supplemental oxygen to correct hypoxemia stopped the respiratory drive and caused CO2 retention leading to seizure
158
An infant with low bicarb, high chloride, and failure to thrive could have what?
Renal tubular acidosis
159
A patient has clear lungs but prominent pulmonary arteries and an enlarged right heart border- diagnosis?
Primary pulmonary HTN- secondary causes- MS, MVP, LV failure, will not have clear lungs
160
What is erysipelas?
Strep A cellulitis which results in a well demarcated tender raised rash
161
What treatment worsens ophthalmology associated with Graves disease?
Radioactive iodine
162
A 16 year old breaks his clavicle- on exam there is a bruit heard beneath his clavicle. Neuro exam is normal- next step?
Get angiogram before using brace
163
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?
Have mom eliminate all dairy and soy from her diet and recheck in 2 weeks
164
A patient has a cystic breast mass drained and clear fluid is aspirated- next step?
F/u in 4 weeks- do NOT send fluid to cytology unless fluid is bloody/ foul smelling
Biopsy if mass returns in 4 weeks
165
A home birth baby with spasms and swollen erythematous umbilical cord at 2 weeks- diagnosis?
Tetanus
166
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!
Frederich ataxia- neuro sxs, skeletal sxs, cardiomyopathy around 20 years old
Cardiomyopathy most common cause of death
167
Does impetigo need oral or topical treatment?
Topical erythromycin or mupirocin for local cases
Oral dicloxacillin or ampicillin for severe cases
NEVER penicillin due to s aureus
168
A patient with hepatic encephalopathy needs treatment but lactulose isn't an option- look for what answer?
Correct electrolyte abnormalities or give albumin!
169
A patient returns from Florida with multiple velvety pink, pale macules on his trunk that scale upon scraping- diagnosis, confirmatory test, tx?
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
170
A prostitute with a high fever, malaise, skin rash on arms, and arthralgias has a negative blood culture x3- diagnosis?
Disseminated gonnorrhea
171
A patient with hypertension has bilateral palpable upper abdominal masses- most likely diagnosis?
Polycystic kidney disease
| Pheochromocytoma, hyperaldosteronism do not have PALPABLE masses
172
Why do DM type 2 patients have elevated LFTs?
Non-alcoholic fatty liver disease 2/2 insulin resistance
173
Vitamin therapy in measles that reduces M and M?
Vitamin A
174
Tx for frostbite- warm water, dry heat, or infusion of warm fluids?
Warm water
175
A patient with prolonged atrial fibrillation has LV dilation and a low ejection fraction- next step?
Control rate and rhythm via medications before optimizing preload and afterload
176
A newborn had bilateral hydronephrosis and oligohydramnios on 2nd trimester ultrasound- 5 things he might be born with?
Pulmonary hypoplasia, skin, face, and limb deformities, posterior urethral valves
177
A 5 year old develops pertussis and is started on appropriate treatment (erythromycin for 14 days)- next step?
Erythromycin for 14 days for all close contacts REGARDLESS of immunization history
178
Tx for hemodynamically unstable atrial fibrillation?
DC cardioconversion
179
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?
L basal ganglia hemorrhage 2/2 HTN
| Not SAH due to motor deficits and focal eye deficits
180
A boy presents with severe treatment resistant acne, pubic and axillary hair development , and normal testes- diagnosis?
Gonadotropin independent precocious puberty 2/2 congenital adrenal hyperplasia
181
A patient is rescued from a fire, has a seizure, and is confused- next step?
100% oxygen facemask to treat CO poisoning
182
4 Indications for renal/bladder US following UTI in child?
- does not respond to appropriate treatment
- family history of renal or urologic disease
- <24 months of age
- Recurrent febrile UTIs
183
Electrolyte abnormalities in Cushing's? Na, K
Hypernatremia with hypokalemia due to crossreactivity of glucocorticoids with aldosterone receptors
184
First line treatment for osteoarthritis? (3)
Weight loss and moderate exercise with Acetaminophen>>>NSAIDs
185
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?
Compartment syndrome 2/2 soft tissue swelling after reperfusion
186
3 side effects of erythropoietin therapy?
HTN, headaches, Flu like syndrome
187
A patient with conjunctivitis has itense itching in both eyes- likely diagnosis?
Allergic conjunctivitis >> infectious
188
Tx of 3rd degree heart block?
Pacemaker to avoid V tach of V fib
189
A patient with hx of atherosclerosis has HTN and systolic-diastolic abdominal bruit- diagnosis?
Renal artery stenosis
190
12 year old boy presents with chronic back pain, bed wetting, and a palpable step off in lumbosacral area- diagnosis?
Spondyloisthesis
191
A child presents with hypotension, dry mouth, dilated pupils, a widened QRS on EKG after taking grandma's amitriptyline- next step? USMLE High Yield!
Sodium bicarbonate for OD
192
Two ways to differentiate papillary muscle rupture vs LV aneurysm as both can present with MR murmur
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
Confounding vs effect modification?
Confounding- significance disappears after stratification
| Effect modification- significance appears after stratification
194
A baby has bilious emesis and mom did cocaine during pregnancy- likely diagnosis? Sign on X-ray?
Jejeunal atresia, will see triple bubble sign compared to double bubble with duodenal atresia (also duodenal atresia associated with down's syndrome)
195
A patient with a history of food allergies has acute shortness of breath and difficulty swallowing- diagnosis?
Laryngeal edema
196
Henoch-Schonlein purpura, presenting with purpura, abdominal pain, arthalgias, +/- scrotal swelling increases risk for what sequelae?
Intussusception
197
Treatment for anemia of chronic disease? Low iron, low TIBC
Treat underlying condition
198
Best way to improve prognosis 1 hour after MI?
Restore coronary blood flow
199
What should be tried before intubation during acute exacerbation of COPD?
Noninvasive positive pressure ventilation
200
A 60 year old presents two weeks after treatment for thrombophlebitis with a DVT- next step?
CT of C/A/P looking for malignancy
201
A patient recently started amitriptyline then presents with lower abdominal pain- next step?
Urinary catheterization- detrusor inactivity 2/2 amitriptyline causing urinary rentention
202
A patient with CLL has anemia- treatment?
Prednisone to treat autoimmune hemolytic anemia
203
A dentist presents with non-purulent vesicles on his finger- diagnosis? USMLE High Yield
Herpetic whitlow
204
First step in the workup of dyspepsia?
H pylori testing unless dysphagia, weight loss, or persistent vomiting occurs--> straight to upper endoscopy
205
Ophtho- "curtain coming down" loss of vision?
Retinal emboli causing amaurosis fugax
206
A patient presents with fatigue and dark urine. Abdomen nontender, increased alk phos, normal AST, ALT on labs- next step?
Abdominal US to assess for cholestasis
207
A patient has pneumomediastinum and subcutaneous emphysema after blunt chest trauma- diagnosis?
Tracheobronchial rupture
| NOT esophageal rupture if 2/2 blunt trauma- look for Borhaave or iatrogenic
208
How does chronic steroid use cause bone pain- pathophysiology?
Disruption of bone vasculature
209
A child presents with polyuria and diaper candidiasis- must rule out what?
DM type I
210
An HIV patient has cerebral toxoplasmosis- tx?
Sulfadiazine and pyrimethamine
| TMP-SMX is prophylaxis NOT tx
211
A patient with rheumatoid arthritis has kidney damage- diagnosis, best test?
Amyloidosis causing kidney damage
| Renal biopsy shows apple-green birefringence under polarized light after Congo red stain
212
How does valsalva affect murmurs?
Decreases venous return therefore decreases most murmurs except HOCM
213
A patient gets nasal packing 2/2 epistaxis- 2 days later presents with fever, tachycardia, hypotension, and erythematous macules on trunk and extremities- diagnosis?
Toxic shock syndrome! Nasal packing or tampon can cause it
214
Most common cause of death in acute MI is what arrhythmia?
Reentry arrhythmia
215
A patient with nephrotic syndrome has low complement, rash, arthralgias- diagnosis, next test?
Cryglobulinemia
Get hepatitis panel
Low complement also seen with Post-strep glomerulonephritis, membranoproliferative, and lupus nephritis- differentiate based on history
216
First test, best test for CLL?
First- CBC and peripheral smear
| Best- Flow cytometry of blood
217
A child has head circumference rapidly increasing across percentiles- next step?
CT or MRI - must get imaging
218
Best test for diagnosis of Ankylosing spondylitis?
X ray of sacro-iliac joints
219
How does iron deficiency anemia change MCHC and RDW?
MCHC decreased
| RDW increased
220
An Asian immigrant has MR- next step?
Pencillin prophylaxis until 21 years old
221
A patient has renal stones- 4 dietary recommendations? USMLE High Yield!
Decrease protein and oxalate
Decrease sodium
Increase fluids
Increase dietary calcium
222
A patient with HTN, hypokalemia, hyperglycemia, and weight gain has HTN because of what part of what organ?
Adrenal cortical disease- this is Cushing's
223
Nasopharyngeal cancer risk factor?
EBV
224
A patient presents with symptoms of hyperthyroid, visual disturbances, but a normal TSH- most likely diagnosis?
TSH secreting pituitary adenoma- vision changes from mass effect
225
A elderly man has urinary retention and absent Achilles reflexes- diagnosis?
BPH!
| Cord compression would cause urinary incompetence, achilles reflex loss is normal with old age
226
Treatment for Acute transplant rejection? USMLE High Yield!
IV steroids
227
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?
Dx- renal vein thrombosis due to loss of antithrombin III
| Most common- membranous glomerulonephritis
228
A patient has high amylase in the pleural fluid- 2 options and how to differentiate?
Pancreatitis- abdominal pain radiating to back, no mediastinal widening
Esophageal perforation- look for chronic alcohol use (Borhaave), widened mediastium on CXR
229
Why can LP be performed immediately in infants < 1 year old when meningitis is suspected?
Fontanelles have not closed yet. Give Ceftriaxone/Vanc immediately after LP
230
```
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?
```
DIC- M3 AML
Auer rods- M3 AML
Tx M3 AML- All-trans retinoic acid
ALL tx- intrathecal MTX
231
Best test for multiple myeloma?
BM biopsy- > 10% plasma cells is diagnostic
| First test- X-ray, next- SPEP, but best is BM biopsy NOT SPEP
232
How do estrogen replacement therapy and pregnancy affect thyroid hormones?
Increased thyroid binding globulin leads to increased requirement for L-thyroxine dose during pregnancy and HRT
233
A newborn has equinus and varus of the calcaneum and talus, varus of the midfoot, and adduction of the forefoot- diagnosis and treatment?
Clubfoot/ talipes equinovarus
Tx- stretching and manipulation with serial casting immediately
Surgery only if treatment fails after 3-6 months
234
DO NOT MAKE DUMB MISTAKES WITH STATISTICS
DO NOT MAKE DUMB MISTAKES WITH STATISTICS
235
Why can SaO2 change with position in pneumonia?
Physiologic shunting to and from the consolidation changes SaO2- lying on side of consolidation decreases SaO2
236
With dehydration do you bolus solution with D5?
No, never in bolus only in maintenance
237
A patient has crypotococcal meningitis- tx and f/u?
Tx- amphotericin and flucytosine
| F/u HIV testing
238
A patient w/ h/o prostate cancer and bony metastases has orchiectomy. Symptoms return with new bony metastases- next step?
Radiation therapy
239
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?
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
SAAG > 1.1 of alcoholic- mechanism of ascites?
Increased capillary hydrostatic pressure
241
Crohn's or UC- crypt abscess? Non-caseating granuloma?
UC- crypt abscess, but could be both
| Crohn's- Non-caseating granulomas- BEST way to differentiate
242
An HIV patient has branching partially acid fast bacteria- bug and drug?
Norcardia- also common in transplant patients
| TMP-SMX is treatment
243
A patient's pleural fluid shows protein of 5.2 vs serum protein of 6.0- mechanism?
Exudate (protein ratio >0.5) therefore increased capillary permeability
244
Adult patient presents with obstructive lung disease and bronchodilator challenge is unequivocal- how can you tell asthma vs COPD?
DLCO- normal in asthma, decreased in COPD- except for chronic bronchitis (normal DLCO)
245
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?
Ankylosing spondylitis- causes apophyseal joint arthritis/inflammation
246
Crohn's or UC- always involves rectum?
UC always involves rectum
| Patient who only has oral ulcers- Crohn's
247
A baby has bloody stools after being born premature- what to look for on X-ray?
Pneumatosis intestinalis= NEC
248
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?
Next step- nasopharyngeal culture
Dx is likely pertussis
Tx- azithromycin
249
A patient on phenytoin has anemia- next step? USMLE High Yield!
Folic acid supplementation
| Other drugs interfering with folic acid are MTX, trimethoprim
250
Nocardia or Actinomyces- anaerobic?
Actinomyces! Tx is penicillin while nocardia is tx with bactrim
251
Most common cause of unilateral cervical lymphadenitis in children?
S. aureus
252
A patient has low Ca, high P, and normal kidney function- diagnosis?
Primary Hypoparathyroid
253
A patient following blunt abdominal trauma has delayed onset hypotension- next step?
CT scan- likely splenic injury
254
Most common part of the spine to be affected by rheumatoid arthritis?
Cervical spine
255
A patient has a history of anorexia- 5 things she is at risk for? USMLE High Yield
```
Osteoporosis
Arrhythmias
Anovulation
If pregnant- IUGR
Postpartum depression
```
256
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?
Intussusception
Abdominal US
Air enema
257
Dermatology- stuck on waxy appearance in elderly patient?
Seborrheic keratosis
258
A patient with blunt chest trauma has decreased breath sounds and dullness on the L with tracheal deviation to the R- diagnosis?
Hemothorax!
| Pneumothorax is hyperresonant
259
A patient has LLQ pain, hematochezia, and ulcerations on colonoscopy after a surgical repair of a large abdominal aortic aneurysm- diagnosis?
Ischemic colitis
260
A 2 month old has a white relfex on eye exam- next step? USMLE High Yield
Ophtho consult to rule out retinoblastoma
261
Test and treatment for disseminated histoplasmosis?
Test- urine antigen
| Tx- itraconazole
262
Polymyositis vs Myasthenia Gravis- ptosis and diplopia?
MG
263
New diagnosis of HTN needs what 4 tests?
UA, CMP, Lipid profile, EKG
264
Strongest modifiable risk factor for predicting aortic aneurysm expansion?
Smoking
265
Tx of Lyme disease during pregnancy?
Amoxicillin>>>>Azithromycin
266
An old lady lifts an box then has acute severe back pain- fracture vs lumbosacral strain?
Fracture- more rapid, dramatic onset with spinal tenderness, look for osteoporosis risk factors
Strain- paravertebral muscle tenderness
267
A child has isolated hemihyperplasia, macroglossia, and macrosomia. Next step?
Abdominal ultrasound for wilms tumor or hepatoblastoma
268
Why would an obese lady with normal FSH and LH have amenorrhea?
Anovulation
269
A 3 week old has a leg-length discrepancy- next step?
Perform ortolani and barlow maneuvers- if palpable click--> orthopedics
If negative- hip ultrasound
270
A patient with ulcerative colitis has fatigue and increased Alk Phos- diagnosis?
Primary sclerosing cholangitis
271
A patient has a pulsatile mass in the right groin area, right thigh pain that is worse with walking- diagnosis?
femoral artery aneurysms
272
First line therapy for mild acne?
Topical retinoids
273
What rash spreads cranio-caudally and spares the palms and soles?
Rubella
274
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?
Psuedomonas causing erythema gangrenosum
275
Syncope with prodromal dizziness and blurred vision?
Orthostasis
276
A patient has thready pulses in the radial arteries that disappears with inspiration- what sign?
Pulsus paradoxus- possibly cardiac tamponade
277
CSF findings in HSV encephalitis- RBC, WBC, % neutrophils, protein, glucose?
RBC elevated
WBC elevated with low neutrophils
protein elevated
Glucose normal
278
A patient presents with shortness of breath. PFTs show FEV1 65% and FEV1/FVC ratio of 85%- what's the answer?
Whatever mentions fibrosis!
279
Empyema vs TB as cause of pleural effusion?
Empyema- will have frank pus aspirated, low glucose, more PMNs
TB- high protein, more lymphocytes, not frank pus
280
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?
SVC syndrome
| Tx is radiation
281
Treatment for wide complex tachycardia?
Amiodarone
282
Post-gastric bypass patients prophylaxis?
Ursodeoxycholic acid for 6 months to prevent gallstones
283
Pain seen with peritoneal irritation 2/2 perforation?
Somatic
| Visceral is more diffuse- seen with SBO
284
Most common cause of aortic stenosis in elderly?
Calcifications of aortic valve leaflets
285
Prognostic factor for astrocytomas?
Degree of anaplasia
286
A patient with pancreatic cancer has severe itching. He has multiple metastasis- next step?
Stent placement in common bile duct
287
A sickle cell patient has diffuse thigh and back pain- avascular necrosis or microvascular occlusion?
Microvascular occlusion- look for high LDH value
288
Mechanism of renal failure in multiple myeloma?
toxic effect of light chain casts on renal tubules
289
A patient with rheumatoid arthritis has a low grade fever and monoarticular swelling and tenderness of right second MCP- diagnosis?
Septic athritis- monoarticular does not occur with RA
290
What is the anemia associated with DIC caused by?
Microangiopathic hemolytic anemia
291
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?
Hemothorax causing decreased LV preload
292
What physical exam finding is absent in testicular torsion?
Cremasteric reflex
| Pain relief with elevation of testes= epididymitis
293
A young male with worsening diarrhea, loud bowel sounds, anemia, and a history of R wrist fracture likely has what diagnosis?
Celiac's disease leading to malabsorption
294
A child has pharyngitis without lymphadenopathy- next step?
Nothing!
| No lymphadenopathy means not GAS and penicillin not necessary
295
A patient has an EKG with flattened P waves and prolonged QRS- next step?
Check K levels- if high give Ca gluconate
296
Pheochromocytoma associated with what part of adrenals?
Medulla
297
A patient develops a fever 1 week after blood transfusion and chemotherapy. Has confusion and altered mental status- diagnosis?
Bacterial infection, possibly sepsis. Signs can be less in chemo patient due to less WBCs
298
A diabetic ulcer without erythema or purulent drainage does not involve the bone- next step?
Debride the necrotic tissue
299
Mechanism of ketone production in DKA?
Fatty acid breakdown in the liver
300
HIV drug causing vivid dreams?
Efavirenz
301
Initial treatment for urge incontinence?
Frequent voluntary voiding, bladder training
302
A patient with psychosis has tachycardia, restless leg syndrome, dilated pupils- best treatment?
Group therapy- he has cocaine intoxication
303
A patient has sclera above her iris on downward gaze- what is this seen with?
Lid lag seen with hyperthyroidism
304
An iatrogenic cause of thrombocytosis?
Splenectomy
305
A patient on sotalol for atrial fibrillation has two episodes of syncope without warning- what arrhthymia could be causing symptoms and treatment?
Torsade's
| Tx is mag sulfate
306
Adrenergic drugs used for tocolysis?
Beta agonists- terbutaline
307
Treatment for familial hypertriglyceridemia?
Fibrates
308
A child with febrile seizures has pharyngitis and macules on his chest and abdomen- diagnosis?
HHV-6- typical rash and common cause of febrile seizures
309
What can present with ipsilateral ataxia- weak L side, falls to the L, sways to the L while getting up from chair?
Cerebellar tumor- also can see nystagmus and tremor
310
Tx for fibromyalgia?
Exercise program
311
A newborn has anemia, hepatosplenomegaly, hyperbilirubinemia, rhinorrhea, and ulcerative lesions on his feet- diagnosis?
Syphilis- can also see x ray abnormalities (metaphyseal dystrophy)
312
Mutation that causes osteogenesis imperfecta? USMLE High Yield!
Collagen type 1
313
A patient with recent diabetes diagnosis has arthralgias, hepatomegaly, testicular atrophy. He also has high iron levels. What cardiac abnormality can be seen?
Conduction abnormalities
314
A patient has gastinoma- what other tumors could be seen?
MEN 1- parathyroid, pituitary, pancreatic
315
What causes zenker's diverticulum and what is treatment? USMLE High Yield
Cause- motor dysfunction
| Treatment- myotomy
316
Which knee injury has a palpable snap on exam with knee flexion and tibial torsion?
Medial meniscus tear
317
Treatment of first episode of acute bronchitis?
Reassurance
318
A patient with a normal PCWP but high right heart pressures and high pulmonary artery pressures could have what?
Pulmonary Embolism
319
Pronator drift is a physical exam finding seen with what?
Upper motor neuron lesion
320
A COPD patient has acute worsening of respiratory symptoms with L chest pain. 2 things to suspect?
Spontaneous pneumothorax- hyperresonant
| PE- look for risk factors
321
How does raising the head of the bed help prevent atelectasis?
Increases FRC
322
Reyes syndrome causes what morphologic changes in liver?
Extensive fatty vacuolization
323
Which is used first for treatment of enuresis after behavior modifications fail- desmopressin or imipramine?
Desmopressin first, then imipramine if no improvement
324
Most common cause of abnormal hemostasis in patients with chronic renal failure? USMLE High Yield!
Platelet dysfunction- treat with DDVAP if necessary
325
Subarachnoid hemorrhage leads to what electrolye abnormality?
Hyponatremia- cerebral salt wasting syndrome
326
Treatment for central retinal artery occlusion?
High flow oxygen and ocular massage
327
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
Rubella
| Measles- higher fever, cough, coryza
328
Post exposure prophylaxis to varicella in children?
Give vaccine if no history of vaccine
| If hx of vaccination- observe
329
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?
Pulmonary contusion
| Not Fat embolism- will see petechiae and have latent period of 12-72 hours after accident
330
A patient with septic shock after aspiration pneumonia has elevated AST and ALT (in the 1000s) the next day- diagnosis?
Ischemic hepatic injury
331
Ophtho- sudden onset of floaters and a curtain coming down over her eyes?
Retinal detachment
332
What is electrical alternans?
Varying amplitude in QRS seen with cardiac tamponade?
333
A patient with SLE has proteinuria and increased Cr- next step?
Get biopsy- outcomes and treatment vary depending on class of lupus nephritis
334
A patient with IBD has signs of sepsis- next step?
Abdominal X ray to r/o toxic megacolon
335
HNPCC increases risk for which cancer other than colon cancer?
Endometrial cancer
336
Most serious side effect of hydroxychloroquine?
Retinopathy
337
A patient with asthma has new onset tremors, weakness- next step?
Get electrolytes- hypokalemia 2/2 beta agonists
338
A G1P0 @ 28 weeks has PROM. US shows bilateral renal agenesis- next step?
Allow spontaneous vaginal delivery- incompatible with life so no need for steroids
339
Common OTC drug that decreases warfarin metabolism?
Tylenol, also NSAIDs
340
Other name for Osgood-Schlatters disease?
Traction apophysitis
341
A 58 year old with Parkinson's has new headache, blurred vision, constipation, and vomiting- most likely?
Anticholinergic toxicity
342
Paroxysmal supraventricular tachycardia (HR >160) has conduction through what anatomic structure?
AV node
343
Treatment for amniotic fluid embolism?
Intubation or respiratory support as necessary
344
A patient has spinal metastases- next step?
Steroids ans MRI
345
A patient on long term steroids is having new onset hip pain without trauma- next step?
MRI for avascular necrosis
346
Pigment granules in hepatocytes- rotor's or dubin-johnson?
Dubin-Johnson
347
A patient with metabolic acidosis has a high CO2 and lethargy- why?
Not compensating appropriately leading to hypercarbia
348
What physical exam finding is often associated with an increased BNP (cardiac exam)
S3
349
Most common cause of brain abscess 2/2 sinusitis?
Anaerobic bacteria- streptococci or bacteroides
350
6 indications for pneumococcal vaccine before 65?
```
Chronic liver disease
Asplenia
DM
COPD/asthma
CV disease
Alcoholism
```
351
Treatment for stroke 2/2 sickle cell disease?
Exchange transfusion
| NOT fibrinolytic or thrombolytic therapy
352
Patient with head trauma and lucid interval?
Epidural hematoma- ruptured middle meningial artery
353
How to prevent post-op pneumonia? Incentive spirometry or post-op antibiotics?
Incentive spirometry>>>>>>antibiotics
354
Quantitative pilocarpine iontophoresis is better known as what?
Chloride sweat test for CF
355
Although known for pseudomonal infections, CF patients are at risk for what other infection in childhood?
S. aureus
356
GVHD is caused by activation of what cells?
Donor T cells
357
Most common cause of B12 deficiency in US?
Pernicious anemia- look for glossitis, vitiligo
358
Metabolic side effects of thiazides? USMLE High Yield!
Hyperglycemia, hypokalemia, hypercalcemia, increased LDL, increased TGs
359
A patient has dense intra-basement membrane deposits that are C3 not Igs- diagnosis?
membranoproliferative glomerulonephritis
360
Most likely cause of meningitis in 18 month old with petechial rash on trunk and extremities?
Neisseria
361
A patient who has been on TPN for 2 years has cholecystitis- why?
Gallbladder stasis
362
A patient presents with signs of cholecystitis, PUD, possible perforation- first step?
EKG to rule on MI
363
Ehrlichiosis- diagnosis and treatment?
Clinical- tick bite from southeast without rash, leukopenia and thrombocytopenia
364
A COPD patient has SaO2 of 88- best treatment to increase survival?
Oxygen- actually better benefit than pneumococcal and influenza vaccine, although patient should receive these too
365
Best way to monitor for respiratory failure with Guillain-Barre? USMLE High Yield!
Vital capacity
366
First step in work up of a patient with hypertension and hypokalemia?
Plasma renin-aldosterone ratio before any imaging
367
Mechanism of thrombocytopenia in SLE?
Auto-immune destruction
368
Classic triad of congenital rubella?
Deafness, PDA, cataracts
369
Healthcare worker exposed to HIV- next step?
Testing immediately, 6 weeks, 3 months, 6 months
| 3 ART treatment
370
Values of Ca, P, K, and Uric acid in tumor lysis syndrome?
Ca and P- decreased
| Uric acid and K- increased
371
A patient with PPROM @ 34 weeks should get what treatment?
Penicillin due to unknown GBS
372
Medication to avoid in acute coronary syndrome?
Ca channel blockers due to worsening cardiac ischemia
373
Treatment for polymyalgia rheumatica- presents with neck, shoulder and pelvic pain, one hour of morning stiffness, and elevated ESR?
Low dose prednisone
374
A positive urinary cyanide nitroprusside test is used as screening for what? USMLE High Yield!
Cystinuria- inherited cause of uric acid stones due to amino acid transport abnormaility
375
What is the classic triad of splenic abscess and what is the most common risk factor?
fever/chills, LUQ pain, and splenic fluid collection
| Most common risk factor- infective endocarditis
376
4 steps to treat ascites?
Na and H2O restriction-->Spironolactone-->loop diuretics-->Frequent paracentesis
377
A known alcoholic has mental status changes on day 2 of hospitalization but normal vital signs. Has asterixis as well- treatment?
Lactulose
378
A patient with COPD has new onset clubbing- cause?
Cancer is the most common
379
Patient presents with fever, chills, urinary frequency, and tender, boggy prostate. UA positive for leukocyte esterase, next step?
Midstream urine culture to guide antibiotic therapy
380
A patient with recurrent intussusception should be evaluated for what? What vaccine is contraindicated with intussusception?
Meckel's diverticulum
| Rotavirus
381
Treatment for acute popliteal occlusion 4 days s/p MI?
Embolectomy via interventional radiology
382
A patient with post-op oliguria has an inconclusive bladder scan- next step?
Insert foley to see if symptoms improve--> no improvement give consider fluid bolus if pre-renal
383
A patient from Mississippi has a asymptomatic pulmonary nodule on exam. He is healthy, non-smoker, 33 years old. Diagnosis?
Histoplasmosis
384
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)
Treat! Liver failure, cirrhosis, DNA > 20,000, and HBV reactivation prophylaxis during chemo are indications to treat
Tenofivir and Entecavir are first line
385
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
KNOW THIS- have gotten many questions wrong
386
A baby has inspiratory stridor that worsens when lying down, crying, or feeding and gets better in prone position- diagnostic test and treatment?
Laryngomalacia
Dx- laryngoscopy
Tx- reassurance
387
Eccentric lytic lesion of bone on x-ray is better known as what buzzword?
Soap bubble appearance- think giant cell tumor
388
2 vaccines that should be given to pregnant Hep C positive patient? USMLE High Yield!
Hep A and B- should be given to all Hep C carriers even if pregnant!
389
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?
Aortic dissection- can present with sharp pain in back of neck!
390
Most common cause of asymptomatic elevation of alk phos in elderly?
Paget's disease
391
Definitive treatment for best long-term outcome for Graves disease?
Radioactive iodine therapy
392
An elderly lady comes in with complaints of memory loss. Also has weight gain, fatigue, constipation and hoarseness- diagnosis?
Hypothyroid
393
Abnormal D-xylose test?
Celiac's disease
394
Moderate pustular acne with erythema but no scarring should get what treatment?
Topical antibiotics
| Oral antibiotics are reserved for large nodular or cystic acne
395
An elderly lady with severe back pain, elevated ESR, and excessive urination has constipation- why?
Hypercalcemia 2/2 multiple myeloma
396
A mobile cavitary lung lesion with intermittent hemoptysis is indicative of what?
Aspergilloma
397
A patient has rapidly progressing bilateral cellulitis of the submandibular space with subcutaneous emphysema- where did infection start?
Teeth- this is ludwig angina
398
A 2 week old infant has conjunctivitis- dx and tx?
Chlamydial, treat is ORAL erythromycin
| Topical erythromycin at birth is gonococcal prophylaxis!
399
A tachycardic afebrile patient has an exudative pleural effusion- diagnosis?
Pulmonary embolism
400
A patient with HTN has a potassium of 3.5 and undetectable renin level- diagnosis?
Primary hyperaldosteronism
401
What is the most important risk factor for strokes- USMLE High Yield!
HTN
402
Fastest way to correct hyperkalemia?
Insulin and glucose
403
4 things associated with osteogenesis imperfecta?
Blue sclera, hearing loss, recurrent fractures, opalescent teeth
404
Single most important test to assess liver function during acute hepatitis?
PT- increasing in PT means progression to fulminant liver failure
405
2 risks for untreated hyperthyroid?
Atrial fibrillation, rapid bone loss
406
An elderly patient sees vertical lines as bent and wavy- diagnosis?
Macular degeneration
407
EKG shows flat broad T waves and premature ventricular beats- diagnosis?
Hypokalemia
408
Confirmatory test for ALL?
Bone marrow biopsy
409
HOCM has what inheritance pattern?
Autosomal dominant
410
An 8 year old girl has dark axillary hair but no pubic hair and no breast development- diagnosis and next step? USMLE High Yield
Diagnosis is adrenarche and next step is reassurance
| ANY breast or pubic hair means premature pubarche and needs investigation
411
Drug induced esophagitis not caused by bisphosphonates?
Potassium chloride
412
3 risk factors for pancreatic cancer?
Chronic pancreatitis, smoking, obesity
413
A patient breastfeeding has amenorrhea- why?
Prolactin suppresses GnRH
414
An HIV patient with esophagitis- what is a major clue it will be candida?
Oral thrush- without thrush most likely diagnosis is HSV>>CMV
415
Pathophysiology of ARDS? (2)
Decreased lung compliance and impaired gas exchange
416
HIV patient has painful loss of vision- diagnosis?
HSV
| CMV retinitis is painLESS
417
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?
Surgery- fever, leukocytosis, acidosis mean impending strangulation
peritoneal signs mean necrosis
418
Penile fracture treatment? (2)
Retrogreade urethrogram then surgery
419
A patient has flushed skin and telangiectasias, papules, and pustules that worsen when she drinks hot drinks or tans- diagnosis?
rosacea- look for 30-50 year old lady
420
Treatment for acute otitis media?
Amoxicillin
| Do NOT observe unless > 2 years old with mild unilateral symptoms
421
A patient with severe coughing paroxysms has subcutaneous emphysema over the chest- next step?
CXR- must rule out pneumothorax
| Although possibly has pertussis, cultures still come after CXR
422
Respiratory alkalosis leads to hypocalcemia how?
Increases Ca bound to albumin thus decreasing ionized Ca
423
What comes first in infective endocarditis- TEE or culture?
Cultures!
424
A diabetic patient wants viagra- what counseling is necessary? (think medication)
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
What is a factorial design study?
3 different interventions looking at > 2 variables
426
A young otherwise healthy patient with symptomatic HTN and evidence of LVH on EKG should be assessed for what?
Coarction of the aorta with BPs in both arms and legs- high in arms compared to legs
427
Most frequent origin for ectopic foci of atrial fibrillation?
Pulmonary veins
428
An HIV patient with multiple intrahepatic lesions begins to bleed when biopsy is attempted- diagnosis?
Bartonella causing bacillary angiomatosis
429
Poor prognostic factor in CLL?
Thrombocytopenia
430
Most important risk factor for cerebral palsy?
PREMATURITY
| NOT hypoxia
431
An infant with ambiguous genitalia, hyponatremia, and hyperkalemia is most likely to have what steroid elevated?
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
An IVDU with new conduction abnormality and diastolic murmur has what complication?
Perivalvular abscess
| Remember, tricuspid regurg will be systolic murmur
433
Confirmatory test for amyloidosis?
Fat pad biopsy
434
A patient who has to travel for business has fear of flying, tried friends BZDs and they worked. Next step
Behavioral therapy is first line treatment
435
2 criteria for tocolysis when no extreme risks to mother or fetus are present?
Cervical changes and 4 contractions in 20 minutes
| Typically should give steroids too!
436
A patient with chronic kidney failure presents with liekly aortic disection- first test after ECG?
TEE>>>>aortography is NEVER right
| If no kidney failure TEE or CT scan
437
Most common cause of firm hard cervical lymphadenopathy in elderly smoker?
Squamous cell carcinoma
438
A 5 year old has regressed from milestones after meningitis- why? LP, meningitis, or medication side effect?
Sequelae of meningitis
439
Ruptured submucosal arteries of distal esophagus or proximal stomach is the pathophysiology behind what?
Mallory-Weiss tears
| Dilated veins are esophageal varices
440
Variable decelerations can be treated with what, most of the time? What would be next?
Oxygen administration and change in maternal position
| Amnioinfusion
441
A patient with traumatic cord spinal injury has his airway secured and is hemodynamically stabilized- next step?
Urinary catheter to assess for retention and prevent bladder injury
442
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?
Yes- only contraindications are allergies to ingredients, or uncontrolled epilepsy, or encephalopathy within one week of prior vaccine
443
Uncomplicated UTI in non-pregnant lady- nitrofurantoin or levofloxacin?
Nitrofurantoin
| Levo saved for complicated cases (diabetes, obstruction, indwelling catheter)
444
What does TMP-SMX do to potassium levels?
Causes hyperkalemia
445
A patient with hirsutism and amenorrhea has elevated 17-hydroxyprogesterone- PCOD or CAH?
CAH- elevated 17-hydroxyprogesterone not seen with PCOD
446
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?
Reactive arthritis- NOT Gonococcla arthritis
Clues- enthesitis- heel pain, mouth ulcers, low back pain, afebrile
Tx is NSAIDS
447
Lidocaine decreases risk of what, but increases risk of what else?
Decreases risk of V fib
| Increases risk of Asystole
448
Diagnosis for unilateral varicocele that fails to empty when the patient is recumbent?
Tumor- Renal Cell Carcinoma
449
A hypertensive patient presents with ataxia, vomiting, gaze palsy, occipital headaches and facial weakness- where is the brain bleed?
Cerebellar
| Putamen would have hemiparesis usually
450
Maintenance treatment for Bruton's?
IVIG
451
A patient on risperidone has elevated prolactin and low TSH- diagnosis?
Pituitary adenoma- signs of hypopituitarism
452
A patient from Cambodia has hemoptysis, irregular heart beats, palpitations, and acute onset of left sided weakness- underlying diagnosis?
Rheumatic fever leading to mitral stenosis--> atrial fibrillation--> thrombus causing stroke
453
A 2 week old infant has conjugated hyperbilirubinemia- biliary atresia or breast milk jaundice?
biliary atresia
| Breast milk jaundice is unconjugated
454
A patient with cholesterol emboli can have what interesting finding on CBC with differential?
Eosinophils
455
A patient with pharyngitis is given amoxicillin and develops a rash and urticaria 30 minutes later- next step?
Anti-histamines
| This is not EBV- that rash develops at least 24 hours after amoxicillin
456
A 45 year old diabetic patient has a 30 pack year history and an LDL of 70- next step
start statins- basically all diabetic patients over 40 need a statin regardless of LDL
457
A patient on TB therapy has microcytic anemia with increased iron and low TIBC- next step?
Give pyridoxine for sideroblastic anemia 2/2 isoniazid
458
Management of cocaine induced chest pain?
BZDs or nitroglycerin
459
What lab value should be followed to document HBV clearance that is NOT in the hepatitis panel?
ALT should be followed every 3 months w/ HbeAg
460
Most common cause of thyrotoxicosis with reduced radioactive iodine uptake diffusely?
Thyroiditis
461
A patient on PTU has a fever and sore throat one week after starting treatment- next step?
Stop PTU- agranulocytosis!
462
Best long term treatment for PUD? If refractory?
Antibiotics and pantoprazole--> if refractory then proceed to vagotomy
463
Lactose intolerance labs- stool pH, stool osmotic gap, hydrogen breath test?
Stool pH low, stool osmotic gap high, positive hydrogen breath test
464
A patient with DiGeorge syndrome has fever, seizures, and R sided weakness- why seizures?
Brain abscesses 2/2 sinusitis
| Not hypocalcemia because of R sided weakness and fever
465
Treatment for SIADH 2/2 lung cancer? What if severely symptomatic hyponatremia?
Fluid restriction first
| If severe or symptomatic--> hypertonic saline
466
```
Name the disease associated with the renal casts? USMLE High Yield!
Muddy brown-
RBC-
WBC
Fatty-
Broad and Waxy-
```
```
Muddy brown- ATN
RBC- Glomerulonephritis
WBC- Pyelonephritis
Fatty- Nephrotic
Broad and Waxy- Chronic Renal Failure
```
467
A patient with MGUS has normal UPEP, no proteinuria, and normal calcium- next step?
X rays to look for lytic lesions to r/o multiple myeloma
468
Most common cause of folate deficiency in USA?
Alcohol- if question is just alcoholic with megaloblastic anemia choose folate>>B12 unless methylmalonic acid or neuro sxs are given
469
What fluoroquinolone should a patient be started on with pneumonia? Cipro or Levo?
Levo because cipro does not have streptococcal coverage
470
Most common predisposing factor for acute bacterial sinusitis?
Viral URI
471
What is the initial treatment for symptomatic relief for hyperthyroid? USMLE High Yield!
Propanolol until underlying cause is identified
472
Pyridostigmine can be used to treat what?
MG
473
How does heroin affect pupils, HR, and BP?
Miosis, bradycardia, hypotension
474
A patient comes in 3 days after starting cipro for UTI with no improvement. Bacteria is susceptible to cipro. Next step?
Ultrasound
475
2 tests before lithium treatment?
Cr and thyroid function tests
476
Guidelines for colon cancer screening in ulcerative colitis?
Colonoscopy 8 years after diagnosis with f/u colonoscopy every 1-2 years after
477
Diagnosis of shoulder pain if pain with lifting the arm ceases after lidocaine injection?
Rotator cuff impingement
478
a 27 year old lady, not obese, only taking OCPs has 3 visits with BP > 140/90- next step?
Stop OCPs to see if HTN disappears before starting thiazides
479
A patient has symmetric lower extremity symptoms- GBS or compression?
Look for UMN signs or sensory deficits--> would be compression and get MRI
If no
