Qbank Flashcards
One anatomical difference between pilonidal disease and perianal abscess? Suppurative hidradenitis vs pilonidal?
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
A patient 2 weeks post op of a partial gastrectomy presents with postprandial abdominal cramps, weakness, diaphoresis 30 minutes after eating- diagnosis and treatment?
Dumping syndrome- rapid emptying of stomach leads to fluid shift and autonomic reflexes
Tx is dietary changes 1st, octreotide if refractory
Preferred way to establish airway in patient with C spine injury?
Orotracheal intubation after stabilizing C spine
A patient presents with edema, hypoalbuminemia, and proteinuria- what does this do to the patient’s lipid profile?
Increased LDL, low HDL–> increased risk of accelerated atherosclerosis
Treatment for acute dystonic reaction?
Benzotropine or benadryl
Treatment for akathisia?
Propanolol
Treatment for Drug induced parkinsonism?
Amantadine or benzotropine
A demented patient has pneumonia 2/2 aspiration- likely pathogenesis?
Impaired epiglottic reflex
A 18 month old has atopic dermatitis, gets treatment, then has umbilicated vesicles erupt over each cheek with submandibular adenopathy- diagnosis? What virus? Tx?
Eczema herpeticum- occurs over healed atopic dermatitis, HSV, acyclovir
Isoniazid is known for causing vitamin B6 deficiency but can also cause what side effect?
Hepatitis- will see panlobular mononuclear infiltration and hepatic cell necrosis
What rash typically SPARES the diaper region in infants? Is symmetric everywhere else
Atopic dermatitis
How should you treat tachycardia with narrow QRS complexes and retrograde P waves?
Adenosine- tx for svt
A patient with TB presents with hyponatremia and hyperkalemia and normal anion gap metabolic acidosis- diagnosis?
Primary adrenal insufficiency- TB is a common cause in developing world
A patient with sickle cell presents for their 6th pain crisis hospitalization- what will be seen on peripheral smear besides sickle cells?
Howell Jolly bodies- at this point the patient has functional asplenia due to autoinfarction
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?
Scleroderma- no other pathology has absent peristaltic waves
Achalasia has increased LES tone
GERD has peristalsis
What class of medication can inhibits autonomic thermoregulation?
typical antipsychotics such as fluphenazine and haloperidol
How can blood gas differentiate COPD from CHF?
CHF- respiratory alkalosis
COPD- respiratory acidosis
What adrenergic therapy can treat hyperkalemia?
Albuterol and beta 2 agonists
A patient presents with pericarditis and BUN of 96, Cr of 5.1- next step?
Dialysis- this is treatment for uremic pericarditis
An immunocompromised patient has diffuse bilateral interstitial infiltrates on CXR- diagnosis
PJP
A patient presents with trendelenburg gait- what muscles or nerves could be injured?
Gluteus medius and minimus innervated by superior gluteal nerve
An HIV patient with esophagitis does not get better following fluconazole treatment- next step?
Get biopsy of ulcers showing CMV-large irregular ulcers or HSV- small, well circumscribed ulcers
CMV gets ganciclovir
HSV gets acyclovir
What lab abnormalities are seen with lupus anticoagulant and why is this interesting?
PTT will be prolonged although patient will be hypercoaguable
Russell viper venom test is specific for lupus anticoagulant and will be prolonged
What is a marjolin ulcer?
non-healing burn wound which becomes squamous cell carcinoma
Management of metastatic brain lesions? USMLE High Yield!
If solitary with stable extracranial disease- surgery
If multiple- whole brain radiation
What is the pathogenesis of aspirin sensitivity syndrome? USMLE High Yield!
Pseudo-allergic reaction due to accumulation of prostaglandins and leukotrienes
What is one method of preventing febrile nonhemolytic reaction after blood transfusion
Leukoreduction
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
How does a knee-to-chest position help during a child’s tet spell with TOF?
Increased systemic vascular resistance–> increased pulmonary blood flow
Murmur associated with wide pulse pressure and pounding/racing heartbeat?
AR
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
First step in evaluation of patient with hypercalcemia?
PTH, always
CXR comes after to look for malignancy
How does alcoholism cause impotence?
Cirrhosis causes hypogonadism 2/2 testicular atrophy
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
A patient has symptomatic hypercalcemia- next step?
IV NS and calcitonin or bisphosphonate
Most common infection prior to orbital cellulitis? Dx test?
Bacterial sinusitis
CT scan to rule out abscess that would require surgery
What are two sequelae of mitral stenosis (arrhythmia and lung)? Why?
Pulmonary edema and atrial fibrillation
Due to left atrial overland/enlargement
What are the first two steps with a newborn with respiratory distress and scaphoid abdomen?
First intubate, then decompress bowel with orogastric tube
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
A patient with cirrhosis has stopped drinking, is taking his medications, has been appropriately vaccinated. Next step?
Esophageal varices surveillance with and EGD
Treatment of choice for inflamed fluctuant cervical lymph node in child?
Dicloxacillin> cephalexin or clindamycin
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
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
3 things to lower risk of contrast induced nephropathy?
1) use non-ionic contrast
2) IV hydration
3) acetylcysteine
3 things seen with paroxysmal nocturnal hemoglobinuria?
unconjugated hyperbilirubinemia, thrombosis, pancytopenia
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
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
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
First line treatment for tourette’s?
Antipsychotics- 2nd generations are beginning to be preferred
What is one complication of mono? Why?
Autoimmune hemolytic anemia due to cross-reactivity of EBV antibodies with RBCs and platelets
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
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
What is hyposthenuria?
Complication of sickle cell disease that results in nocturia
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
First diagnostic test, best test, and treatment for HSV encephalitis?
First- r/o intracranial tumor/bleed with CT–> LP
Best- HSV PCR
Tx- Acyclovir
Which atypical antipsychotic is least likely to cause weight gain and diabetes?
Aripiprazole> ziprasidone
Olanzapine is the worst
Ziprasidone causes QT prolongation
What does an ABG of a patient with atelectasis look like?
Respiratory alkalosis with hypoxemia- increased pH, decreased O2 and CO2
A patient has a tension pneumothorax- next step?
Needle thoracostomy comes before IV resuscitation
Can you use low molecular weight heparin in HIT?
No, stop all heparin products and switch to argatroban.
A patient has symptomatic gallstones but refuses surgery- next step? (2)
Counsel to avoid fatty foods and prescribe ursodeoxycholic acid
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
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
Ophtho clue- decreased vision while driving at night and reading newspaper?
Cataracts! Opacity of lens on exam
An alcoholic, chronic smoker has dilated cardiomyopathy without ischemic changes- next step?
Alcohol abstinence can REVERSE process
ACE inhibitors slow progression
Treatment for long QT syndrome?
Beta blockers
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
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
What is the key factor in development of type 2 diabetes and sequelae (HTN, HLD)? USMLE High Yield!
Insulin resistance
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
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
3 options for close contact prophylaxis for Neisseria meningitidis?
Rifampin, ciprofloxacin, ceftriaxone
5 indications for addition of ampicilin for empiric coverage of meningitis?
Covers listeria
Immunocompromised, pregnant, HIV, elderly, steroids, neonates
What is the most sensitive physical exam finding for acute otitis media?
Immobility of TM
Hepatitis B- first indicator to show up and last to be present to indicate risk for transmission?
Surface antigen
Hepatitis B- indicator for need for treatment and best indicator for risk of pregnant woman transmitting disease to her child?
e-antigen
A pelthoric face, splenomegaly and HCT > 50% are indicative of what?
Polycythemia vera
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
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
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
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
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
When does a COPD patient need home oxygen? SaO2? PaO2?
SaO2 < 88, PaO2 < 55
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
A patient with GI complaints comes in a week later with eosinophilia, periorbital edema, and myositis- diagnosis?
Trichonellosis
Most common cause of myocarditis in children?
Viral- coxsackie
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
What is one cardiac finding on physical exam that would make you think angiodysplasia»_space; diverticulosis for rectal bleeding?
Aortic stenosis
Most common risk factor for respiratory distress syndrome in newborn besides prematurity?
Maternal diabetes- delays maturation of surfactant production
6 scenarios for drug induced pancreatitis?
Diuretics- furosemide or thiazides IBD- sulfasalazine Immunosuppression- azathioprine Seizures- VPA AIDS- didanosine Antibiotics- metronidazole, tetracycline
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
A patient has a rash that looks like RMSF but has generalized lymphadenopathy- diagnosis?
2ndary syphilis
Initial test for acromegaly? Best test?
Initial- IGF-1
Best- GH after oral glucose load
An infant with a heart murmur but no cyanosis presents- why not tetralogy of fallot?
NO CYANOSIS
Lumbar flexion makes what worse? What about extension?
Flexion makes disk herniation worse
Extension makes stenosis worse
Initial test for suspicion of ZE syndrome? If unequivocal next test?
Gastrin levels are first
Secretin stimulation test is next
How do the kidneys compensate for obesity hypoventilation syndrome?
Increase bicarb retention and decrease chloride retention
What swelling of the newborn scalp is limited to one bone, which one crosses sutures?
Cephalohematoma limited to one bone
Caput succedaneum crosses sutures
Delayed separation of the umbilical cord leads to defective what?
Leukocyte adhesion- will present as recurrent infections of skin and mucosa
Skin cancer found on the lips is most likely?
Squamous cell carcinoma
Treatment for thrombocytopenia following viral infection in child?
Reassurance
A patient with shortness of breath has an S3 on cardiac exam- treatment?
Diuretics
What kidney pathology is associated with hepatitis B
Membranous glomerulonephritis
What is meconium ileus diagnostic for?
Cystic fibrosis
Most common heart defect in Down’s?
Complete AV septal defect>VSD>ASD
Most common cause of post-influenza pneumonia?
Staph aureus
What is the treatment for syphilis in penicillin allergic patients?
Doxycycline
First vital sign to change with hypovolemia?
Pulse
Which one has full on mania- bipolar I or II
Bipolar I
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
Treatment for Wolff-Parkinson-White?
Procainamide
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
A child with arthralgias, abdominal pain, and nephritis has a nonblanching rash on his lower extremities- diagnosis?
Henoch-Schonlein purpura
Kidney disease associated with HIV?
Focal segmental glomerulosclerosis
Treatment for dermatitis herpetiformis?
Dapsone- remember association with celiac’s disease!
A patient with BPH is having worsening symptoms and an increase in Cr- next step?
Abdominal ultrasound to assess for hydronephrosis
A patient presenting with acute MI can have what change on cardiac exam?
Fourth heart sound
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
Why is age important when diagnosing acute epididymis?
Younger patient-s think gonorrhea or chlamydia
Elderly- think gram - rods like e coli
A patient presents with bipolar- what labs should be drawn prior to giving lithium?
Cr and BUN- renal dysfunction is contraindication to lithium
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
A child presents with croup that is not responding to oxygen or albuterol- next step?
Give epinephrine trial before going to intubation!
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!
Treatment for Dressler’s syndrome?
NSAIDs
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
Tx for hypovolemic hypernatremia?
Normal saline- even in infants!
Pulmonary auscultation- increased breath sounds, dull percussion, increased fremitus?
Consolidation
Pulmonary auscultation- decreased breath sounds, dull percussion, decreased fremitus?
Pleural effusion
Pulmonary auscultation- decreased breath sounds, hyperresonant percussion, decreased fremitus? (2)
COPD or pneumothorax- use history and mediastinal shift to differentiate
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
How does exogenous thyroid hormone abuse present differently than Graves on labs?
Graves- Elevated TSI
Exogenous- low serum thryoglobulin, no TSI
A patient has fever, diarrhea, and vomiting after cruise? bug and drug?
Legionella
Z pack or levofloxacin
Sidney Crosby gets mono- when can start playing again?
When physical exam normalizes- no more splenomegaly
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
Infection 6 months after knee surgery is most likely what bug?
Coagulase negative staph- epidermidis
S. aureus would present within 3 months
Pathophysiology behind cardiac tamponade? Fluid accumulation causes what?
Decreased LV preload due to fluid accumulation in percardial cavity
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
A patient post MI has a cold leg- next step?
get echo to look for thrombus in LV
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
2 ways to differentiate Legg-Calve-Perthes disease and SCFE?
LCP- age 4-10
SCFE- ages 12-14 and OBESE
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
What supplementation should be started in premature infants at birth who are exclusively breastfeeding?
Iron and Vit D
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
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
A patient with a scaly, itchy rash after swimming lessons in a public pool should be treated with what?
Terbinafine- dx is tinea corporis
Complication of temporal arteritis besides blindness (cardiac)
Aortic aneurysms
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
3 contraindications to metformin?
Renal failure, hepatic failure, sepsis- all increase risk for lactic acidosis
Mechanism for hypotension in pulmonary embolism- 5 steps?
Thrombus increases pulmonary vascular resistance–> Increase RV pressure–> RV hypokinesis and dilation–> decreased preload–> hypotension
What is the marker of an aplastic crisis in a sickle cell patient?
Very low hgb with low reticulocyte
Two ways to describe the gait associated with Parkinson’s
Shuffling or Hypokinetic
Two findings on light microscopy in membranous glomerulonephritis?
Diffuse GBM thickening, subepithelial spikes
Transparent or yellow papules with mild scaling plaques on the scalp, eyebrows, or nasolabial folds are characteristic of what rash?
Seborrheic dermatitis
What is genu varum? Rachitic rosary?
Femoral and tibial bowing, bony prominences of the costochondral junctions seen in rickets
Vitamin B12 deficiency can lead to increase risk of what cancer?
Gastric cancer if cause is pernicious anemia
Tea and toast diet?
Folic acid deficiency
A patient with osteoarthritis is most likely to have what kind of anemia?
Iron deficiency from chronic NSAID use
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
An infant with low bicarb, high chloride, and failure to thrive could have what?
Renal tubular acidosis
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
What is erysipelas?
Strep A cellulitis which results in a well demarcated tender raised rash
What treatment worsens ophthalmology associated with Graves disease?
Radioactive iodine
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
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
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
A home birth baby with spasms and swollen erythematous umbilical cord at 2 weeks- diagnosis?
Tetanus
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
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
A patient with hepatic encephalopathy needs treatment but lactulose isn’t an option- look for what answer?
Correct electrolyte abnormalities or give albumin!
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
A prostitute with a high fever, malaise, skin rash on arms, and arthralgias has a negative blood culture x3- diagnosis?
Disseminated gonnorrhea
A patient with hypertension has bilateral palpable upper abdominal masses- most likely diagnosis?
Polycystic kidney disease
Pheochromocytoma, hyperaldosteronism do not have PALPABLE masses
Why do DM type 2 patients have elevated LFTs?
Non-alcoholic fatty liver disease 2/2 insulin resistance
Vitamin therapy in measles that reduces M and M?
Vitamin A
Tx for frostbite- warm water, dry heat, or infusion of warm fluids?
Warm water
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
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
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
Tx for hemodynamically unstable atrial fibrillation?
DC cardioconversion
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
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
A patient is rescued from a fire, has a seizure, and is confused- next step?
100% oxygen facemask to treat CO poisoning
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
Electrolyte abnormalities in Cushing’s? Na, K
Hypernatremia with hypokalemia due to crossreactivity of glucocorticoids with aldosterone receptors
First line treatment for osteoarthritis? (3)
Weight loss and moderate exercise with Acetaminophen»>NSAIDs
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
3 side effects of erythropoietin therapy?
HTN, headaches, Flu like syndrome
A patient with conjunctivitis has itense itching in both eyes- likely diagnosis?
Allergic conjunctivitis»_space; infectious
Tx of 3rd degree heart block?
Pacemaker to avoid V tach of V fib
A patient with hx of atherosclerosis has HTN and systolic-diastolic abdominal bruit- diagnosis?
Renal artery stenosis
12 year old boy presents with chronic back pain, bed wetting, and a palpable step off in lumbosacral area- diagnosis?
Spondyloisthesis
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
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
Confounding vs effect modification?
Confounding- significance disappears after stratification
Effect modification- significance appears after stratification
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)
A patient with a history of food allergies has acute shortness of breath and difficulty swallowing- diagnosis?
Laryngeal edema
Henoch-Schonlein purpura, presenting with purpura, abdominal pain, arthalgias, +/- scrotal swelling increases risk for what sequelae?
Intussusception
Treatment for anemia of chronic disease? Low iron, low TIBC
Treat underlying condition
Best way to improve prognosis 1 hour after MI?
Restore coronary blood flow
What should be tried before intubation during acute exacerbation of COPD?
Noninvasive positive pressure ventilation
A 60 year old presents two weeks after treatment for thrombophlebitis with a DVT- next step?
CT of C/A/P looking for malignancy
A patient recently started amitriptyline then presents with lower abdominal pain- next step?
Urinary catheterization- detrusor inactivity 2/2 amitriptyline causing urinary rentention
A patient with CLL has anemia- treatment?
Prednisone to treat autoimmune hemolytic anemia
A dentist presents with non-purulent vesicles on his finger- diagnosis? USMLE High Yield
Herpetic whitlow
First step in the workup of dyspepsia?
H pylori testing unless dysphagia, weight loss, or persistent vomiting occurs–> straight to upper endoscopy
Ophtho- “curtain coming down” loss of vision?
Retinal emboli causing amaurosis fugax
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
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
How does chronic steroid use cause bone pain- pathophysiology?
Disruption of bone vasculature
A child presents with polyuria and diaper candidiasis- must rule out what?
DM type I
An HIV patient has cerebral toxoplasmosis- tx?
Sulfadiazine and pyrimethamine
TMP-SMX is prophylaxis NOT tx
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
How does valsalva affect murmurs?
Decreases venous return therefore decreases most murmurs except HOCM
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
Most common cause of death in acute MI is what arrhythmia?
Reentry arrhythmia
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
First test, best test for CLL?
First- CBC and peripheral smear
Best- Flow cytometry of blood
A child has head circumference rapidly increasing across percentiles- next step?
CT or MRI - must get imaging
Best test for diagnosis of Ankylosing spondylitis?
X ray of sacro-iliac joints
How does iron deficiency anemia change MCHC and RDW?
MCHC decreased
RDW increased
An Asian immigrant has MR- next step?
Pencillin prophylaxis until 21 years old
A patient has renal stones- 4 dietary recommendations? USMLE High Yield!
Decrease protein and oxalate
Decrease sodium
Increase fluids
Increase dietary calcium
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
Nasopharyngeal cancer risk factor?
EBV
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
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
Treatment for Acute transplant rejection? USMLE High Yield!
IV steroids
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
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
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
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
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
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
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
DO NOT MAKE DUMB MISTAKES WITH STATISTICS
DO NOT MAKE DUMB MISTAKES WITH STATISTICS
Why can SaO2 change with position in pneumonia?
Physiologic shunting to and from the consolidation changes SaO2- lying on side of consolidation decreases SaO2
With dehydration do you bolus solution with D5?
No, never in bolus only in maintenance
A patient has crypotococcal meningitis- tx and f/u?
Tx- amphotericin and flucytosine
F/u HIV testing
A patient w/ h/o prostate cancer and bony metastases has orchiectomy. Symptoms return with new bony metastases- next step?
Radiation therapy
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
SAAG > 1.1 of alcoholic- mechanism of ascites?
Increased capillary hydrostatic pressure
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
An HIV patient has branching partially acid fast bacteria- bug and drug?
Norcardia- also common in transplant patients
TMP-SMX is treatment
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
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)
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
Crohn’s or UC- always involves rectum?
UC always involves rectum
Patient who only has oral ulcers- Crohn’s
A baby has bloody stools after being born premature- what to look for on X-ray?
Pneumatosis intestinalis= NEC
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
A patient on phenytoin has anemia- next step? USMLE High Yield!
Folic acid supplementation
Other drugs interfering with folic acid are MTX, trimethoprim
Nocardia or Actinomyces- anaerobic?
Actinomyces! Tx is penicillin while nocardia is tx with bactrim
Most common cause of unilateral cervical lymphadenitis in children?
S. aureus
A patient has low Ca, high P, and normal kidney function- diagnosis?
Primary Hypoparathyroid
A patient following blunt abdominal trauma has delayed onset hypotension- next step?
CT scan- likely splenic injury
Most common part of the spine to be affected by rheumatoid arthritis?
Cervical spine
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
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
Dermatology- stuck on waxy appearance in elderly patient?
Seborrheic keratosis
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
A patient has LLQ pain, hematochezia, and ulcerations on colonoscopy after a surgical repair of a large abdominal aortic aneurysm- diagnosis?
Ischemic colitis
A 2 month old has a white relfex on eye exam- next step? USMLE High Yield
Ophtho consult to rule out retinoblastoma
Test and treatment for disseminated histoplasmosis?
Test- urine antigen
Tx- itraconazole
Polymyositis vs Myasthenia Gravis- ptosis and diplopia?
MG
New diagnosis of HTN needs what 4 tests?
UA, CMP, Lipid profile, EKG
Strongest modifiable risk factor for predicting aortic aneurysm expansion?
Smoking
Tx of Lyme disease during pregnancy?
Amoxicillin»»Azithromycin
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
A child has isolated hemihyperplasia, macroglossia, and macrosomia. Next step?
Abdominal ultrasound for wilms tumor or hepatoblastoma
Why would an obese lady with normal FSH and LH have amenorrhea?
Anovulation
A 3 week old has a leg-length discrepancy- next step?
Perform ortolani and barlow maneuvers- if palpable click–> orthopedics
If negative- hip ultrasound
A patient with ulcerative colitis has fatigue and increased Alk Phos- diagnosis?
Primary sclerosing cholangitis
A patient has a pulsatile mass in the right groin area, right thigh pain that is worse with walking- diagnosis?
femoral artery aneurysms
First line therapy for mild acne?
Topical retinoids
What rash spreads cranio-caudally and spares the palms and soles?
Rubella
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
Syncope with prodromal dizziness and blurred vision?
Orthostasis
A patient has thready pulses in the radial arteries that disappears with inspiration- what sign?
Pulsus paradoxus- possibly cardiac tamponade
CSF findings in HSV encephalitis- RBC, WBC, % neutrophils, protein, glucose?
RBC elevated
WBC elevated with low neutrophils
protein elevated
Glucose normal
A patient presents with shortness of breath. PFTs show FEV1 65% and FEV1/FVC ratio of 85%- what’s the answer?
Whatever mentions fibrosis!
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
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
Treatment for wide complex tachycardia?
Amiodarone
Post-gastric bypass patients prophylaxis?
Ursodeoxycholic acid for 6 months to prevent gallstones
Pain seen with peritoneal irritation 2/2 perforation?
Somatic
Visceral is more diffuse- seen with SBO
Most common cause of aortic stenosis in elderly?
Calcifications of aortic valve leaflets
Prognostic factor for astrocytomas?
Degree of anaplasia
A patient with pancreatic cancer has severe itching. He has multiple metastasis- next step?
Stent placement in common bile duct
A sickle cell patient has diffuse thigh and back pain- avascular necrosis or microvascular occlusion?
Microvascular occlusion- look for high LDH value
Mechanism of renal failure in multiple myeloma?
toxic effect of light chain casts on renal tubules
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
What is the anemia associated with DIC caused by?
Microangiopathic hemolytic anemia
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
What physical exam finding is absent in testicular torsion?
Cremasteric reflex
Pain relief with elevation of testes= epididymitis
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
A child has pharyngitis without lymphadenopathy- next step?
Nothing!
No lymphadenopathy means not GAS and penicillin not necessary
A patient has an EKG with flattened P waves and prolonged QRS- next step?
Check K levels- if high give Ca gluconate
Pheochromocytoma associated with what part of adrenals?
Medulla
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
A diabetic ulcer without erythema or purulent drainage does not involve the bone- next step?
Debride the necrotic tissue
Mechanism of ketone production in DKA?
Fatty acid breakdown in the liver
HIV drug causing vivid dreams?
Efavirenz
Initial treatment for urge incontinence?
Frequent voluntary voiding, bladder training
A patient with psychosis has tachycardia, restless leg syndrome, dilated pupils- best treatment?
Group therapy- he has cocaine intoxication
A patient has sclera above her iris on downward gaze- what is this seen with?
Lid lag seen with hyperthyroidism
An iatrogenic cause of thrombocytosis?
Splenectomy
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
Adrenergic drugs used for tocolysis?
Beta agonists- terbutaline
Treatment for familial hypertriglyceridemia?
Fibrates
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
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
Tx for fibromyalgia?
Exercise program
A newborn has anemia, hepatosplenomegaly, hyperbilirubinemia, rhinorrhea, and ulcerative lesions on his feet- diagnosis?
Syphilis- can also see x ray abnormalities (metaphyseal dystrophy)
Mutation that causes osteogenesis imperfecta? USMLE High Yield!
Collagen type 1
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
A patient has gastinoma- what other tumors could be seen?
MEN 1- parathyroid, pituitary, pancreatic
What causes zenker’s diverticulum and what is treatment? USMLE High Yield
Cause- motor dysfunction
Treatment- myotomy
Which knee injury has a palpable snap on exam with knee flexion and tibial torsion?
Medial meniscus tear
Treatment of first episode of acute bronchitis?
Reassurance
A patient with a normal PCWP but high right heart pressures and high pulmonary artery pressures could have what?
Pulmonary Embolism
Pronator drift is a physical exam finding seen with what?
Upper motor neuron lesion
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
How does raising the head of the bed help prevent atelectasis?
Increases FRC
Reyes syndrome causes what morphologic changes in liver?
Extensive fatty vacuolization
Which is used first for treatment of enuresis after behavior modifications fail- desmopressin or imipramine?
Desmopressin first, then imipramine if no improvement
Most common cause of abnormal hemostasis in patients with chronic renal failure? USMLE High Yield!
Platelet dysfunction- treat with DDVAP if necessary
Subarachnoid hemorrhage leads to what electrolye abnormality?
Hyponatremia- cerebral salt wasting syndrome
Treatment for central retinal artery occlusion?
High flow oxygen and ocular massage
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
Post exposure prophylaxis to varicella in children?
Give vaccine if no history of vaccine
If hx of vaccination- observe
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
A patient with septic shock after aspiration pneumonia has elevated AST and ALT (in the 1000s) the next day- diagnosis?
Ischemic hepatic injury
Ophtho- sudden onset of floaters and a curtain coming down over her eyes?
Retinal detachment
What is electrical alternans?
Varying amplitude in QRS seen with cardiac tamponade?
A patient with SLE has proteinuria and increased Cr- next step?
Get biopsy- outcomes and treatment vary depending on class of lupus nephritis
A patient with IBD has signs of sepsis- next step?
Abdominal X ray to r/o toxic megacolon
HNPCC increases risk for which cancer other than colon cancer?
Endometrial cancer
Most serious side effect of hydroxychloroquine?
Retinopathy
A patient with asthma has new onset tremors, weakness- next step?
Get electrolytes- hypokalemia 2/2 beta agonists
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
Common OTC drug that decreases warfarin metabolism?
Tylenol, also NSAIDs
Other name for Osgood-Schlatters disease?
Traction apophysitis
A 58 year old with Parkinson’s has new headache, blurred vision, constipation, and vomiting- most likely?
Anticholinergic toxicity
Paroxysmal supraventricular tachycardia (HR >160) has conduction through what anatomic structure?
AV node
Treatment for amniotic fluid embolism?
Intubation or respiratory support as necessary
A patient has spinal metastases- next step?
Steroids ans MRI
A patient on long term steroids is having new onset hip pain without trauma- next step?
MRI for avascular necrosis
Pigment granules in hepatocytes- rotor’s or dubin-johnson?
Dubin-Johnson
A patient with metabolic acidosis has a high CO2 and lethargy- why?
Not compensating appropriately leading to hypercarbia
What physical exam finding is often associated with an increased BNP (cardiac exam)
S3
Most common cause of brain abscess 2/2 sinusitis?
Anaerobic bacteria- streptococci or bacteroides
6 indications for pneumococcal vaccine before 65?
Chronic liver disease Asplenia DM COPD/asthma CV disease Alcoholism
Treatment for stroke 2/2 sickle cell disease?
Exchange transfusion
NOT fibrinolytic or thrombolytic therapy
Patient with head trauma and lucid interval?
Epidural hematoma- ruptured middle meningial artery
How to prevent post-op pneumonia? Incentive spirometry or post-op antibiotics?
Incentive spirometry»»»antibiotics
Quantitative pilocarpine iontophoresis is better known as what?
Chloride sweat test for CF
Although known for pseudomonal infections, CF patients are at risk for what other infection in childhood?
S. aureus
GVHD is caused by activation of what cells?
Donor T cells
Most common cause of B12 deficiency in US?
Pernicious anemia- look for glossitis, vitiligo
Metabolic side effects of thiazides? USMLE High Yield!
Hyperglycemia, hypokalemia, hypercalcemia, increased LDL, increased TGs
A patient has dense intra-basement membrane deposits that are C3 not Igs- diagnosis?
membranoproliferative glomerulonephritis
Most likely cause of meningitis in 18 month old with petechial rash on trunk and extremities?
Neisseria
A patient who has been on TPN for 2 years has cholecystitis- why?
Gallbladder stasis
A patient presents with signs of cholecystitis, PUD, possible perforation- first step?
EKG to rule on MI
Ehrlichiosis- diagnosis and treatment?
Clinical- tick bite from southeast without rash, leukopenia and thrombocytopenia
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
Best way to monitor for respiratory failure with Guillain-Barre? USMLE High Yield!
Vital capacity
First step in work up of a patient with hypertension and hypokalemia?
Plasma renin-aldosterone ratio before any imaging
Mechanism of thrombocytopenia in SLE?
Auto-immune destruction
Classic triad of congenital rubella?
Deafness, PDA, cataracts
Healthcare worker exposed to HIV- next step?
Testing immediately, 6 weeks, 3 months, 6 months
3 ART treatment
Values of Ca, P, K, and Uric acid in tumor lysis syndrome?
Ca and P- decreased
Uric acid and K- increased
A patient with PPROM @ 34 weeks should get what treatment?
Penicillin due to unknown GBS
Medication to avoid in acute coronary syndrome?
Ca channel blockers due to worsening cardiac ischemia
Treatment for polymyalgia rheumatica- presents with neck, shoulder and pelvic pain, one hour of morning stiffness, and elevated ESR?
Low dose prednisone
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
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
4 steps to treat ascites?
Na and H2O restriction–>Spironolactone–>loop diuretics–>Frequent paracentesis
A known alcoholic has mental status changes on day 2 of hospitalization but normal vital signs. Has asterixis as well- treatment?
Lactulose
A patient with COPD has new onset clubbing- cause?
Cancer is the most common
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
A patient with recurrent intussusception should be evaluated for what? What vaccine is contraindicated with intussusception?
Meckel’s diverticulum
Rotavirus
Treatment for acute popliteal occlusion 4 days s/p MI?
Embolectomy via interventional radiology
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
A patient from Mississippi has a asymptomatic pulmonary nodule on exam. He is healthy, non-smoker, 33 years old. Diagnosis?
Histoplasmosis
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
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
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
Eccentric lytic lesion of bone on x-ray is better known as what buzzword?
Soap bubble appearance- think giant cell tumor
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!
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!
Most common cause of asymptomatic elevation of alk phos in elderly?
Paget’s disease
Definitive treatment for best long-term outcome for Graves disease?
Radioactive iodine therapy
An elderly lady comes in with complaints of memory loss. Also has weight gain, fatigue, constipation and hoarseness- diagnosis?
Hypothyroid
Abnormal D-xylose test?
Celiac’s disease
Moderate pustular acne with erythema but no scarring should get what treatment?
Topical antibiotics
Oral antibiotics are reserved for large nodular or cystic acne
An elderly lady with severe back pain, elevated ESR, and excessive urination has constipation- why?
Hypercalcemia 2/2 multiple myeloma
A mobile cavitary lung lesion with intermittent hemoptysis is indicative of what?
Aspergilloma
A patient has rapidly progressing bilateral cellulitis of the submandibular space with subcutaneous emphysema- where did infection start?
Teeth- this is ludwig angina
A 2 week old infant has conjunctivitis- dx and tx?
Chlamydial, treat is ORAL erythromycin
Topical erythromycin at birth is gonococcal prophylaxis!
A tachycardic afebrile patient has an exudative pleural effusion- diagnosis?
Pulmonary embolism
A patient with HTN has a potassium of 3.5 and undetectable renin level- diagnosis?
Primary hyperaldosteronism
What is the most important risk factor for strokes- USMLE High Yield!
HTN
Fastest way to correct hyperkalemia?
Insulin and glucose
4 things associated with osteogenesis imperfecta?
Blue sclera, hearing loss, recurrent fractures, opalescent teeth
Single most important test to assess liver function during acute hepatitis?
PT- increasing in PT means progression to fulminant liver failure
2 risks for untreated hyperthyroid?
Atrial fibrillation, rapid bone loss
An elderly patient sees vertical lines as bent and wavy- diagnosis?
Macular degeneration
EKG shows flat broad T waves and premature ventricular beats- diagnosis?
Hypokalemia
Confirmatory test for ALL?
Bone marrow biopsy
HOCM has what inheritance pattern?
Autosomal dominant
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
Drug induced esophagitis not caused by bisphosphonates?
Potassium chloride
3 risk factors for pancreatic cancer?
Chronic pancreatitis, smoking, obesity
A patient breastfeeding has amenorrhea- why?
Prolactin suppresses GnRH
An HIV patient with esophagitis- what is a major clue it will be candida?
Oral thrush- without thrush most likely diagnosis is HSV»CMV
Pathophysiology of ARDS? (2)
Decreased lung compliance and impaired gas exchange
HIV patient has painful loss of vision- diagnosis?
HSV
CMV retinitis is painLESS
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
Penile fracture treatment? (2)
Retrogreade urethrogram then surgery
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
Treatment for acute otitis media?
Amoxicillin
Do NOT observe unless > 2 years old with mild unilateral symptoms
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
Respiratory alkalosis leads to hypocalcemia how?
Increases Ca bound to albumin thus decreasing ionized Ca
What comes first in infective endocarditis- TEE or culture?
Cultures!
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
What is a factorial design study?
3 different interventions looking at > 2 variables
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
Most frequent origin for ectopic foci of atrial fibrillation?
Pulmonary veins
An HIV patient with multiple intrahepatic lesions begins to bleed when biopsy is attempted- diagnosis?
Bartonella causing bacillary angiomatosis
Poor prognostic factor in CLL?
Thrombocytopenia
Most important risk factor for cerebral palsy?
PREMATURITY
NOT hypoxia
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)
An IVDU with new conduction abnormality and diastolic murmur has what complication?
Perivalvular abscess
Remember, tricuspid regurg will be systolic murmur
Confirmatory test for amyloidosis?
Fat pad biopsy
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
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!
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
Most common cause of firm hard cervical lymphadenopathy in elderly smoker?
Squamous cell carcinoma
A 5 year old has regressed from milestones after meningitis- why? LP, meningitis, or medication side effect?
Sequelae of meningitis
Ruptured submucosal arteries of distal esophagus or proximal stomach is the pathophysiology behind what?
Mallory-Weiss tears
Dilated veins are esophageal varices
Variable decelerations can be treated with what, most of the time? What would be next?
Oxygen administration and change in maternal position
Amnioinfusion
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
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
Uncomplicated UTI in non-pregnant lady- nitrofurantoin or levofloxacin?
Nitrofurantoin
Levo saved for complicated cases (diabetes, obstruction, indwelling catheter)
What does TMP-SMX do to potassium levels?
Causes hyperkalemia
A patient with hirsutism and amenorrhea has elevated 17-hydroxyprogesterone- PCOD or CAH?
CAH- elevated 17-hydroxyprogesterone not seen with PCOD
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
Lidocaine decreases risk of what, but increases risk of what else?
Decreases risk of V fib
Increases risk of Asystole
Diagnosis for unilateral varicocele that fails to empty when the patient is recumbent?
Tumor- Renal Cell Carcinoma
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
Maintenance treatment for Bruton’s?
IVIG
A patient on risperidone has elevated prolactin and low TSH- diagnosis?
Pituitary adenoma- signs of hypopituitarism
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
A 2 week old infant has conjugated hyperbilirubinemia- biliary atresia or breast milk jaundice?
biliary atresia
Breast milk jaundice is unconjugated
A patient with cholesterol emboli can have what interesting finding on CBC with differential?
Eosinophils
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
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
A patient on TB therapy has microcytic anemia with increased iron and low TIBC- next step?
Give pyridoxine for sideroblastic anemia 2/2 isoniazid
Management of cocaine induced chest pain?
BZDs or nitroglycerin
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
Most common cause of thyrotoxicosis with reduced radioactive iodine uptake diffusely?
Thyroiditis
A patient on PTU has a fever and sore throat one week after starting treatment- next step?
Stop PTU- agranulocytosis!
Best long term treatment for PUD? If refractory?
Antibiotics and pantoprazole–> if refractory then proceed to vagotomy
Lactose intolerance labs- stool pH, stool osmotic gap, hydrogen breath test?
Stool pH low, stool osmotic gap high, positive hydrogen breath test
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
Treatment for SIADH 2/2 lung cancer? What if severely symptomatic hyponatremia?
Fluid restriction first
If severe or symptomatic–> hypertonic saline
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
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
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
What fluoroquinolone should a patient be started on with pneumonia? Cipro or Levo?
Levo because cipro does not have streptococcal coverage
Most common predisposing factor for acute bacterial sinusitis?
Viral URI
What is the initial treatment for symptomatic relief for hyperthyroid? USMLE High Yield!
Propanolol until underlying cause is identified
Pyridostigmine can be used to treat what?
MG
How does heroin affect pupils, HR, and BP?
Miosis, bradycardia, hypotension
A patient comes in 3 days after starting cipro for UTI with no improvement. Bacteria is susceptible to cipro. Next step?
Ultrasound
2 tests before lithium treatment?
Cr and thyroid function tests
Guidelines for colon cancer screening in ulcerative colitis?
Colonoscopy 8 years after diagnosis with f/u colonoscopy every 1-2 years after
Diagnosis of shoulder pain if pain with lifting the arm ceases after lidocaine injection?
Rotator cuff impingement
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
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