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Step 2 question review > Questions 1-350 > Flashcards

Questions 1-350 Flashcards

1
Q

Posterior costal tenderpoints are typically associated with (inhalation/exhalation) somatic dysfunction (elevated/depressed) ribs.

A

inhalation

elevated

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2
Q

What is the treatment for burkitt lymphoma?

A

rituximab

CD20 antibody

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3
Q

How do you treat small cell lung cancer?

A

radiation and chemo

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4
Q

iron is absorbed in the ….

folate is absorbed in the ….

A

duodenum

jejunum

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5
Q

window period of hep B serology will show

A

core ab IgM then IGg positive

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6
Q

II, III, aVF infarct location

A

RV infarction

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7
Q

treatment for RV infarction

A

isotonic flusids, aspirin and cardiac cath

NO nitrates

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8
Q

How do you prevent infection from foley cath after surgery?

A

keeping urine collecting bag below the level of the bladder, ensuring good downward flow

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9
Q

abundance of small normal appearing lymphocytes and ruptured smudge cells

A

CLL

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10
Q

plasma cells with fried egg appearance

A

multiple myeloma

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11
Q

Dutcher bodies /PAS positive staining IgM deposits around nucleus

A

waldenstrom macroglobulinemia (non-hodgkin like lymphoma)

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12
Q

lymphoid cells with cytoplasmic projections

A

hairy cell leukemia

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13
Q

TRAP stain (tartrate resistant acid phosphatase)

A

hairy cell leukemia

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14
Q

giant cells with bilobar nuclei and eosinophilic nucleoli

A

Reed sternberg cells

hodgkin lymphoma

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15
Q

PT, PTT, and platelet count in Vit C deficiency

A

normal PT, normal PTT, normal platelet count

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16
Q

gingivitis, ecchymoses, perifollicular hemorrhage, petechiae, curly hairs

A

vit C deficiency/scurvy

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17
Q

PT, PTT, platelet count in hemophilia A

A

normal PT, increased PTT, normal platelet count

(factor 8 deficiency, intrinsic pathway affected)

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18
Q

PT, PTT, platelet count in von willebrand disease

A

normal PT, increased PTT, normal platelet count

(vwf carries factor 8)

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19
Q

PT, PTT, platelet count in ITP

A

normal PT, normal PTT, decreased platelet count

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20
Q

what type of RTA is common in sickle cell disease pts and diabetics?

A

type IV RTA

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21
Q

What medications can cause a type IV RTA

A

ACE-I and NSAIDs

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22
Q

What is the physiologic defect in type IV RTA?

A

hypoaldosteronism or aldosterone resistance

hyperK, urine pH <5.5, positive urine anion gap

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23
Q

type I RTA is (distal/proximal)

A

distal

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24
Q

type II RTA is (distal/proximal)

A

proximal

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25
Q

impaired distal acid secretion, hypoK, urine pH > 5.5, positive urine anion gap

A

type I RTA

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26
Q

impaired proximal bicarb reabsorption, hypoK, urine pH <5.5, negative urine anion gap

A

type II RTA

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27
Q

thromboangiitis obliterans aka

A

buerger disease

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28
Q

thromboangiitis obliterans is closely linked to…

A

tobacco use

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29
Q

young smoker with symptoms of claudication, extremity or digit ischemia, or superficial thrombophlebitis

A

thomboangiitis obliterans

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30
Q

granulomatous skin disorder occurring primarily in diabetics, present with well-demarcated papule or plaque that gradually enlarges; generally non painful and on shins

A

necrobiosis lipodica

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31
Q

down and out right eye with pupillary dilation

A

oculomotor nerve palsy due to compression by a posterior communicating artery aneurysm

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32
Q

overall most common site of anuerysm rupture

A

anterior communicating artery branching point with ACA

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33
Q

aneurysm spot causing bitemporal heteronymous hemianopsia

A

compressing optic chiasm, ACOM artery aneurysm

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34
Q

decreased pain and or temp of the ipsilateral face and contralateral body

A

wallenberg syndrome

posterior inferior cerebellar artery

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35
Q

First, second, and third line treatments of status epilepticus

A
  1. benzos (lorazepam)
  2. Antiseizure drugs (fosphenytoin)
  3. rapid sequence intubation with propofol
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36
Q

testicular tumor with AFP + and no b-hCG

prepubertal males

A

yolk sac tumor/endodermal sinus tumor

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37
Q

testicular tumor that is well-defined hypoechoic lesions in testicular parenchyma without cystic areas on US

mild elevation b-hCG, no increase of AFP

A

seminoma

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38
Q

testicular tumor characterized by areas of necrosis and hemorrhage

A

choriocarcinoma

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39
Q

testicular tumor with symptoms of gynecomastia, loss of libido, or ED in adult males/precocious puberty in children

A

leydig cell tumors

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40
Q

treatment of CAP in non-ICU inpatient setting

A

beta-lactam abx plus a macrolide or respiratory fluoroquinolone to cover both typical and atypical bugs

ceftriaxone and azithromycin

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41
Q

MC typical bug in CAP

MC atypical bug in CAP

A

S. pneumo

mycoplasma pneumoniae

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42
Q

What are two respiratory fluoroquinolones?

A

levofloxacin and moxifloxacin

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43
Q

What is CURB-65 and what is it used for?

A

Pneumonia severity

Confusion

Uremia (BUN >20)

Respirations (>30)

Blood pressure (<90 systolic)

65 - age 65 or greater

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44
Q

All HIV pts, regardless of CD4 count should receive what vaccinations?

A

influenza and pneumonia vax

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45
Q

CD4 ct <200, ppx for….. with….

A

PCP with TMP-SMX or dapsone

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46
Q

CD4 ct <100, should ppx for …. with ….

A

Toxoplasma with TMP-SMX

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47
Q

CD4 ct < 50-100 ppx for…. with …

A

MAC with weekly azithromycin or daily clarithromycin

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48
Q

formation of a biliary-enteric fistula from long-standing cholelithiasis eroding through the wall of the gallbladder will possibly cause…

A

gallstone ileus

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49
Q

where does gallstone ileus occur?

A

MC at ileocecal valve due to narrowing, but can be anywhere along GI tract, especially where prior surgical anastomosis is

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50
Q

What is the Rigler triad in gallstone ileus

A

radiographic findings of bowel obstruction, pneumobilia, and RLQ gallstone

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51
Q

what is definitive treatment of gallstone ileus?

A

enterolithotomy

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52
Q

what staging systems are used for CLL?

A

Rai and binet

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53
Q

this staging system for CLL is based on the gradual and progressive increase in the body burden of leukemic lymphocytes

  1. lymphocytosis
  2. lymphadenopathy
  3. organomegaly
  4. anemia, thrombocytopenia
A

Rai system

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54
Q

this staging system of CLL considers 5 potential sites of involvement:

cervical, axillary, inguinal lymph nodes, and spleen and liver

determined by physical exam

A

Binet staging

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55
Q

What is the Ann Arbor staging system used for?

A

stage lymphomas, classically associated with Hodgkin Lymphoma

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56
Q

What is the revised international prognostic index used for?

A

prognosis tool of choice for diffuse large B cell lymphoma (MC NHL) in pts receiving R-CHOP chemo

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57
Q

three drugs commonly causing hyperkalemia

A

TMP-SMX, ACE-Is/ARBs, NSAIDs

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58
Q

empiric therapy for adults >50 yo with bacterial meningitis

A

ceftriaxone, vanc, ampicillin

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59
Q

empiric abx for bacterial meningitis in neonates ( <1 mo)

A

ampicillin and cefotaxime

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60
Q

empiric abx for bacterial meningitis in children to adults < 50 yo

A

ceftriaxone and vanc

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61
Q

in multiple myeloma, plasma cells produce

A

IgG, IgA, and light chains

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62
Q

HIV pregnancy at 38 weeks and >1000 viral load

A

C section with IV zidovudine 3 hours pre op

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63
Q

muscle pain, depressed mood, polyuria, constipation

A

hypercalcemia

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64
Q

hydatid cyst in the liver is due to

A

echinococcus granulosus

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65
Q

eggshell calcification of a hepatic cyst on CT

A

hydatid cyst

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66
Q

treatment of hydatid cyst

A

surgical resection under the cover of albendazole

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67
Q

What is the second MCC of intracerebral hemorrhage after hypertension?

A

cerebral amyloid angiopathy

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68
Q

where will cerebral amyloid angiopathy typically be located within the brain?

A

lobar

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69
Q

What is the MCC of intracerebral hemorrhage in children?

A

cerebral AV malformation

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70
Q

on fetal heart rate tracing, this appears as persistent fetal bradycardia (ie <110)

A

fetal AV block

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71
Q

What is the most serious complication of neonatal lupus?

A

fetal AV block

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72
Q

What is a stool marker for inflammatory diarrhea? (typically elevated in pts with IBD)

A

fecal calprotectin

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73
Q

family history of sudden death, congenital sensorineural deafness, and QT interval prolongation are concerning for…

A

Jervell and Lange-Nielsen syndrome (AR congenital long QT syndrome)

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74
Q

tx of congenital long QT syndrome

A

beta blockers with pacemaker

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75
Q

MC complication of influenza

A

secondary bacterial pneumonia

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76
Q

secondary bacterial pna s/p influenza in a young person is likely…

A

CA-MRSA

(severe, necrotizing pneumonia)

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77
Q

MCC of pediatric stroke

A

sickle cell disease

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78
Q

cyanosis occurs with feeding, relieved by crying

A

choanal atresia

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79
Q

spontaneous cerebellar hemorrhage might present with (ipsilateral/contralateral) hemiataxia

A

ipsilateral

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80
Q

photosensitive rash, multisystemic symptoms (arthralgias, pancytopenia, splenomegaly)

what antibody assay do I get?

A

SLE

antinuclear antibody

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81
Q

fixed, widely split S2

A

atrial septal defect

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82
Q

large ASD or VSD is not corrected and PVR exceeds SVR due to chronic L to R shunting

A

Eisenmenger syndrome

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83
Q

wide pulse pressure and continuous machine-like murmur or loud S2 and bounding peripheral pulses

A

PDA

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84
Q

week 1: fever/chills

week 2: abdominal pain with bloddy diarrhea

week 3: faint, salmon-colored macules (rose-spots)

A

typhoid fever/salmonella typhi

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85
Q

severe enterocolitis with bloody diarrhea s/p undercooked beef

A

E. coli 0157:H7

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86
Q

2nd MC organism related to HUS

A

Shigella dysenteriae

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87
Q

bloody diarrhea possibly with proctitis, rectal prolapse, toxic megacolon, intestinal obstruction, leukemoid reaction, or neurologic symptoms

A

Shigella dysenteriae

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88
Q

vitamin B12 and folate deficiencies will show what on peripheral smears?

A

hypersegmented neutrophils, elevated MCV, and macroovalocytes

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89
Q

bilobed nuclei of neutrophils seen on peripheral smear are indicative of

A

Pelger-Huet anomaly

lamina B receptor gene mutation

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90
Q

In pts with HIV associated nephropathy, what is the prominent feature on kidney biopsy?

A

focal segmental glomerulosclerosis

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91
Q

four features of nephrotic syndrome:

A

proteinuria >3.5, generalized edema, hypoalbuminemia, and hyperlipidemia

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92
Q

what drug is contraindicated in vasospastic/Prinzmetal angina?

A

nonselective beta blocker

because could result in unopposed alpha-1 activity, worsening vasoconstriction, causing cardiac ischemia

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93
Q

Cushing triad (3 things)

A

widening pulse pressure, irregular respirations, and bradycardia

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94
Q

Cushing triad implies

A

impending or imminent brain herniation

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95
Q

grip weakness and numbness of the hand that is exacerbated by abduction and extension of the upper extremity

A

thoracic outlet syndrome

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96
Q

pain on thumb and wrist movement with focal tenderness over the radial styloid

A

De Quervain tenosynovitis

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97
Q

provocative test for dx of de quervain tenosynovitis

A

finkelstein test

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98
Q

PD pts with psychosis, if they cannot tolerate a reduction of carbidopa-levodopa can be treated with

A

second gen antipsychotic

quetiapine, pimavanserin

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99
Q

MCC of oculomotor nerve palsy

A

ischemic neuropathy due to poorly controlled DM

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100
Q

pts with ischemic CN III palsy typically have ptosis, down and out gaze, and

A

preserved pupillary response

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101
Q

What is systemic therapy for angle-closure glaucoma?

A

acetazolamide to reduce production of aqueous humor

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102
Q

child with hx of arthralgia and psychosis, together with thrombocytopenia, hematuria, and proteinuria is concerning for

A

SLE

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103
Q

anti-U1 RNP

A

Mixed Connective Tissue Disease (MCTD)

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104
Q

mixed connective tissue disease has features of …

A

SLE, systemic sclerosis, and polymyositis

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105
Q

acquired autoantibody to ADAMTS13

A

TTP

thrombotic thrombocytopenic purpura

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106
Q

plasma protease that cleaves vWF off the endothelial surface

A

ADAMTS13

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107
Q

treatment for cryptococcal meningioencephalitis

A

amp B with flucytosine

then maintenance with fluconazole

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108
Q

tx for deramtophytosis and onychomycosis

A

griseofulvin

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109
Q

tx for cerebral toxoplasmosis

A

sulfadiazine-pyrimethamine

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110
Q

new onset JVD and RBBB are indicative of…

A

R heart strain

(commonly associated with PE)

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111
Q

total T4, free T4, and TSH in pregnancy

A

increased, unchanged, decreased

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112
Q

tx for invasive pulmonary aspergillosis

A

1-2 weeks IV voriconazole plus an echinocandin (caspofungin)

transitioned to prolonged therapy with voriconazole PO

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113
Q

three common causes of exudative pleural effusion

A

infection (pna)

malignancy

rheumatologic disease

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114
Q

3 MCC of transudative pleural effusion

A

heart failure

cirrhosis (hepatic hydrothorax)

nephrotic syndrome

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115
Q

rheumatoid effusions are marked by very low …. and very high…

A

low glucose

high LDH

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116
Q

why would buproprion be a good choice after 2 failed SSRIs for depression?

A

NE/DA reuptake inhibitor (no serotonergic effects)

does not cause weight gain

no sexual side effects

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117
Q

chronic, near daily HA in setting of regular use of acute HA medications in pts with preexisiting HA disorder

A

medication overuse headache

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118
Q

the presence of a single vertebral fracture, esp cervical, in a pt with blunt trauma is an indication to

A

image the entire spine due to risk of a second, noncontiguous vertebral fx

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119
Q

wide complex tachycardia with fusion beats

A

sustained monomorphic ventricular tachycardia

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120
Q

tx for stable pt with sustained monomorphic VT

A

IV amiodarone

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121
Q

regular, narrow complex tachycardia, no fusion beats

A

paroxysmal supraventricular tachycardia

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122
Q

tx for PSVT

A

carotid sinus massage/vagal maneuver

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123
Q

MC primary cardiac neoplasm

A

atrial myxoma

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124
Q
  • position dependent mitral valve obstruction
    • mid diastolic murmur
    • dyspnea, lightheadedness, syncope
  • embolization -> stroke
  • constitutional symptoms
A

atrial myxoma

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125
Q

pathologic cause of mitral valve prolapse

A

myxomatous valve degeneration

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126
Q
  • high fever, malaise, throat pain
  • throat PE: hyperemic yellow or grayish-white papulovesicles
A

herpangina

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127
Q

four causes of gout from increased urate production

A
  1. primary/idopathic
  2. myeloproliferative/lymphoproliferative disorders
  3. tumor lysis syndrome
  4. hypoxanthine guanine phosphoribosyl transferase deficiency
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128
Q

2 causes of gout from decreased urate clearance

A
  1. CKD
  2. thiazide/loop diuretics
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129
Q

pruritis triggered by hot baths, headaches, hepatosplenomegaly

A

polycythemia vera

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130
Q

what prolactin level correlates with symptomatic prolactinoma

A

>200

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131
Q

How is LH affected in prolactinoma in a male?

A

hypogonadism with low T and low or inappropriately normal LH

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132
Q

all preterm neonates born at <32 weeks gestation should undergo what screening?

A

screening head US at 1-2 weeks

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133
Q

what is the greatest risk factor for intraventricular hemorrhage

A

prematurity

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134
Q

first 3-4 days of life in premature neonate who has bulging fontanel, anemia, apnea, and seizures

A

interventricular hemorrhage

ruptured germinal matrix vessels

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135
Q

tx for unstable, regular, narrow complex tachycardia (SVT)

A

synchronized cardioversion

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136
Q

all pts with persistent tachyarrhythmia (narrow or wide) causing hemodynamic instability should be managed with

A

immediate synchronized direct current cardioversion

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137
Q

subacute thyroiditis is aka

A

de Quervain’s thyroiditis

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138
Q

benign, self-limited condition that classically begins after an upper respiratory infection and progresses

inflammatory process in the neck

A

subacute thyroiditis

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139
Q

subacute thyroiditis tx

A

NSAIDs for pain

resolves on its own

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140
Q

preferred method to evaluate cervical cytology in pregnant women is

A

colposcopy

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141
Q

renal failure, vision changes, neuro deficits in setting of over-consumption of fish

A

mercury poisoning

142
Q

tx of mercury poisoning

A

chelating agents such as succimer, dimercaprol, penicillamine

143
Q

muscle biopsy shows vacuoles and filamentous inclusions

A

inclusion body myositis

144
Q

muscle biopsy shows lymphocytic infiltration of endomysium

A

polymyositis

145
Q

hepatitis virus associated with injection drug abuse and with blistering in sun-exposed areas

A

hepatitis C

porphyria cutanea tarda

146
Q

WAGR syndrome

A

Wilms tumor, aniridia, GU abnormalities, and intellectual disability

147
Q

characteristic triangular lifting of periosteum

A

osteosarcoma

148
Q

Turner syndrome heart defects

A

bicuspid aortic valve, aortic coarctation

149
Q

poor feedings, constipation, low tone, large anterior fontanelle, macroglossia, and an umbilical hernia

A

congenital hypothyroidism

150
Q

rapidly expanding multilobular breast mass

A

phyllodes tumor

151
Q

Cobb angle between 10 and 20 in skeletally immature pt can be managed with

A

home exercises and observation

152
Q

curves with cobb angle between 20 and 45 in skeletally immature pt can be tx’d

A

bracing and serial monitoring

153
Q

cobb angle greater than 45

A

surgical fusion

154
Q
A
155
Q

is ECT safe during pregnancy?

A

yes

156
Q

lamotrigine severe AE

A

SJS

157
Q

irreversible, potentially fatal complication of elevated indirect bilirubin levels

A

kernicterus

158
Q

prophylaxis of variceal bleeding

A

nonselective beta blockers

(propranolol or nadolol)

159
Q

odansetron MOA

A

selective 5-HT3 antagonist

160
Q

Pt with bronchiectasis, concern for infections by what organism?

A

Pseudomonas, TB, H. influ, mor cat, S. aureus, S. pnemo, MAC

161
Q

clinical manifestations of mild bleeding (epistaxis/gingival) with petechiae or ecchymoses and isolated thrombocytopenia

A

ITP

162
Q

What type of hypersensitivity reaction is ITP?

A

type II HS rxn

163
Q

IgG-platelet factor 4 protein complexes

A

HIT

heparin induced thrombocytopenia

164
Q

anticentromere antibody

A

CREST syndrome

165
Q

antihistone antibodies

A

drug induced lupus

166
Q

anti-Jo 1 ab

A

polymyositis

167
Q

scl-70 antibody

anti-DNA topoisomerase I antibody

A

systemic sclerosis

168
Q

proximal, two component, intra-articular first metacarpal fx

A

Bennett fx

169
Q

avulsion fx off the base of the proximal phalanx of the thumb with associated injury to the ulnar collateral ligament

A

gamekeeper thumb fx or skier thumb

170
Q

stress fx involving the base or proximal third of the fifth metatarsal

A

Jones fx

171
Q

avulsion injury at the base of the fifth metatarsal at insertion of peroneous brevis tendon

A

dancer fx aka pseudo-Jones fx

172
Q

why is a pregnant lady hypercoaguable?

A

resistance to activated protein C increases after the first tri

173
Q

leukocytosis with predominance of granulocytes

peripheral smear shows basophilia and granulocytosis with neutrophils

A

CML

174
Q

BCR- ABL1

f(22:9)

philadelphia chromosome

A

CML

175
Q

resistant major depressive disorder - can add what drug to tx?

A

atypical antipsychotic in conjunction with SSRI

176
Q

tx of viral labrinthitis

A

control symptoms of vertigo with meclizine (antihistamine)

177
Q

hx of infection and CHF with evidence of acute intrinsic renal failure

A

acute tubular necrosis (ATN)

178
Q

pts with ATN will typically have a FeUrea…

A

>50%

179
Q

UA in ATN

A

muddy brown, granular casts

180
Q

fatty casts, with a maltese cross

A

nephrotic syndrome

181
Q

increased number of hyaline casts

A

volume depletion

182
Q

tx for nasal polyps

A

intranasal steroid spray

183
Q

if complete polypectomy is not feasible for colon lesion, you should get

A

multiple biopsies to get pathologic diagnosis

184
Q

negligence of a physician to an established pt, which results in direct harm to the pt

A

breach of duty

185
Q

parvovirus in pt with SCD can lead to

A

aplastic crisis

186
Q

>10% clonal plasma cells

A

multiple myeloma

187
Q

“dry tap”

A

primary myelofibrosis

188
Q

EKG showing ST depression with concave-up morphology (hockey stick morphology)

A

digoxin toxicity

189
Q

In patients with Myasthenia Gravis, what drug is contraindicated in a preeclamptic pregnant pt?

A

magnesium sulfate

may trigger myasthenic crisis due to inhibition of acetylcholine release at the neuromuscular junction

190
Q

Seizure ppx for pregnant, preeclamptic pt with MG

A

valproic acid

191
Q

What abx will worsen symptoms of MG?

A

fluoroquinolones or aminoglycosides

192
Q

What most often occurs in young, athletic men who lift weights or engage in activities that have repetitive overhead arm motions?

A

spontaneous upper extremitiy DVT

193
Q

normal creative and healthy behaviors for young children include…

A

imaginary friends, pretend play, and storytelling with fanciful detail

194
Q

type of psychotherapy that is used to reinforce a patient’s ability to cope with stressors and is commonly used for low-functioning patients or those in crisis who are at risk of decompensating

A

supportive psychotherapy

195
Q

This type of psychotherapy focuses on the role of unconscious conflict and gaining insight into how past experience shapes present situations

A

psychodynamic psychotherapy

196
Q

what technique is commonly used to treat substance abuse

A

motivational interviewing

197
Q

monoarticular arthritis of the knee that occurs in a weight-bearing, afebrile pt

A

Lyme arthritis part of Lyme disease

198
Q

infective endocarditis due to prosthetic valves, intravascular catheters, implanted devices (PM/defib), and IV drug users

A

S. aureus

199
Q

infective endocarditis due to nosocomial UTI

A

enterococci

200
Q

Next step for penile fracture?

A

retrograde urethrography prior to surgery

201
Q

dermatitis, diarrhea, dementia

A

pellagra

niacin deficiency

202
Q

niacin deficiency is seen in populations like…

A

corn products diet

alcholics/chronic illness

carcinoid syndrome

Hartnup disease

prolonged isoniazid interfering with tryptophan metabolism

203
Q

painless loss of monocular vision

RF: CAD, endocarditis, valvular disease, long bone fx, hypercoaguable conditions, vasculitis, atrial myxoma

A

central retinal artery occlusion (CRAO)

204
Q

tx of central retinal artery occlusion

A

ocular massage and high flow oxygen

205
Q

buspirone is primarily used to treat

A

anxiety disorders

206
Q

mirtazapine antidepressant has AE of

A

sedation, fatigue, and weight gain

207
Q

emphysema plus liver issues

A

alpha-1 antitrypsin deficiency

208
Q

deep ST depressions in leads V1-V3, with ST elevations when leads V7-V9 are placed

A

isolated posterior STEMI

L circumflex artery

209
Q

used in children to test vesicoureteral reflux

A

voiding urethrogram

210
Q

What kind of poisoning is common after house fires?

AMS, elevated lactate, breath that smells like bitter almonds

A

cyanide poisoning

211
Q

Rib inhalation somatic dysfunction is noted to have restriction in rib motion on …

the key rib being the most…

A

exhalation

caudal

212
Q

supination of the ankle causes the fibular head to move

A

posteriorly

213
Q

pronation of the ankle cause the fibular head to move…

A

anteriorly

214
Q

one of the most common complaints of male patients receiving beta blockers

A

ED

215
Q

What is the most aggressive type of lung cancer, often centrally located, and has a very strong correlation with smoking?

A

small cell lung vancer

216
Q

peripheral lung cancer and more commonly causes superior vena cava syndrome and hoarseness

A

large cell carcinoma

217
Q

mature appearing lymphocytes with scant cytoplasm, condensed chromatin, and clefted nuclei are commonly seen following what infxn?

A

bordetella pertussis

218
Q

two times you might see rouleaux formation

A

Waldenstrom macroglobulinemia or multiple myeloma

219
Q

MC leukemia that occurs after the age of 50

A

CLL

220
Q

response to infection, drugs, or from an underlying medical condition like DKA

WBC >50k

A

leukemoid reaction

221
Q

raloxifene acts as an estrogen receptor antagonist in …

A

breast, endometrial, and vaginal tissues

222
Q

Raloxifene may worsen

A

menopausal symptoms

223
Q

Organisms commonly causing bloody diarrhea

A

salmonella

shigella

campylobacter

EHEC

yersinia

entamoeba

224
Q

acetazolamide MOA

A

carbonic anhydrase inhibitor

225
Q

rash, GI symptoms, and liver dysfunction is the classic triad of …

A

acute graft v host disease

226
Q

first line tx for acute GVHD

A

corticosteroids

MC methylprednisolone

227
Q

group of AD disorders that progressively affect the cerebellum and its connections

gait unsteadiness and extremity incoordination

A

spinocerebellar ataxia

228
Q

autosomal recessive disorder with onset in childhood with gait unsteadiness and associated cardiac and skeletal disorders

A

Freidrich ataxia

229
Q

next step for woman beyond 20 weeks gestation presenting with vaginal bleeding

A

US to check for previa

230
Q

What is contraindicated in any patient suspected to have a placenta previa?

A

digital cervical exam

231
Q

upper extremity weakness in cape distribution

A

central cord syndrome

232
Q

Which RTA has hyperkalemia?

A

RTA type IV

233
Q

pts with nephrotic syndrome are at increased risk of infxn, particularly by …

A

encapsulated organisms such as S. pneumo

234
Q

US after 14 weeks dating uses what measures?

A

biparietal diameter

head circumference

femur length

abdominal circumference

235
Q

what is the single most predictive parameter of gestational age between 14 and 22 weeks?

A

head circumference

236
Q

acute, raised, sharply demarcated area of erythema with slowly advancing margins - associated with infectious signs and symptoms

in adults in setting of stasis dermatitis and venous insufficiency

in infants, on face, dorsal hands, and scalp

A

erysipelas

237
Q

loop diuretics (4)

A

bumetanide, furosemide, torsemide, and ethacrynic acid

238
Q

anaphylaxis within … days of receiving any vaccine is considered an adverse effect from the vaccine and should be reported to VAERS

A

7

239
Q

amyloid light chain amyloidosis leads to

A

restrictive cardiomyopathy

symmetrically thickened ventricular walls

240
Q

impaired consciousness, pupillary abnormalities, neuro-ophthalmic abnormalities, especially of vertical gaze, and acute confusional state

A

‘top of the basilar’ syndrome

embolus lodging in rostral basilar artery

241
Q

pt with saddle nose deformity and bilateral auricular inflammation who may have been treated on multiple occasions with antibiotics

A

relapsing polychondritis

242
Q

what is removed in a Whipple procedure?

A

head of the pancreas, duodenum, gallbladder, and common bile duct

243
Q

unilateral pure motor hemiparesis

A

lacunar infarct

244
Q

lacunar infarct involves what arteries

A

lenticulostriate branches

245
Q

XR shows new periosteal bone formation and osteolysis in ankle of child

A

osteomyelitis

246
Q

Chadwick sign - during early pregnancy

A

bluish discoloration of the vulva, cervix, and vagina

247
Q

Psoas syndrome occurs with a hypertonic psoas, which reflexively affects the contralateral…

A

piriformis

248
Q

upper lumbar somatic dysfunctions that are flexed, side bent, and rotated …. the side of the hypertonic psoas are usually found

A

toward

249
Q

in psoas syndrome, what should be treated first

A

upper lumbar segments

250
Q

Posterior chapman point on the upper edge of the TP of L2

A

bladder

251
Q

posterior chapman point on the intertransverse space of T12-L1 midway between the spinous process and tips of the transverse processes

A

kidney

252
Q

posterior chapman point on the upper edge of the transverse process of L2 (L3)

A

urethra

253
Q

3 MC etiologies for fever of unknown origin

A

collagen vascular disease

chronic infections

malignancies

254
Q

milestones:

  1. sit momentarily propped on hands
  2. raking grasp
  3. babbling
  4. transfer hand to hand
A

6 mo

255
Q

milestones

  1. pull to stand
  2. crawl
  3. pincer grasp
  4. say mama and dada
A

9 mo

256
Q

is duchenne muscular dystrophy associated with developmental delay?

A

yes

257
Q

DMD causes a primary …. cardiomyopathy and conduction abnormalities

A

dilated

258
Q

person with SCD and new infiltrate on chest XR plus one of the other symptoms

A

Acute chest syndrome

259
Q

prior to starting direct acting antivirals, a pt should be tested for

A

NS5A resistance-associated substitutions

260
Q

4-7 days after initiation of heparin ppx and pt gets DVT

A

heparin induced thrombocytopenia

261
Q

manifests as thrombosis and drops platelets by 50% from baseline

A

HIT

262
Q

tx of HIT

A

stop all heparin products

direct thrombin inhibitor: bivalirudin or argatroban

263
Q

multiple myeloma CRAB mneumonic

A

Calcium elevation

Renal insufficiency

Anemia

Bone lesions

264
Q

stable pt, provoked DVT, tx

A

outpatient with apixaban

265
Q

what can increase the serum levels of warfarin, leading to a higher bleeding risk?

A

statins

266
Q

what tumor would be composed of delta cells from the head of the pancreas?

A

somatostatinoma

267
Q

somatostatin inhibits the release of many hormones, including

A

TSH

GH

insulin

glucagon

gastin

CCK

268
Q

deficiencies caused by a somatostatinoma lead to

A

mild DM

steatorrhea

gallstones

269
Q

somatostatin can act in a paracrine fashion to inhibit the secretion of both

A

insulin and glucagon

270
Q

DM, steatorrhea, gallstones

A

somatostatinoma

271
Q

in tx of DKA, you start subQ insulin at what time in relation to turning off insulin drip

A

2 hours before the drip is stopped

272
Q

thiazide diuretic used as a first line for HTN without comorbidities

A

chlorthalidone

273
Q

spironolactone can be used as a first line medication in the case of

A

primary aldosteronism

274
Q

missed ART for HIV for a sustained period, prior to restarting ART asap, you should

A

evaluate pt’s viral genotype to see if there are acquired mutations

275
Q

two complications that can occur when restarting ART

A

immune reconstitution inflammatory syndrome

anti-retroviral therapy resistance

276
Q

an overwhelming immune response upon initiation of ART, as the sudden increase in CD4 cells upon initiating ART tx paradoxically worsens symptoms

(strong immune response causing inflammation)

A

immune reconstitution inflammatory syndrome

277
Q

viral mutations occuring during an interval without tx for HIV can cause

A

anti-retroviral therapy resistance

278
Q

what should be suspected in asthmatics with poorly-controlled disease who are unable to wean themselves from corticosteroids

A

aspergillosis

279
Q

BPP fetal breathing movements must be

A

one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes

280
Q

BPP fetal movement means

A

three or more discrete body or limb movements within 30 minutes

281
Q

BPP fetal tone is

A

one or more episodes of extension of a fetal extremity with return to flexion, or opening and closing of a hand

282
Q

BPP amniotic fluid volume must be

A

single deepest vertical pocket greater than 2 cm

283
Q

oligohydraminos is defined as… or …

A

single deepest vertical pocket of amniotic fluid of 2 cm or less

AFI of 5 cm or less

284
Q

golfer elbow counterstrain set up

A

elbow flexion, pronation with forearm adduction

285
Q

What two things are strong predictors of diabetic retinopathy?

A

proteinuria and increased BUN/Cr levels

286
Q

risk for developing post-herpetic neuralgia increases with

A

age

287
Q

how is friedreich’s ataxia inherited?

A

autosomal recessive condition

288
Q

3 systems of glasgow coma scale

A

eye response

verbal response

motor response

289
Q

increasing and decreasing respiratory rate and volume followed by period of apnea

A

Cheyne-stokes

290
Q

rapid deep respirations with short pauses

A

biot’s breathing

aka ataxic breathing or cluster breathing

291
Q

deep increased respirations

A

Kussmaul’s respirations

292
Q

when ROSC occurs, CO2 levels will abruptly rise to

A

30-40 mmHg

293
Q

proficient quality CPR can be confirmed with waveform capnography with CO2 levels of

A

10-15 mmHg

294
Q

first step in FPR

A

flatten the spinal curve

295
Q

Facilitated positional release is an (indirect/direct) and (passive/active) technique

A

indirect, passive

296
Q

partial or complete absence of the cerebellar vermis

A

Dandy-Walker Malformation

297
Q

herniation of the cerebellar tonsils, cerebellar vermis, and medulla

A

chiari type 2 malformation

298
Q

downward displacement of cerebellar tonsils through the foramen magnum

typically asymptomatic

A

chiari malformation type 1

299
Q

chiari type 2 malformation is also associated with …

A

meningomyelocele or syringomyelia

300
Q

chronic nonproductive cough, hypercalcemia, and decreased diffusion capacity

dad died of a ‘heart problem’

A

sarcoidosis

301
Q

bilateral symmetric hilar and mediastinal lymphadenopathy on CXR

A

sarcoidosis

302
Q

MC lab values in sarcoidosis

A

elevated ACE and hypercalciuria

303
Q

what lab value can assist in dx of lead toxicity?

A

serum free erythrocyte protoporphyrin

304
Q

hypertension, hypoK (metabolic alkalosis), hyperNa, hypoMg

A

Conn syndrome

primary aldosteronism

305
Q

IgG and IgM mediated complement fixation

A

type II hypersensitivity

306
Q

immune complex mediated complement fixation and subsequent cytotoxicity

A

type III hypersensitivity

307
Q

3 major causes of delayed emergence from anesthesia

A

drug effect

metabolic disorder

neurologic disorder

308
Q

what will not trigger a positive result on a standard UDS

A

semisynthetic (oxycodone, hydrocodone, hydromorphone) and synthetic (fentanyl, meperidine, methadone, and tramadol)

309
Q

despite appropriate tube thoracostomy, repeat CXR shows rapid pneumothorax reaccumulation and increased subcutaneous emphysema, suggesting

A

tracheobronchial injury/bronchial rupture

310
Q

rapid, large air leak into the chest-tube drainage system and persistent pneumothorax/pneumomediastinum despite tube thoracostomy

A

tracehobronchial injury

311
Q

older individual witha stenotic cervical spinal canal experiences hyperextension injury to the neck (whip-lash, rear-end collision)

A

central cord syndrome

312
Q

what modality is used to dx central cord syndrome?

A

cervical myelogram

313
Q

complication of mediastinal irradiation and cause of R heart failure

A

constrictive pericarditis

314
Q

progressive peripheral edema, elevated JVP, hepatomegaly, and ascites

A

constrictive pericarditis

315
Q

lack of decrease or increase in jugular venous pressure on inspiration

A

Kussmaul’s sign

316
Q

multiple white nodules in the hands and a hx of painful arthritis in the fingers and feet

A

tophaceous gout

317
Q

deposition of calcium and phosphorus in the skin, presenting with scattered whitish papules, plaques, or nodules

A

calcinosis cutis

318
Q

CXR shows widened mediastinum, abnormal aortic contour, and/or left-sided effusion due to hemothorax

A

blunt thoracic aortic injury

319
Q

confirmation of dx of blunt thoracic aortic injury for stable and nonstable pt

A

stable - CTA

unstable - TEE in OR

320
Q

for blunt thoracic aortic injury, what is the goal systolic blood pressure while doing repiar?

A

<100

321
Q

first pneumonia vaccine recommended for all adults >65

A

PCV13

322
Q

pna vaccine recommended alone for adults <65 with other chronic medical conditions

A

PPSV23

323
Q

In an adult, do you give Td or Tdap?

A

Td every 10 years with Tdap as a one time dose in place of Td

324
Q

stepwise illness that begins with 1-2 weeks of nonspecific symptoms and then progresses to several weeks of the classic paroxysmal cough

A

pertussis

325
Q

adult with persistent, vigorous cough, posttussive hemoptysis, and peripheral lymphocytosis

A

bordetella pertussis

326
Q

respiratory infection that occurs in those with underlying asthma or CF

eosinophil count is elevated

bronchial obstruction, expectoration of brownish mucous plugs, and low grade fever

A

aspergillosis

327
Q

severe AE of PTU

A

agranulocytosis

328
Q

how do you watch for agranulocytosis in PTU use?

A

once pt complains of fever and sore throat, d/c thyroid drug and measure WBC ct.

<1k warrants permanent discontinuation of the drug

if >1.5k, drug is unlikely cause

329
Q

anti-mitochondrial antibodies

A

primary biliary cholangitis

330
Q

antinuclear antibodies and anti-smooth muscle antibodies

A

autoimmune hepatitis

331
Q

kidney histology in Alport syndrome

A

longitudinal splitting of the glomerular basement membrane

332
Q

pt <6 yo with marked proteinuria but no hematuria, renal insufficiency, or hypertension

A

minimal change disease

333
Q

linear IgG deposition in glomerular basement membrane

A

Goodpasture syndrome

334
Q

mesangial and glomerular capillary deposition of C3 and IgG

A

poststreptococcal glomerulobnephritis

335
Q

what is the MC malignancy diagnosed in pts exposed to asbestos?

A

bronchogenic carcinoma

336
Q

almost 50% of pts with asbestosis have … which can help differentiate from other causes of pulmonary fibrosis

A

pleural plaques

337
Q

nail and digit hypoplasia, dysmoprhic facies, and intellectual disability

exposure to phenytoin in utero

A

fetal hydantoin syndrome

338
Q

retrograde and antegrade amnesia with intact long-term memory, confabulation, apathy, lack of insight, and hx of alcohol use disorder

A

Korsakoff syndrome

339
Q

dementia, motor dysfunction, dysarthria

a/w severe damage to corpus callosum and surrounding white matter in the context of chronic alcohol use disorder and attendant malnutrition

A

marchiafava-bignami disease

340
Q

greater than 2 weeks of daily fever, fixed arthritis lasting >6 weeks, and a pink macular rash that worsens during fever

A

systemic juvenile idiopathic arthritis

341
Q

malabsorptive bowel disease complication leading to cheilosis, glossitis, and seborrheic dermatitis

A

riboflavin deficiency

342
Q

blunt chest trauma, persistent tachycardia, new arrhythmia

A

blunt cardiac injury

343
Q

next step to diagnose blunt cardiac injury

A

transthoracic echo

344
Q

overloading the knee’s extensor mechanism is the fundamental role thought to play in this syndrome

A

patellofemoral pain syndrome

345
Q

having weaker medial quadricep muscle than lateral quadricep muscles can cause the patella to be pulled…

A

laterally during quad contraction

346
Q

callus formation on the dorsal surface of the index finger and long fingers of the hand from repetitive contact with the teeth during self-induced vomiting

A

Russell sign

347
Q

bluish discoloration of the periumbilical area and can be seen in early pregnancy and cases of pancreatic necrosis with retroperitoneal bleeding

A

Cullen sign

348
Q

Anterior and middle scalenes can elevate what rib?

A

rib 1

349
Q

posterior scalene elevates rib (#) to tx an (inhalation/exhalation) somatic dysfunction

A

rib 2

exhalation

350
Q

exhalation somatic dysfunction of ribs 3-5 will use what muscle?

ribs 6-8?

ribs 9-10?

ribs 11-12?

A

3-5 pec minor

6-8 serratus anterior

9-10 latissimus dorsi

11-12 quadratus lumborum

Step 2 question review (9 decks)

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