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Step 2 question review > Questions 351-700 > Flashcards

Questions 351-700 Flashcards

1
Q

if pt has 2 or more errors in drawing the clock, what disease should be considered?

A

Alzheimer disease

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2
Q

Alzheimer disease often presents concurrently with

A

vascular dementia

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3
Q

acute epididymitis tx for <35

A

ceftriaxone and doxycycline

covers gonorrhea and chlamydia

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4
Q

acute epididymitis tx for >35 yo

A

levofloxacin OR ofloxacin

E. coli, other coliforms, and pseudomonas

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5
Q

tx for moderate acute otitis externa

A

topical Cipro HC (hydrocortisone)

topical preparation that is acidic and contains an antibiotic, an antiseptic, and a glucocorticoid

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6
Q

suspect what in elderly adults with anemia, fatigue and hypercalcemia

A

multiple myeloma

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7
Q

presents in adolesence with progressive ataxia, dysarthria, scoliosis, and cardiomyopathy;

loss of vibratory sense and proprioception also occur due to degeneration of the dorsal spinal columns

A

Friedreich ataxia

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8
Q

typically occurs following an infection (eg varicella), and presents with acute onset (within hours to days) of ataxia, nystagmus, and dysarthria

vibratory and position senses and reflexes are not affected

symptoms resolve in about 2 weeks

A

acute cerebellar ataxia

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9
Q

claw and hammer toe deformities in an older person

A

longstanding diabetes with peripheral neuropathy

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10
Q

characteristic triad of periorbital edema, myositis, and eosinophilia

A

trichinellosis

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11
Q

ischemia in the affected UE, vertebrobasilar ischemia (dizziness, ataxia, dysequilibrium)

lower brachial systolic BP in affected arm and systolic bruit in supraclavicular fossa on affected side

A

subclavian steal syndrome

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12
Q

stenosis or occlusion of the proximal subclavian artery, leading to reversal of blood flow in the ipsilateral vertebral artery

A

subclavian steal syndrome

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13
Q

acute graft rejection time frame

A

first 6 months following transplant

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14
Q

lymphocytic infiltration of the intima with inflammatory tubular disruption

A

renal biopsy of acute renal allograft rejection

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15
Q

vasoconstriction of the afferent and efferent arterioles, leading to prerenal AKI and HTN

renal biopsy unremarkable

what drug caused this reaction?

A

acute toxicity to calcineurin inhibitors (tacrolimus)

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16
Q

dx vestibular schwannoma

A

MRI of internal auditory canals

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17
Q

corrected calcium equation

A

= (measured Ca) + 0.8 x (4 - serum albumin)

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18
Q

once hypoparathyroidism has been r/o for hypocalcemia, what is the next step?

A

serum 25-hydroxyvitamin D level

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19
Q

increased anterior-posterior diameter of the eye will cause

A

myopia

nearsightedness

image to converge anterior to the retina

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20
Q

cotton wool spots on retina

A

retinal microinfarctions

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21
Q

two complications of myopia

A

retinal detachment

macular degeneration

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22
Q

MOA of ecstasy

A

increase in synaptic NE, DA, and 5HT

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23
Q

what illicit drugs might cause serotonin syndrome?

A

ecstasy and bath salts

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24
Q

increased bone turnover, XR evidence of widespread osteopenia and subperiosteal bone reabsorption

pt already has CKD

A

renal osteodystrophy

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25
Q

progressive back pain with focal lumbar tenderness, increased alkaline phosphatase, and L1/L2 sclerotic lesions

A

metastatic prostate cancer

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26
Q

mucin producing tumors (pancreatic, gastric, ovarian, breast) can secrete tissue factor into the blood, which intermittently triggers …. and can lead to …

A

coagulation cascade and can lead to chronic DIC

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27
Q

in this consumptive coagulopathy, pts have normal platelet counts and coagulation times but are at increased risk for venous and arterial thrombosis, and to a lesser extent, mucocutaneous bleeding

A

chronic DIC

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28
Q

Down syndrome 6 yo with weakness, gait changes, urinary/fecal incontinence, and vertebrobasilar symptoms such as dizziness, vertigo, imbalance, and diplopia.

upper motor neuron findings

A

atlantoaxial instability

(rheumatic)

symptoms due to compression of the spinal cord

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29
Q

individual transforms unacceptable emotions, desires, or impulses into their extreme opposite

A

reaction formation

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30
Q

low mood but doesnt meet criteria for MDD after an event

dx and tx?

A

adjustment disorder

psychotherapy

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31
Q

when an extraneous variable changes the direction or strength of an association between a risk factor and a disease

A

effect modification

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32
Q

the bias that results when the exposure-disease relationship is obscured by the effect of an extraneous factor associated with both exposure and disease

A

confounding bias

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33
Q

what helps determine whether a variable is a confounder or an effect modifier

A

stratified analysis

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34
Q

this results when an external variable positively or negatively impacts the effect of a risk factor on the disease of interest

A

effect modification

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35
Q

complex, multiloculated adnexal mass with thick walls and internal debris

A

tubo-ovarian abscess

complication of PID

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36
Q

fever = infection or malignancy

A

infection

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37
Q

tx for female head hair loss

A

topical minoxidil

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38
Q

tx for male pattern balding

A

minoxidil, finasteride

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39
Q

bipolar woman wants to switch from valproate to another medication because she wants to get pregnant

A

lamotrigine

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40
Q

tx for OCD

A

CBT based on Exposure and response prevention and/or pharmacotherapy with an SSRI

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41
Q

MOA of clomipramine

A

TCA

inhibits reuptake of serotonin and NE

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42
Q

hoarseness of voice and fungating laryngeal mass

A

laryngeal squamous cell carcinoma

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43
Q

(breastfeeding jaundice/breast milk jaundice)

starts the first week of life

A

breastfeeding jaundice

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44
Q

(breastfeeding jaundice/breast milk jaundice)

peaks at 2 weeks of age

A

breast milk jaundice

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45
Q

insufficient intake of breast milk resulting in decreased bilirubin elimination and increased enterohepatic circulation

A

breastfeeding jaundice

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46
Q

high levels of beta-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation

A

breast milk jaundice

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47
Q

prerenal AKI is characterized by (low/high) urine sodium of…

(low/high) FeNa of …

and BUN:Cr > ….

A

low urine sodium of <20 mEq/L

low FeNA of <1%

BUN:Cr >20:1

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48
Q

pt OD on what?

CNS depression, hypotension, and other anticholinergic effects (dilated pupils, hyperthermia, and intestinal ileus)

A

TCAs

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49
Q

OD of TCA besides anticholinergic symptoms can cause…

and is treated with…

A

QRS prolongation

sodium bicarb to improve BP, narrow QRS, and prevent arrhythmia

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50
Q

prolonged QT has caused torsades

tx

A

magnesium sulfate

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51
Q

4 anomalies of tetrology of Fallot

A
  1. RVOT obstruction ( pulmonary stenosis or atresia)
  2. RVH
  3. overriding aorta
  4. ventricular septal defect
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52
Q

how does squatting during a tet spell help the patient?

A

knee-to-chest positioning will kink the femoral arteries

increasing systemic vascular resistance

reducing R to L shunting

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53
Q

four things to suspect when a pt presents with hypokalemia, alkalosis, and normotension

A
  1. surreptitious vomiting
  2. diuretic abuse
  3. bartter syndrome
  4. gitelmans syndrome
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54
Q

inherited disease of a defect in the thick ascending limb of the LOH leading to hypokalemia, alkalosis, and normotension/hypotension

A

Bartter syndrome

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55
Q

normotensive, hypokalemia, hypocalciuria, severe hypomagnesiemia, metabolic alkalosis, increased renin and aldosterone

ion exchange defect in distal convoluted tubule

autosomal recessive

A

gitelman syndrome

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56
Q

Ethacrynic acid is a loop diuretic used in patients with what allergies?

A

sulfonamide allergies

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57
Q

what action will increase intensity of mitral stenosis murmur

why

A

squatting

increased venous return to the heart and an increased amount of blood traversing the stenotic valve

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58
Q

the handgrip maneuver acts to

A

increase afterload, resulting in decreased LV emptying

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59
Q

handgrip will increase the intensity of what murmur

A

aortic regurg

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60
Q

duty to protect individuals threatened by a patient court case

A

Tarasoff

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61
Q

court case confirming patients have the right to refuse life-sustaining treatments and confirmed that a feeding tube was a medical tx that did not have unique status

A

Cruzan v Director, MO DoH

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62
Q

operation without consent is assault case/legal precedent for informed consent

A

Schloendorff v Society of NY hospital

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63
Q

ulcer on the medial side of the leg

A

venous stasis ulcer

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64
Q

prophylactic therapy for migraines

A

beta blockers, CCB, TCAs, valproic acid, SSRIs, and topiramate

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65
Q

dihydroergotamine is …

A

an abortive medication for migraine headache

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66
Q

erenumab binds to

A

CGRP receptor and can be used for migraine prevention

high cost

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67
Q

common lab abnormalities in tumor lysis syndrome

A

hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia

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68
Q

side effect of stimulants for treating ADHD

A

decreased seizure threshold

insomnia

increased BP

appetite suppression

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69
Q

why do you transplant the left kidney?

A

L kidney has longer vein, making transplantation technically easier

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70
Q

presence of both a major mood disorder (bipolar I or MDD) and a primary psychotic disorder (schizophrenia)

psych symptoms must be present without the presence of mood symptoms for at least one 2-week period

A

schizoaffective disorder

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71
Q

subacute cutaneous lupus erythematous genetic HLA associations

A

HLA-B8 and HLA-DR3

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72
Q

HLA-Cw6

A

Psoriasis

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73
Q

HLA-DQ2 and HLA-DQ8

A

celiac disease

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74
Q

4 diseases that go with HLA-B27

A

Psoriatic arthritis

Ankylosing spondylitis

Reactive arthritis

IBD-related arthritidies

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75
Q

HLA-B51

A

Bechet disease

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76
Q

TCA overdose does what to EKG?

A

wide QRS complexes and QT prolongation

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77
Q

antidote for TCA overdose

A

sodium bicarb infusion to narrow the QRS

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78
Q

bupropion is contraindicated if a pt has…

A

hx of seizures

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79
Q

Smoking cessation tx

A

behavioral intervention and nicotine replacement

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80
Q

anti-NMDA receptor IgG antibodies

A

NMDA receptor encephalitis

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81
Q

NMDA receptor encephalitis most often occurs in young women with

A

ovarian teratomas

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82
Q

Antibodies found in the majority of patients with Dermatitis herpetiformis

A

anti-endomysial antibodies

anti-tissue transglutaminase antibody

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83
Q

mineral oil preparation of skin scraping with microscopy

A

scabies dx

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84
Q

positive sphinx test indicates the sacrum is

A

stuck backward

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85
Q

first line prophylactic treatment of chronic GVHD

A

methotrexate

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86
Q

If the % BSA affected by burn injury exceeds 20%, then ..

A

place a urinary cath to measure urinary output

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87
Q

The goal for urinary output in severe burn victims is about

A

0.5 mL/kg/hour

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88
Q

Patients with severe bleeding require platelet transfusion if platelet count is below

A

50k

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89
Q

pt that is not bleeding, platelet transfusion recommended when platelet ct is less than

A

10k

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90
Q

discolored lesion on colonoscopy with vessels that are dilated, thin walled and without smooth muscle

A

angiodysplasia

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91
Q

brain stem encephalitis aka…

can be caused by…

but MC is…

A

rhomboencephalitis

infectious, autoimmune, and paraneoplastic

MC infectious cause is Listeria

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92
Q

electric sensation down the back with flexion of the neck

A

Lhermitte’s sign

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93
Q

pharm tx for bulimia nervosa

A

fluoxetine

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94
Q

first line tx for schizoid personality disorder

A

psychotherapy

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95
Q

corneal vascularization and cheilosis or glossitis

A

riboflavin deficiency (vit B2)

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96
Q

sympathetic innervation of the heart, thoracic levels

A

T1-T5

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97
Q

chapman point for the heart

A

between the second and third rib

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98
Q

pervasive distrust and suspiciousness of others

A

paranoid personality disorder

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99
Q

Cluster A - odd or eccentric

A

paranoid, schizoid, schizotypal

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100
Q

cluster B - dramatic, emotional, or erratic

A

antisocial, borderline, histrionic, narcissistic

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101
Q

cluster c- anxious or fearful

A

avoidant, dependent, OCPD

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102
Q

XXY

A

Klinefelter syndrome

majority of men are infertile

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103
Q

enterobius vermicularis

A

pinworm

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104
Q

tapeworm acquired through ingestion of undercooked infected pork

A

taenia solium

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105
Q

intestinal protozoa that causes bloody diarrhea and may lead to the formation of a hepatic abscess

A

Entamoeba histolytica

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106
Q

affected leg is usually externally rotated and appears longer than the unaffected leg

A

hip - anterior dislocation

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107
Q

affected limb is shortened and internally rotated

A

posterior hip dislocation

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108
Q

elderly patient falls laterally onto a hip - dx?

physical exam?

A

femoral neck fx

externally rotated and shortened limb

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109
Q

bleeding episode in pt with vWD tx

A

desmopressin

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110
Q

Brugada on EKG

A

persistent ST elevations in V1-V3 leads with RBBB, with or without terminal S waves in lateral leads

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111
Q

can fluoroquinolones be used in pregnancy?

A

no, risk bone and cartilage damage

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112
Q

shortest effective course of tx for uncomplicated UTI

A

fosfomycin

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113
Q

cyanide toxicity typically presents with ….

leading to an increased anion gap metabolic acidosis

A

profoundly elevated lactic acid

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114
Q

differentiate DKA from alcholic ketoacidosis by

A

hyperglycemia

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115
Q

What differentiates PCP from cocaine intoxication?

A

absence of nystagmus in cocaine intoxication

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116
Q

differentiate symptoms of polymyalgia rheumatica with polymyositis

A

Polymyalgia rheumatica - proximal muscle pain and stiffness

polymyositis - proximal muscle weakness

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117
Q

what fundoscopic exam finding is consistent with abuse?

A

vitreous hemorrhage

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118
Q

lipid and protein deposits found in Bruch’s membrane in the macula in patients with age related macular degeneration

A

Drusen

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119
Q

increased optic cup to disc ratio

A

glaucoma

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120
Q

test for ataxia and proprioceptive loss in which the patient stands with their feet together and eyes closed

A

Romberg test

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121
Q

trigger finger is aka

A

stenosing flexor tenosynovitis

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122
Q

loss of full extension of the affected finger or fingers at the MCP joint

painless and nodule on the palmar surface

A

dupuytren contracture

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123
Q

fetal US shows bilaterally enlarged kidneys with increased echogenicity, oligohydraminos, and pulmonary hypoplasia

A

ARPKD

autosomal recessive polycystic kidney disease

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124
Q

rheumatic heart disease causes what valve issue?

A

mitral stenosis

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125
Q

pts on chronic steroids who are going to undergo surgery should…

A

increase their steroid dose to keep from adrenal insufficiency

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126
Q

serum immunoglobulins and B cell concentration are markedly low to absent

A

Bruton agammaglobulinemia

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127
Q

serum immunoglobulins are decreased but B cells are normal

A

Common variable immunodeficiency

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128
Q

caused by impaired T cell development and subsequent B cell dysfunction

T and B cells are markedly decreased

A

severe combined immunodeficiency

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129
Q

prevertebral calcifications

A

extensive atherosclerosis consider AAA

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130
Q

complication of atopic dermatitis with painful vesicles and punched out erosions with hemorrhagic crusting along with fever and LAD

A

eczema herpeticum of HSV

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131
Q

burning or itching of the eyelids, discharge, and often foreign body sensation in the eye

exam shows redness, swelling, and scaling at the lid margin, and conjunctiva may be inflamed

etiology is variable

A

blepharitis

inflammation at the eyelid margin, most prominent at the opening of the meibomian glands

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132
Q

when dopamine is blocked in the tuberoinfundibular pathway, the production of … increases, resulting in…

A

prolactin

galactorrhea, menstrual irregularities, and infertility

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133
Q

4 antipsychotic meds most likely to cause increase in prolactin level?

A

first gen: haloperidol and fluphenazine

second gen: risperidone and paliperidone

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134
Q

N. meningitidis ppx agents

A

rifampin or ciprofloxacin

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135
Q

In ILD, pts have impaired gas exchange resulting in reduced diffusion capacity of CO and increased

A

alveolar-arterial gradient

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136
Q

anemia of CKD is due to

A

erythropoietin deficiency

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137
Q

tx for anemia of CKD is

A

erythropoiesis-stimulating agents such as erythropoietin or darbepoetin

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138
Q

Inadequate response to erythropoietin-stimulating agents (ESAs) is most commonly due to

A

iron deficiency

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139
Q

hyperventilation in panic attacks results in

A

respiratory alkalosis

elevated pH, low pCO2

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140
Q

elevated blood pH results in dissociation of the hydrogen ions bound to albumin, leading to increased calcium binding and a decrease in

A

serum ionized calcium

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141
Q

abx tx for postpartum endometritis

A

ampicillin, clindamycin, gentamicin

142
Q

abx tx for chorioamnionitis

A

ampicillin, genatmicin

143
Q

clonidine is an alpha 2 agonist; missing doses of this can cause

A

rebound hypertension due to vasoconstriction

144
Q

anticholinergic overdose toxidrome

A
  • blind as a bat - blurred vision
  • mad as a hatter - psych issues
  • red as a beat - flushing
  • hot as hell - decreased sweating
  • dry as a bone
  • tacky as a leisure suit - tachycardia
145
Q

differentiate serotonin syndrome with overdose of anticholinergic

A

SSRI overdose will have sweating and diaphoresis while anticholinergic excess will have decreased sweating

146
Q

p-ANCA and eosinophilia

A

Churg struass

147
Q

p-ANCA, hep B surface antigen or antibody, mononeuropathies such as foot drop

A

polyarteritis nodosa

148
Q

tx for porphyria cutanea tarda

A

phelbotomy and chloroquine

149
Q

initial tx of bullous pemphigoid

A

topical corticosteroid and systemic anti-inflammatory

150
Q

persistent difficulty in the social use of verbal and nonverbal communication

A

social (pragmatic) communication disorder

151
Q

child onset fluency disorder

A

stuttering

152
Q

gestational thrombocytopenia

A

benign and self-limited

reassure and observe

153
Q

a pincer grasp would be expected at what age?

A

9 months

154
Q

volar aspect of the first 3.5 digits is innervated by what nerve?

A

median nerve

155
Q

highly sensitive test that can be used to rule out muscular dystrophy if the test is negative

A

serum CK

156
Q

anteromedial aspect of tibia

A

pes anserine bursitis

157
Q

pes anserine is made up of what muscle insertions?

A

gracilis, sartorius, and semitendinosis

158
Q

personality disorder with shyness and low self confidence

A

avoidant personality disorder

159
Q

intense fear of being disliked and avoid relationships for fear of rejection

A

avoidant personality disorder

160
Q

basal body temp elevates once..

A

ovulation has occurred

161
Q

Ewing sarcoma on biopsy

A

small round blue cells

162
Q

Tardive dyskinesia develops in the setting of prolonged exposure to dopamine blocking agents, causing

A

upregulation and supersensitivity of dopamine receptors

163
Q

male pt with infertility, associated with tall stature, gynecomastia, small testes, and signs of decreased virilization

A

Klinefelter syndrome XXY

164
Q

in klinefelter syndrome, infertility is due to testicular fibrosis with

A

seminiferous tubule dysgenesis, azoospermia, hypogonadism, and elevated FSH and LH levels

165
Q

pts with this complete syndrome are genetically male but phenotypically female and most often present with primary amenorrhea

A

Congenital androgen insensitivity syndrome

166
Q

cerebral and retinal hemangioblastomas, pheos, and renal cell carcinoma are associated with

A

von hippel lindau syndrome

167
Q

ischemic stroke is (hypoattenuated/hyperattenuated) on CT

A

hypoattenuated

168
Q

cerebellar hemorrhage tx with signs of neuro degeneration or bleed >3cm is

A

urgent surgical decompression

169
Q

what is the most sensitive test for screening for nephropathy

A

urine albumin to creatine ratio test

diabetics screen annually with this

170
Q

early diastolic murmur

A

aortic regurg

171
Q

testing for vertebral osteomyelitis?

A

MRI spine

172
Q

MC GI complication of HSP

A

intussusception

intestinal edema and bleeding associated with HSP act as lead point

173
Q

in this syndrome jaundice may be triggered by fasting or consumption of a fat-free diet, physical exertion, febrile illness, stress, or menstruation.

caused by reduced bilirubin glucuronidation and results in intermittent jaundice due to a mild, unconjugated hyperbilirubinemia

A

Gilbert syndrome

174
Q

mangement of Gilbert syndrome

A

reassurance and supportive care

175
Q

what do vagal maneuvers do to the heart?

A

increase parasympathetic tone in heart

temporary slowing of conduction in the AV node

increase AV node refractory period

leading to termination of AV node reentrant tachycardia

176
Q

MC form of paroxysmal supraventricular tachycardia

A

AVNRT

177
Q

neonatal conjunctivitis at 5-14 days

dx and tx

A

chlamydial

oral azithromycin (PO macrolide)

178
Q

neonatal conjunctivitis 2-5 days

dx and tx

A

gonococcal

single dose IM 3rd gen cephalosporin

179
Q

<24 hours neonatal conjunctivitis

dx and tx

A

chemical

eye lubricant

180
Q

neonatal presentation of maternal infection with Listeria

A

sepsis or meningoencephalitis

181
Q

neonate with short palprebral fissures, thin vermilion border, and smooth philtrum

A

fetal alcohol syndrome

182
Q

neonatal presentation of maternal toxoplasmosis infection

A

chorioretinitis and jaundice

183
Q

isolated hyperpigmented patches with an increased density of hair follicles

A

congenital melanocytic nevus

184
Q

first line medication for pertussis tx and postexposure ppx?

who gets postexposure ppx?

A

macrolides (eg azithromycin)

all close and high risk contacts should get ppx, regardless of immunization status

185
Q

commonly used anti-seizure medication that can cause pancreatitis?

A

valproic acid

186
Q

holosystolic murmur heard over the apex with radiation to the axilla

A

mitral regurg

187
Q

fever, HA, and periorbital swelling; usually palsy of CN III, IV, VI resulting in ophthalmoplegia

A

cavernous sinus thrombosis

188
Q

unilateral HA and ipsilateral Horner’s syndrome (with pupillary constriction)

A

carotid artery dissection

189
Q

acute onset, severe HA, patients with …. often have vomiting, photophobia, neck stiffness, and lethargy

A

SAH due to saccular aneurysm

190
Q

characteristic polysomnographic finding in MDD

A

decreased REM sleep latency

decreased slow wave sleep

increased REM sleep duration and density

191
Q

confirmation of clinical dx of perforated viscus

A

upright XR chest and abdomen

192
Q

what is contraindicated if acute GI perf is suspected?

A

endoscopy

because air insulfflation and instrumentation may worsen the perforation

193
Q

child <2 yo with cough, congestion, diffuse wheezes/crackles, and respiratory distress

A

bronchiolitis

194
Q

hx of diabetes, opiate use; symptoms of bloating, abdominal pain, loose stools, and positive glucose breath test

A

small intestinal bacterial overgrowth (SIBO)

195
Q

why would SIBO develop in someone

A

altered small bowel motility (uncontrolled DM, chronic opiate use, scleroderma) or those who have surgery involving the ileocecal valve

196
Q

gold standard for diagnosis of small intestinal bacterial overgrowth

A

jejunal aspiration demonstrating a high bacterial concentration

197
Q

carbohydrate breath test using glucose or lactulose can diagnose

A

small intestinal bacterial overgrowth

198
Q

tx of small intestinal bacterial overgrowth

A

abx like rifaximin or neomycin

199
Q

tx for mild ulcerative colitis

A

mesalamine

200
Q

posterior mediastinum mass

A

neurogenic tumors

meningocele, enteric cysts, lymphomas, diaphragmatic hernias, esophogeal tumors, and aortic aneurysms

201
Q

middle mediastinum mass

A

bronchogenic cysts

202
Q

anterior mediastinum mass

A

thymoma, retrosternal thyroid, teratoma, and lymphomas

203
Q

osteoporosis, normocytic anemia, renal insufficiency, and hypercalcemia

A

multiple myeloma

204
Q

multiple myeloma can be diagnosed with

A

serum protein electrophoresis

205
Q

to get symptomatic relief from heart failure, what drug do you give?

A

IV diuretics

206
Q

S3 is associated with

A

left ventricular heart failure

207
Q

recurrent edema without associated pruritis or urticaria

A

autosomal dominant, hereditary angioedema

208
Q

pathophys of hereditary angioedema

A

deficiency in or dysfunction of C1 inhibitor (C1 esterase inhibitor)

leads to elevated bradykinin, causing edema

209
Q

tx for acute swelling in hereditary angioedema

A

C1 inhibitor concentrate; or a bradykinin antagonist (icatibant), or kallikrein inhibitor (ecallantide)

210
Q

examples of cell mediated (type IV) hypersensitivity

A

PPD test and allergic contact dermatitis

211
Q

what are typical findings in immune complex mediated (type III) hypersensitivity reactions?

A

joint swelling, fever, and rash

212
Q

age >50 yo

subacute to chronic pain in shoulder and hips

morning stiffness lasting >1 hr

consitutional symptoms

elevated ESR >40

no other apparent explanation

A

polymyalgia rheumatica

213
Q

tx for polymyalgia rheumatica

A

low dose glucocorticoids (prednisome 10-20 mg daily)

214
Q

excessive daytime sleepiness, cataplexy, and REM sleep-related phenomenon

A

narcolepsy

215
Q

shy-drager syndrome

A

multiple system atrophy

216
Q
  1. parkinsonism
  2. autonomic dysfunction
  3. widespread neurological sings
A

multiple system atrophy/shy-drager syndrome

217
Q

tx for multiple system atrophy

A

aimed at intravascular volume expansion with fludrocortisone, salt supplementation, alpha agonists, and application of constrictive garments to the lower body

218
Q

horner syndrome triad

A

regional dysautonomia

anhydrosis, miosis, and ptosis

219
Q

in children of Ashkenazi Jewish descent, presenting at birth, with feeding problems and low muscle tone

gross dysfunction of the ANS (no tears) with severe orthostatic hypotension

A

Riley-Day syndrome aka familial dysautonomia

220
Q

pt has isolated urticaria that improves with transfusion cessation and diphenhydramine administration

A

urticarial transfusion reaction

preformed IgE antibodies

221
Q

what can differentiate cocaine intoxication from bipolar disorder and other primary psych disorders?

A

signs of sympathetic stimulation (eg diaphoresis, mydriasis, tachycardia, and hypertension)

222
Q

anion gap calculation

A

anion gap = sodium - (chloride + bicarb)

normal is 10-14

223
Q

MUDPILES mneumonic

A

Methanol

Uremia

DKA

Propylene glycol/paraldehyde

Isoniazid/iron

Lactic acidosis

Ethylene glycol (anitfreeze)

salicylates (aspirin)

224
Q

Bell palsy tx

A

prednisone

225
Q

can copy a circle or a line, but no squares or stick figures

age?

A

3 yo

226
Q

African American, HIV hx, and IV heroin use are all risk factors for

A

focal segmental glomerulosclerosis

227
Q

increased excretion of protein in the urine leads to decrease in oncotic pressure.

response to oncotic pressure by the liver includes increasing synthesis of…

A

lipoproteins, resulting in hyperlipidemia

228
Q

macroglossia, restrictive cardiomyopathy, congo red stain

A

amyloidosis

229
Q

At what age do you switch to forward facing car seats?

A

2 years old

230
Q

when can children use the seat belt without other boosters?

A

4’ 9 and between 8 and 12 years old

231
Q

finding seen on both CXR that may resemble the thymus gland in children or a lateral XR of the humerus indicating a distal humerus fx in a child or a radial head fx in adult

A

sail sign

232
Q

for stable patients with a primary spontaneous pneumothorax >50%

tx

A

moderate size chest tube

233
Q

what happens to CO, PVR, and PCWP in anaphylactic shock?

A

CO increases (through an increase in HR in order to maintain BP)

PVR decreases (arteries dilate due to histamine release)

PCWP decreases (slightly, due to relative hypovolemia because of vasodilation)

234
Q

chronic hemolysis, such as in sickle cell, can lead to what gallbladder issue?

A

pigmented gallstones and complications thereof

235
Q

up to 80% of osteosarcomas will metastasize to

A

the lungs

236
Q

salicylate toxicity will initially cause….

and then turn into…

A

respiratory alkalosis

high anion gap metabolic acidosis

237
Q

initial tx of salicylate toxicity

A

gastric lavage

238
Q

loss of stapedial reflex is in

A

otosclerosis

239
Q

pathophys of migraine?

A

trigeminovascular system dysfunction

240
Q

what causes atypical community acquired pna in otherwise healthy people?

what can be developed in this?

A

mycoplasma pna

autoantibodies against RBCs called cold agglutinins (IgM antibodies that agglutinate RBCs at 4C)

241
Q

for pts for one month with recent implantation of BMCS, or for 12 months in setting of a DES or ACS

A

dual antiplatelet therapy

(asa + P2Y12 blocker)

242
Q

Score greater than or equal to 2 on CHA2DS2VASC recommends

A

anticoagulation recommended

243
Q

asymptomatic bacturia, if left untreated in pregnancy can lead to

A

acute pyelonephritis, ARDS, and preterm labor and delivery

244
Q

What will LH level be in patient with central precocious puberty?

A

high basal LH or an LH level that increases with GnRH stimulation

245
Q

What will LH level be in peripheral precocious puberty?

A

low/normal LH levels

246
Q

in pts whom RA is suspected but who have a negative RF test result get

A

anti-CCP

247
Q

does seronegative RA have a better or worse prognosis than RF+ and CCP+ RA

A

better prognosis

248
Q

new solitary pulmonary nodule on CXR, next step

A

chest CT to eval for malignancy

249
Q

the antecedent illness of intussusception is thought to cause

A

hypertrophy of peyer patches in the terminal ileum

thereby serving as a nidus for telescoping

250
Q

HSP can cause intussusception due to the

A

formation of a small bowel hematoma from the autoimmune vasculitis

251
Q

bone marrow infiltration -> anemia and thrombocytopenia

splenomegaly -> severe and worse than hepatomegaly

bony pain/skeletal involvement

failure to thrive or delayed puberty

A

Gaucher disease

252
Q

glucocerebrosidase deficiency

A

Gaucher disease

253
Q

short stature, anemia, hypoplastic thumbs, pancytopenia

A

fanconi anemia

254
Q

mechanism of pulmonary hypertension in systemic sclerosis

A

hyperplasia of the intimal smooth muscle layer of the pulmonary arteries leading to increased PVR

255
Q

chronic inflammation with noncaseating granulomas is consistent with

A

sarcoidosis

256
Q

Has received 3 tetanus toxoid doses but have not received revaccination for tetanus in the last five years

dirty puncture wound

A

single dose of Tdap

257
Q

unimmunized, uncertain, or <3 tetanus toxoid doses

clean wound

A

tetanus vaccine, no TIG

258
Q

unimmunized, uncertain, or <3 tetanus toxoid doses

dirty wound

A

tetanus vaccine plus TIG

259
Q

infant with periventricular calcifications

A

congenital CMV

260
Q

MC sequelae of CMV

A

sensorineural hearing loss, presenting as failed hearing screen in a newborn or develop later in childhood

261
Q

what will decrease the murmur heard in hypertrophic cardiomyopathy?

A

valsalva, moving to standing, nitrates, vasodilators, diuretics

262
Q

to slow the accumulation of ascites, what should you suggest?

A

diuretics and dietary sodium control

263
Q

tx for toxic alcohol consumption

A

hemodialysis if

  • metabolic acidosis
  • elevated levels of methanol or ethylene glycol
  • evidence of end-organ damage
264
Q

indications for acute hemodialysis

A

Acidosis- severe metabolic acidosis

Electrolytes - severe hyperkalemia

Ingestion - toxic alcohols, lithium

Overload - refractory fluid overload

Uremia - uremic pericarditis or encephalopathy

265
Q

deadly toxin exposure at a work site must be reported to

A

Occupational Health and Safety Administration (OSHA)

266
Q

meningismus is caused by

A

breakdown of blood products within the CSF that triggers inflammation of the meninges

267
Q

amaurosis fugax is dx’d… what next?

A

tx like TIA, start on aspirin and get neuro consult

268
Q

amaurosis fugax is MC due to

A

plaque rupture from internal carotid artery

269
Q

kids with ADHD are at increased risk of developing what as an adult?

A

antisocial personality disorder

270
Q

GFR value that would contraindicate metformin use in a diabetic?

A

< 30 GFR

271
Q

MC type of vulvar cancer

A

squamous cell carcinoma

272
Q

athletes that perform repetitive backbending could get

A

spondylolithesis

273
Q

purely observational study that looks at a single point in time

A

cross-sectional study

274
Q

how is data analyzed in case-controlled study

A

odds ratio

275
Q

retrospective and observational study

A

case-controlled study

276
Q

observational and prospective study

A

cohort study

277
Q

pt divided into groups based on exposure, then followed for development of disease

A

cohort study

278
Q

magnetic gait

A

normal pressure hydrocephalus

279
Q

to assess severity of Guillian Barre, get

A

vital capacity

280
Q

side effect of tretinoin cream for acne

A

dryness and excessive skin peeling

281
Q

H. influ is a gram negative …

A

coccobacilus

282
Q

Fusobacterium is a group of obligate anaerobic gram negative bacilli responsible for causing

A

Lemierre syndrome

283
Q

antecedent oropharyngeal infection, disseminated foci of infection or septic emboli, and bacteremia

A

Lemierre syndrome

284
Q

PAS-staining IgM deposits around the nucleus of plasma cells

A

Waldenstrom macroglobulinemia

285
Q

urine vanillylmandelic acid is elevated in

A

pheos

286
Q

pt at high risk for complications of ETEC should take this as ppx

A

rifaximin

287
Q

healthy pt wants ppx for ETEC

A

bismuth subsalicylate

288
Q

psoriatic arthritis affects what joint

A

DIP

289
Q

elevated anti-streptolysin O titer

A

Group A strep infection

(rheumatic fever, erythema marginatum, guttate psoriasis)

290
Q

spoon nails or koilonychia

A

iron deficiency

291
Q

what anatomic landmarks do you use to assess leg length

A

ASIS and medial malleolus

292
Q

methylene blue is an antidote for what three possible ODs?

A

nitrates, nitroprusside, or antimalarials

293
Q

ferritin, serum Fe, TIBC, and RDW

in Fe deficiency anemia

A

ferritin low

serum Fe low

TIBC high

RDW high

294
Q

ferritin, serum Fe, TIBC, and RDW

in chronic disease anemia

A

ferritin high

serum Fe low

TIBC low

RDW normal

295
Q

ferritin, serum Fe, TIBC, and RDW

in thalassemia

A

ferritin low

serum Fe low

TIBC normal

RDW normal

296
Q

tx for severe hyponatremia

A

100 mL bolus of 3% saline

297
Q

corkscrew esophagus

A

esophageal spasm

298
Q

patients with …. syndrome have low urinary excretion of calcium and high urinary excretion of magnesium

A

Gitelman syndrome

299
Q

form of familial hypokalmic alkalosis due to a proximal tubule defect, resulting in hypouricemia

A

Gullner syndrome

300
Q

hypokalemia and metabolic alkalosis with hypertension at a young age

A

Liddle syndrome

301
Q

polyhydraminos, premature delivery, severe hypokalemia, hypochloremia, metabolic alkalosis, and normal BP

A

Bartter syndrome

302
Q

should thoracics or ribs be treated first?

A

thoracic dysfunction treated first

303
Q

reciprocal inhibition involves setting up the pt …

A

to their barrier

and then gently push further toward their barrier

304
Q

the common peroneal branch of the sciatic nerve innervates what hamstring muscle?

A

short head of the biceps femoris

305
Q

the tibial branch of the sciatic nerve innervates all of teh hamstring muscles except for

A

the short head of the biceps femoris

306
Q

what kind of stroke tends to present initially with focal neuro symptoms but can progress to signs of increased ICP like vomiting, HA, bradycardia, reduced alertness?

A

intracerebral hemorrhage

307
Q

weeks to months after an MI and the pt now has pericarditis

A

Dressler syndrome - immune mediated inflammation

aka post-cardiac injury syndrome

308
Q

midodrine MOA and indication

A

alpha agonist to tx orthostatic hypotension

309
Q

when do you give varicella vaccines?

A

age 1 and 4

310
Q

major depression and worsening diabetic neuropathy, tx?

A

duloxetine (SNRI)

311
Q

ratio of an event rate occurring in the treatment arm versus the non-treatment arm

A

hazard ratio

312
Q

hazard ratio less than 1 indicates

A

the treatment arm had a lower event rate than the non treatment arm

313
Q

study that involves 2 or more experimental interventions, each with 2 or more variables that are studied independently

A

factorial design

314
Q

(renal) dense intramembranous deposits that stain for C3

A

membranoproliferative glomerulonephritis, type 2

aka dense deposit disease

315
Q

pathophys of membranoproliferative glomerulonephritis type 2

A

IgG abs (C3 nephritic factor) directed against C3 convertase of the alternative complement pathway

persistent complement activation and kidney damage

316
Q

fever, polyarthralgia, pustular rash, sexually active

A

disseminated gonnococcal infxn

317
Q

chronic venous insufficiency tx

A

leg elevation, exercise, and compression therapy

318
Q

confirm ALS dx with what test?

A

EMG

shows fibrillation and loss of innervation in multiple muscle groups

319
Q

seated flexion test assess…

while the standing flexion test assess…

A

seated: sacroiliac motion
standing: iliosacral motion

320
Q

top 3 MCC of meningitis in newborn

A
  1. GBS
  2. Neisseria
  3. Listeria
321
Q

mangement of recurrent eclamptic seizures that are not responsive to mag sulfate

A

diazepam

322
Q

tx of magnesium toxicity

A

calcium gluconate

323
Q

MRI brain showing large lesion with irregular borders and central hypointensity, representing areas of focal necrosis

ring enhancing and surrounding edema is common

A

GBM

324
Q

MC malignant pediatric brain tumor, infratentorial

A

medulloblastoma

325
Q

tx of chancroid/H. ducreyi

A

single dose PO azithromycin, IM ceftriaxone, a week of erythromycin, or 3 days cipro

326
Q

tx for lymphogranuloma venereum

A

doxycycline

327
Q

liability reason as to why the hospital can be named as a defendant

A

vicarious liability

328
Q

failure to continue a work up when it is called for is considered

A

breach of duty

329
Q

MCC of osteomyelitis

A

staph aureus

330
Q

increased number of lymphocute precursors that are positive for terminal deoxynucelotide transferase, marker of pre B cells or pre T cells

A

ALL

331
Q

ALL is often accompanied with what during dx?

A

tumor lysis syndrome

332
Q

initial tx of Tumor Lysis Syndrome

A

start IV fluids and promote diuresis as well as use adjunctive medications such as allopurinol to help lower uric acid levels and prevent renal failure

333
Q

GI symptoms, excessive weight loss, myalgias, hyperpigmentation

hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia

A

Addisonian crisis

334
Q

herbal supplement known for aphrodisiac properties and is used for tx of sexual dysfunction, DMT2, and fatigue

A

ginseng

335
Q

MC adverse effect of ginseng

A

insomnia

336
Q

herbal supplement popularly taken to improve overall immune function

A

echinacea

337
Q

herbal supplement for tx of dementia, memory impairment, and vascular disorders

A

ginkgo biloba

338
Q

Serious adverse effect of Ginkgo biloba use

A

bleeding

339
Q

herbal supplement to treat BPH

A

Saw palmetto

340
Q

kartagener syndrome triad

A

situs inversus, chronic sinusitis, and bronchiectasis

341
Q

excessive fluid accumulation in the interstitium, eg pericardial and pleural effusions in utero

A

hydrops fetalis

342
Q

what is the MCC of immune fetal hydrops

A

Rh (D) alloimmunization

343
Q

what causes nonimmune fetal hydrops

A

parvovirus B19

344
Q

single, subcapsular, low density lesion in the right lobe of the liver

A

entamoeba histolytica

345
Q

echinococcous granulosis v entamoeba histolytica

A

fever is rare in echinococcus unless cyst ruptures, diarrhea is also uncommon

346
Q

fatigue, weight loss, hypotension, and hyperpigmentation of the skin and mucous membranes in young woman with hypothyroidism

A

primary adrenal insufficiency

347
Q

distinct episodes of major depression and hypomania

A

bipolar disorder type II

348
Q

heart defect in diGeorge syndrome

A

truncus arteriosus

349
Q

intense blood glucose control with insulin decreases the risk of

A

microvascular complications of diabetes

350
Q

initial tx for PAD includes smoking cessation, statin, and

A

exercise program

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