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NICOLE - Pance > Random/Questions from 300 question exam > Flashcards

Random/Questions from 300 question exam Flashcards

1
Q

At what age are males screened for dyslipidemia if no risk factors?

A

All males 40-75

25 if risk factors which include obesity, smoking history, hypertension, Type 2 diabetes and a family history of cardiovascular disease.

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2
Q

When does colon cancer screening for low risk individuals begin?

A

Colonoscopy at age 50

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3
Q

How do you differentiate conduct disorder from oppositional defiance disorder?

A

Conduct disorder occurs in childhood and adolescence and includes repetitive violations of rights of others

OPP - 6 months of negative, hostile and defiant symptoms but DOES NOT include aggressive behavior toward people, animals, destruction of property

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4
Q

What is the best initial medication for african american male after no improvement with lifestyle modifications?

A

First line = CCB or diuretic

Amlodipine often first line

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5
Q

Tibial tubercle tenderness should prompt you to think of which disease (average age 10yo)

A

Osgood Schlatter disease = Tibial apophysitis. Seen in adolescents with growth spurts and overuse

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6
Q

What are the rule of 9s?

A

Anterior torso = 18% (chest + abdomen)
Arms = 9% (front 4.5% + back arms 4.5%)
Full leg = 9%
Perineum = 1%
Hands = 1%

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7
Q

MCC bacteria involved in postop surgical site infections

A

Staph aureus

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8
Q

What population is most at risk for spontaneous pneumothorax?

A

Tall, thin males between 10-30yo are at greatest risk

Acute onset of ipsilateral chest pain + dyspnea

On exam = unilateral chest expansion, decreased tactile fremitus, hyperresonance, and diminished breath sounds

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9
Q

How does coal worker’s pneumoconiosis present?

A

Small opacities in the upper lung fields

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10
Q

How does silicosis present?

A

Small round opacities throughout lung fields, calcified lymph nodes

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11
Q

What are common xray findings associated with asbestososis?

A

Interstitial fibrosis and thickened pleura

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12
Q

What is the test of choice to confirm diagnosis of intussception?

A

Barium enema is diagnostic and therapeutic

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13
Q

What is the best test to confirm bladder cancer?

A

Cystoscopy + biopsy has rate of almost 100% and is definitive diagnostic procedure

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14
Q

What is the salter- harris classification

A

S- Slipped
M- Metaphysis
A- Articular
C - Complete
K - Krushed

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15
Q

What is the MC type of kidney stone? What is the MC type of infected kidney stone associated with UTIs and urease-producing bacteria?

A

Calcium oxylate

MC infected = Struvite stones

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16
Q

Which congenital abnormality is commonly associated with tracheoesophageal fisula?

A

Esophageal atresia

Common in newborns
Sx = excessive saliva, choking, or coughing with feeding

Dx = inability to pass NG tube

Tx = Surgical + suction or withholding of oral feeds to prevent pulmonary aspiration until surgery

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17
Q

What is the medication of choice for those who desire medication for insomnia during pregnancy

A

Doxylamnie = Unisom
Benadryl

*melatonin isnt studied significantly to recommend

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18
Q

First line tx for pertussis?

A

Zpack = Azithromycin
Alternative = Bactrim

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19
Q

Vertigo lasting one minute or less and are provoked by head movements; “room is spinning”

A

BPPV -
Dx = Dix hallpike
Tx = epley maneuver

*Due to calcium debris within the posterior semicircular canals

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20
Q

What are the MCC of acute respiratory distress syndrome?

A

Sepsis, multiple trauma, aspiration of gastric contents = 75% of cases

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21
Q

Signs and symptoms of acute respiratory distres syndrome?

A

Tachypnea, dyspnea, frothy pink or red sputum, diffuse crackles, hypoxemia that doesn’t respond to O2

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22
Q

Short stature, webbed neck, prominent ears, low posterior hairline, broach chest with widely spaced nipples should indicate which syndrome?

A

Turner syndrome (monosomy x)

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23
Q

Which leads are posterior?

A

V1, V2

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24
Q

Which leads are anterior?

A

V1-V3; Artery = Left anterior descending

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25
Q

Which leads are lateral?

A

I, AVL, V5, V6; Circumflex artery

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26
Q

What is the most likely complication associated with Kawasaki disease?

A

Coronary artery aneurysm = occurs in 25% of cases

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27
Q

Radiographs of what area are best for evaluating bone age?

A

Distal radius

Ossifications of the hand and wrist including the distal radius are the most predictable and sensitive for determining bone age

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28
Q

What is first line medication for social phobias>

A

SSRI - first line for social phobias

Short term benzo or TCA are less effective

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29
Q

Idiopathic adolescent scoliosis should be monitored based on curve of degree. How often should 10-15 degrees be monitored? 15-20? 20 or greater?

A

10-15 = monitoring every 6-12 months

15-20 = Serial AP radiographs every 3-4 months

20 degrees or more = referral to orthopedist for continuous monitoring and management (braces, electrical stimulation, surgery)

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30
Q

Which type of lung cancer has the most aggressive clinical course, is likely to spread early, and is rarely amenable to surgery?

A

Small cell lung cancer

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31
Q

What is the test to confirm celiac disease?

A

Initial test = IgA antiendomysial and anti-TTg antibodies

Confirm with small bowel biopsy

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32
Q

What does a positive (HBsAg) indicate?

A

Ongoing infection of any duration

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33
Q

What does a positive (anti-HBs) indicate

A

Immunity by past infection or vaccination

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34
Q

What does a positive Hep B core antibody (anti-HBc) indicate

A

Acute hepatitis

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35
Q

What does a positive hep b envelope antigen indicate (HBeAg)

A

Indicates active infection that is highly contagious

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36
Q

MC type of shoulder dislocation?

A

Anterior = MC

If seizure or electrocution is involved = Posterior

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37
Q

MC type of renal malignancy in children ; Most commonly associated with sudden abdominal swelling without other signs or symptoms; firm, nontender smooth mass palpable on exam

A

Wilms tumor

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38
Q

Transmural inflammation is associated with UC or Crohns?

A

Crohns

MC location terminal ileum

String sign seen on barium xray

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39
Q

Passage of intestine through the internal ring down the inguinal canal describes what type of hernia?

A

Inguinal hernia

Indirect = passage through INTERNAL inguinal ring

Direct - Passage through external ring at hesselbachs triangle

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40
Q

What is charcots triad vs reynold pentad?

A

RUQ pain, jaundice, fever

Pentad includes hypotension + AMS

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41
Q

Hip dysplasia occurs is MC in what population?

A

Increased incidence in firstborn infants

Unequal thigh folds on exam due to ligament laxity

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42
Q

Herpangina is caused by what virus? What other disease does this virus cause?

A

Coxsackie

Presents with onset of fever and posterior pharyngeal vesicles, painful and children often dont want to eat or drink

Coxsackie also causes hand foot and mouth but is more mild than herpangina

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43
Q

If a baby <3 weeks contracts pneumonia, what is the MCC?

A

Group B strep
E.Coli
Chlaymydia

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44
Q

If a baby 3 weeks -3 months contracts pneumonia, what is the MCC?

A

Bacterial = Strep pneumo

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45
Q

If a preschool child (4yo) contracts pneumonia, what is the MCC?

A

Virus = RSV, parainfluenza, influenza

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46
Q

What is the MCC of atypical pneumonia in age 5 and up?

A

Mycoplasma pneumonia

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47
Q

What cervical myotome affects the biceps and flexion of the arm?

A

C6

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48
Q

What cervical myotome affects the triceps and extension of the arm?

A

C7

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49
Q

What cervical myotome affects the interossei including the thumb?

A

C8

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50
Q

What cervical myotome affects the deltoid and aBduction of the arm?

A

C5

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51
Q

Which type of insulin has an onset of 30-60min, peaks around 2 hours, and lasts 6-8 hours?

A

Regular insulin

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52
Q

Which type of insulin has a rapid onset of 5-15 minutes, peaks at 60-90 min and lasts 3-4 hours?

A

Lispro aka Humalog or Novolog

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53
Q

Which type of insulin is an intermediate acting and has an onset of 2-4hours, peaks at 6-7 hours and lasts 10-20 hours?

A

NPH (Humalin)

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54
Q

What clotting factors are inhibited by warfarin?

A

2, 7, 9, 10

Warfarin inhibits the vitamin K dependent synthesis of these

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55
Q

Hodgkins disease is diagnosed by the presence of which cells?

A

Reed-sternberg

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56
Q

JAK-2 mutation is a diagnostic for what?

A

Primary polycthemia vera

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57
Q

Auer rods are associated with what?

A

AML

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58
Q

G6PD is x-linked recessive disorder which causes chronic hemolysis and is associated with what cells?

A

Heinz bodies

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59
Q

If a patients father was diagnosed with colorectal cancer at 45, at what age should that patient recieve their first colonoscopy?

A

If its a first degree relative diagnosed before age 60 then the patient should receive one 10 years younger than the earliest diagnosis

In this case, the patient should receive one at 35 if their relative was diagnosed at 45. If negative, repeat colonoscopy every 5 years

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60
Q

What is the cause of increased risk of preeclampsie?

A

Multifetal gestation (twins), nulliparity, advanced maternal age, AA race, obesity

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61
Q

Which drugs have an effect on the INR of a patient taking Warfarin?

A

TMP.Sulfa = Bactrim
Metronidazole
Fluconazole

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62
Q

Sudden, unilateral painless blurry vision or vision loss

A

Retinal vein occlusion

Retinal artery occlusion can also present like this but on exam the patient will have retinal pallor and “cherry red spot” or fovea

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63
Q

What are retinal findings associated with retinal vein occlusion?

A

Venous hemorrhage, disc swelling, cotton wool spots, dark, dusky retinal background

DM and HTN are risk factors

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64
Q

MCC of overuse injury of the elbow

A

Lateral epicondylitis (tennis elbow)

Pain with lifting when arm is pronated ; Reproducible pain on exam if arm is pronated and extend the wrist and fingers against resistance

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65
Q

Which vaccines are contraindicated in an immunosupressed patient?

A

Live vaccines such as MMR

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66
Q

Which type of meningitis presents with an increased opening pressure, increased cell count, decreased glucose, and increased protein?

A

Bacterial meningitis = Strep pneumo

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67
Q

Patient has barky cough and cxr revelas subglottic tracheal narrowing, what is the most likely diagnosis?

A

Laryngotracheobronchitis aka CROUP

“Steeple sign” on CXR

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68
Q

Renal artery stenosis is the MC 2ndary cause of HTN, but what are some other causes?

A

Pheochromocytoma
Cushings
Hyperthyroid
Hyperaldosteronism
Chronic steroid use
Estrogen use
OSA
Coarctation of Aorta

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69
Q

Describe PCN mechanism of action?

A

Inhibits cell-wall synthesis

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70
Q

What is a common side effect of statin therapy?

A

Muscle pain (myalgias) rarely patients will develop rhabdo

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71
Q

Which cardiac marker initially rises in 1-4 hours, peaks at 6-7 hours and returns to normal after 24hours?

A

Myoglobin

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72
Q

What is the first line tx for endometritis (most likely developed a few days postpartum, patient will have pelvic pain + fever)

A

Clindamycin and gentamicin

Ampicillin can be added if there is no response and metronidazole added if patient is septic

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73
Q

Which medication lowers blood glucose by slowing gastric emptying, stimulating pancreatic insulin response to glucose and reducing glucagon release after meals?

A

Liraglutide (victoza/saxenda) which is a GLP-1

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74
Q

How do DDP-4 inhibitors (aka -gliptans) work?

A

Reduce the breakdown of endogenous GLP-1; Work similarly to GLP-1s but do not have the higher effect on gastric emptying

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75
Q

A lesion present on the right optic tract posterior to the optic chiasm will have what effect?

A

Left homonymous hemianopsia

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76
Q

An elevated BUN to creatinine ratio >20:1 indicates what?

A

Prerenal cause of acute renal failure most likely due to hypovolemia, hypotension, HF, aortic aneurysm, renal artery stenosis

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77
Q

Is cystic fibrosis autosomal dominant or recessive?

A

Autosomal recessive disorder of the CFTR gene

CF causes abnormal mucus production that causes obstruction in multiple organs including the lungs, and pancreas (decreased life span because of this)

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78
Q

Which vaccine significantly decreased the incidence of epiglottitis?

A

Hib (haemophilus influenza type B)

Patients w/ epiglottitis present with “tripoding”, fever, drooling

Thumb sign on lateral soft tissue xray

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79
Q

EKG findings of a RBBB and ST elevation in leads V1-V3 should may you think of what diagnosis?

A

Brugada syndrome - hereditary condition that may cause sudden death in those without heart disease

Responsible for 1/2 of sudden death in healthy young individuals WITHOUT structural heart disease

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80
Q

If a 20yo sexually active female presents for wellness exam, what is recommended?

A

Chlamydia/Gonorrhea screening

*Pap smear not recommended until age 21 regardless of sexual activity and every 3 years after

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81
Q

Which test is used to determine cortisol excess in patients suspected of having Cushings syndrome?

A

Overnight dexamethasone suppression test

*Dexamethasone works by lowering amount of ACTH released by posterior pituitary which lowers amount of cortisol released by the gland. In patients with Cushings, the dexamethasone wont work and they will still have elevated cortisol levels

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82
Q

A patient with heart disease has marked limitations of physical activity, they are asymptomatic at rest, but even mild activity causes symptoms. What NY heart stage functional classification is this?

A

Stage 3

Stage 1 = No limitation
Stage 2 = Slight limitation of physical activity
Stage 3 = Marked limitation of physical activity
Stage 4 = Unable to engage in physical activity without discomfort

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83
Q

What are signs/symptoms of lower motor neuron lesions?

A

Hyporeflexia, absent Babinski, weakness, muscle atrophy

*Lower motor neuron symptoms are caused by Guillain Barre or spinal radiculopathy

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84
Q

What are signs/symptoms of upper motor neuron lesions?

A

Hyperreflexia, positive Babinski, spastic weakness

*Upper motor neuron symptoms are caused by multiple sclerosis or cerebral palsy

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85
Q

The Centor criteria is used in diagnosing strep pharyngitis, what are the 4 criteria?

A

Tonsillar exudates
Absence of cough
Tender anterior cervical lymphadenopathy
Fever

*Pts with at least 3 of these have a 60% chance of infection with Beta hemolytic group A strep

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86
Q

Which antiarrhythmic inhibits conversion of T4 to T3?

A

Amiodarone

Carries risk of thyroid dysfunction due to decreased iodine uptake, inhibition of T4 to T3 and possibly direct immune-mediated destruction of thyroid

**TSH should be obtained prior to initiating therapy and at regular intervals

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87
Q

Which labs are increased in acute pancreatitis?

A

Serum lipase

Often liver enzymes are indicating biliary obstruction (gallstone, MCC)

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88
Q

Patellar reflex is caused by stimulation of which nerve roots?

A

L3/L4

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89
Q

Topical anesthetic agents are MCC of methemoglobinemia which causes which symptoms?

A

Cyanosis, low pulse ox, normal ABG

Check a methemoglobin level

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90
Q

If a patient (30-50yo) presents with hip pain with activity, loss of ROM, and possible a limp due to pain what should be suspected? + Crescent sign

A

Aseptic necrosis or avascular necrosis

MRI = preferred imaging

Crescent sign = linear area of subchrondral lucency

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91
Q

MCC of first trimester pregnancy losses?

A

Congenital abnormality

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92
Q

If acetaminophen overdose is suspected and patient is alert and vitals are normal, how should the patient be managed?

A

Obtain immediate acetaminophen levels and if normal repeat in 4 hours

If overdose and patient is symptomatic tx = acetylcysteine (NAC)

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93
Q

What is the treatment for PDA?

A

Indomethacin = treatment

If pt is going to have surgery and we want to keep it open use prostaglandin E1 to maintain patency

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94
Q

What type of hernia is more prevelant in females and is highly susceptible to incarceration?

A

Femoral hernias

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95
Q

Bullous myringitis and cold agglutinins is associated with which type of pneumonia?

A

Mycoplasma

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96
Q

What is the treatment of choice for treating cystitis in pregnant female?

A

Nitrofurantoin

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97
Q

What is the initial tx of dacrostenosis?

A

Digital massage

If symptoms persist longer than 6-10 months lacrimal duct probing can be performed

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98
Q

What physical exam findings would raise suspicion in abuse in a child?

A

Abdominal bruising = most suspicious

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99
Q

Boxer fracture is fracture of what?

A

Metacarpal neck fracture

Common in patients punching a wall

*5th metacarpal is MC affected

Tx = Ulnar/Gutter splint

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100
Q

What lab finding is most consistent with B12 deficiency?

A

Elevated MCV (Macrocytic anemia)

Other findings could include thrombocytopenia, low WBC, low reticulocytes

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101
Q

What is the MC bacteria associated with dog bites?

A

Pasteurella

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102
Q

Eikenella is MC associagted with what type of bite?

A

Human

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103
Q

Bartonella bacteria is MC associated with what type of bite?

A

Infected cats

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104
Q

When is there a surge in LH for a female with a 28 day menstrual cycle?

A

Day 12

24-36 hours after the LH surge, follicular rupture occurs releasing oocyte from follicle at the surface of the ovary (ovulation)

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105
Q

What is the MOA of metformin?

A

Decrease hepatic glucose production and increase peripheral uptake

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106
Q

What is the MOA of SLG-2? (-Flozins)

A

Lower renal glucose threshold and increase glucose excretion in urine

FLO = Increased risk of UTI

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107
Q

What is the treatment of chlamydia/gonorrhea?

A

Azithromycin 1000mg single dose and doxycycline 100mg BOD for 7 days

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108
Q

8mm TB reaction in a patient with an HIV would be positive or negative?

A

Positive

> 5mm in HIV positive or those with known contact with active TB or evidence of TB on CXR and immunocompromised on steroids

> 10mm recent immigrants, HIV negative IV drug users, immunocompromised not on steroids

> 15mm healthy persons with no risk factors

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109
Q

Diagnostic study to confirm PE?

A

Chest CT

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110
Q

Most common fracture after FOOSH?

A

Colles = Distal radius fracture

Colle = Dog = Distal

Smith = opposite Colle

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111
Q

Which ligament is injured in a gamekeeper’s thumb?

A

Ulnar collateral ligament

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112
Q

When testing for accomodation, what is the expected result?

A

As the person shifts gaze from far object to a near object, pupils constrict

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113
Q

What happens in all phases of clinical trials?

A

0 = evaluating bioavailability and half life
1= testing for safety and involves multiple doses
2- testing for efficacy and side effects
3= assessing efficacy, effectiveness, and safety
4 = assessing long term effects

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114
Q

What are symptoms of Parkinsons caused by?

A

Imbalance of dopamine and acetylcholine

Degeneration of substantia nigra

DX - Clinical; MRI not needed but may be helpful in identifying structural lesions

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115
Q

Which test is helpful in diagnosing De Quervains tendinopathy?

A

Finklestein - Thumb into hand, pressure on wrist causes pain

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116
Q

Which test is used to assess for blood flow in hands?

A

Allens test

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117
Q

Tinel and Phalens test evalute what?

A

Carpal tunnel

118
Q

What is the MC innocent murmur of early childhood?

A

Stills murmur

Heard between ages 2-7

119
Q

Severe attack of orbital, supraorbital, or temporal pain accompanied by restlessness or agitation, what type of HA?

A

Cluster = Pain begins quickly reaches a crescendo within minutes

120
Q

What sign is associated with idiopathic intracranial hypertension (aka pseudotumor cerebri)

A

Papilledema

121
Q

What lab finding is suggestive of subclinical hypothyroidism?

A

Elevated TSH and normal T4

122
Q

What is first line treatment for primary dysmenorrhea?

A

Trial of scheduled NSAIDs beginning 1-2 days before cycles

NSAIDs inhibit prostaglandins which cause muscle contractions in the uterus and decreased blood flow and oxygen to utereus

123
Q

What congenital abnormality presents with an absent or delayed femoral pulse when compared to brachial pulse?

A

Coarcation of aorta

124
Q

Stable angina is defined as

A

Chronic angina with a fixed level of exertion alleviated by rest

**Any new onset of angina, with a lower exertional threshold or angina at rest is considered unstable

125
Q

When does the follicular phase begin?

A

Onset of menses and ends on the day before the LH surge

126
Q

Progressive prolongation of PR interval culminating in a nonconducted P wave is what type of block?

A

Mobitz I

127
Q

Inadequate drainage of aqueous humor and painful red eye

A

Angle-closure glaucoma = narrowing of anterior chamber angle

Backup of aqueous humor and backup results in increased pressure and damage to optic nerve

**Treat urgently to prevent blindness

128
Q

Ottawa ankle rules used to r/o fracture includes what 2 main rules?

A

Any pain to malleolar zone AND bone tenderness along distal posterior edge of tibia

OR

tip of medial malleolus OR distal posterior edge of fibula or top of lateral malleolus

129
Q

25yo female with weight gain + depression, what lab should be checked?

A

TSH

Weight gain my be a symptom of hypothyroid + small percent of patients have depression

130
Q

What is the role of Oxytocin in breastfeeding? What about Prolactin?

A

Oxytocin = milk ejection and flow

Prolactin = Increase during feedings but doesnt regulate milk production

131
Q

What is a common heart med that should be monitored for hypokalemia?

A

Furosemide

132
Q

What is a common finding on peripheral smear in a patient with extreme iron deficiency?

A

Poikilocytosis = abnormally shaped RBCs

133
Q

For complicated abscess or patients with DM, what is the treatment?

A

I&D + abx (clindamycin)

134
Q

What is the most common PE sign for appendicitis?

A

Rovsings = Rosings = Across abdomen (RLQ pain with palpation of LLQ)

135
Q

Mcmurrays test is used in evaluation of what?

A

Meniscal tear

136
Q

What does the Romberg test evaluate?

A

Loss of balance when eyes are closed to assess for neurological function

137
Q

E.coli is what type (cocci, rod, negative, positive?)

A

Gram negative rods

138
Q

Unilateral chest expansion should make you think of what diagnosis?

A

Pneumothorax

Also presents with decreased breath sounds on affected area, decreased tactile fremitus, hyperresonance to percussion

139
Q

What impairs absorption of iron?

A

Calcium impairs

Vitamin C helps absorption

140
Q

Which patients should not use stool DNA test for colorectal cancer?

A

Patients with hx of inflammatory bowel disease

141
Q

Which condition presents commonly in patients with cystic fibrosis?

A

Bronchiectasis

Chronic cough, purulent sputum, hemoptysis, recurrent pneumonia

142
Q

Hutchinsons sign presents as vesicles on tip or side of nose in herpes zoster, what cranial nerve does that affect?

A

5- Trigeminal nerve

143
Q

Which lab value predicts severe pancreatitis with increased risk of mortality?

A

Glucose >250

Ransons criteria

144
Q

Hernia of the bladder into the vagina causing a soft anterior fullness

A

Cyctocele

RF = pelvic organ prolapse from vaginal birth with pelvic floor injury, prior pelvic surgery, advancing age, straining, constipation

145
Q

MC muscle entrapped in blowout fracture?

A

Inferior rectus

Causes limited ability for upward gaze

146
Q

What vaccination can be given to infants prior to leaving the hospital after birth?

A

Hep B

147
Q

What is the treatment for outpatient management of diverticulitis?

A

Metronidazole + Cipro

148
Q

What type of fracture is associated with positive “fat pad” sign

A

Radial head

149
Q

Most common congenital heart defect

A

VSD

150
Q

What are the diseases associated with HLA-B27?

A

PAIR

P-Psoriasis/Psoriatic arthritis
A- Ankylosing Spondylitis
I-Inflammatory Bowel
R-Reactive arthritis

151
Q

What is potential adverse effect of bisphosphonates

A

Osteonecrosis

152
Q

Ptosis and weakness should make you think of which diagnosis?

A

Myasthenia gravis

Neuromuscular junction disorder; fatigability and weakness of skeletal muscles that worsens with repeated movement

90% of patients will have ocular involvement during the course of their disease

153
Q

MCC of postpartum hemorrhage

A

Uterine atony

154
Q

Diagnosis of ADHD requires what?

A

Qualifying symptoms must be present in 2 or more settings (School and home)

155
Q

What is an indication for induction of labor?

A

PROM - must occur within 24hr of membrane rupture

Contraindications:
Placenta previa or transverse lie are ABSOLUTE contraindications

Fetal macrosomia and oligohydroaminos are contraindications

156
Q

Which joints are usually spared in RA?

A

DIP joints; Most commonly involves MCP and PIP joints

157
Q

What are the main causes of hypermagnesium?

A

Supplementation
Laxatives
Antacids

158
Q

Which antibiotic have a high risk of ototoxicity?

A

Aminoglycosides - Gentamicin

159
Q

“cloudy” vision with halos around lights especially at night should make you think of what diagnosis?

A

Cataracts

On exam patients have absence of red reflex

160
Q

Which lab value is associated with acromegaly?

A

IGF-1 Insulin growth factor

161
Q

Gastrin secreting gastrinoma causing hypergastrinemia and acid hypersecretion

A

Zollinger-Ellison syndrome

High risk of peptic ulcers

Sx: Pts present with GERD symptoms + diarrhea

Elevated gastrin is most sensitive above 150

162
Q

Pain, clicking, and locking sensation as well as pain with squatting should make you think of what diagnosis?

A

Mensical injury

MRI best diagnostic imaging

163
Q

What are the biggest risk factors for stroke?

A

AV malformation and aneurysms = biggest risk for hemorrhagic stroke

Majority of CVAs are ischemic

164
Q

What is the most significant treatable risk factor for stroke?

A

Hypertension

165
Q

What arrhythmia increases risk of embolic stroke from a clot?

A

A.fib

166
Q

How is natural menopause defined?

A

Absence of menses for 12 months with no pathologic cause

Estradiol and FSH are often measured to aid diagnosis but not required

167
Q

Mid-systolic murmur that decreases with squatting

A

HOCM

168
Q

Which murmur gets louder with standing from a squatted position and softer with valsava?

A

Aortic stenosis

169
Q

Painless testicular swelling for 2 weeks

A

Testicular cancer

Order ultrasound

170
Q

Huntington disease is what type of inherited disease?

A

Autosomal dominant

171
Q

Philadelphia chromosome should make you think of what?

A

CML

Genetic abnormality of chromosome 22

172
Q

In what disease would you see Bence jones proteins?

A

Multiple myeloma

173
Q

Catecholamines are synthesized in the

A

Adrenal medulla

Catecholamines include: Dopamine, epinephrine, norepinephrine

174
Q

A patient with a seizure disorder is noted to have gingival hyperplasia, which medication is most likely responsible?

A

Phenytoin

175
Q

What is a potential complication of cryptorchidism?

A

Infertility

176
Q

Chest pain that occurs at rest, not provoked by exercise, and is accompanied by transient ST segment elevation?

A

Prinzmetal angina

Intermittent focal spasms of a coronary artery, often associated with atherosclerotic lesions near the spasm site

177
Q

MC of erectile dysfunction

A

Vascular disease - claudication

178
Q

The best way to prevent rabies is

A

Postexposure prophylaxis

Nobody gets rabies vaccines unless they’re in a high risk occupation or area

179
Q

Blowing holosystolic murmur along the lower left sternal margin which intensifies with inspiration and decreases with valsalva

A

Tricuspid regurg

Regurge = Blowing

180
Q

Functional incontinence is described as:

A

Inability to get to the bathroom due to a physical or cognitive disability (patients with dementia)

181
Q

Involuntary bladder contractions causes what type of incontinence

A

Urge

182
Q

Increased intra-abdominal pressure causes which type of incontinence

A

Stress

183
Q

Urinary retention and bladder distention causing overflow of urine through urethra is which type of incontinence

A

Overflow

184
Q

Which stage of syphilis includes a painless ulcer on genital, perianal or rectal area?

A

Primary, this is a chancre

185
Q

Which stage of syphilis includes a maculopapular rash (palms and soles), mucous membrane lesions, systemic inflammation?

A

Secondary which occurs a few weeks to 6 months later

186
Q

What happens in latent syphillis?

A

Clinically inactive period without primary or secondary lesions

187
Q

When does tertiary syphillis occur?

A

Any time, years after untreated secondary. Infiltrative tumors of skin, bones, and liver, aneurysms and vascular disease can occur

Neurosyphilis can occur at any stage of disease

188
Q

Most common neoplasm in men aged 20-35?

A

Testicular cancer

Painless testicular nodule

189
Q

Red cell casts are seen on microscopy with which disease?

A

Poststrep glomerulonephritis

Patients often present with edema, hypertension, and occur 2-3 weeks post infection

190
Q

What is the most likely cause of anemia in a patient with alcohol dependence?

A

Folate deficiency

191
Q

Acid-fast bacilli is diagnostic of which condition?

A

TB

192
Q

What is the best contraception method for a 42yo women with hx of hypertension and known coronary artery disease?

A

Depo because it has progestin and no estrogen

193
Q

What is the MC diagnosed form of botulism?

A

Infant

194
Q

Poor growth and bowing of legs should make you think of which diagnosis? What lab value would be elevated?

A

Rickets - Vitamin D deficiency

Elevation in PTH = parathyroid hormone + elevated alk phos

Vitamin D deficiency doesn’t allow the body to absorb calcium and keep parathyroid hormone levels in check

195
Q

When is a hepatitis C screening recommended?

A

One-time screening for Hep C is recommended for anyone age 18 and over

196
Q

MCC of painful thryroid gland

A

Subacute thryoiditis

Result of preceding viral infection in most cases

Tx = supportive

197
Q

Newborns with PKU if not detected and treated with a phenylalanine-restricted diet will exhibit what?

A

Intellectual diasbility

198
Q

What is the pathophysiology behind PKU

A

Decreased activity of phenylalanine hydroxylase which converts phenylalanine to tyrosine

199
Q

Retrograde urine flow from bladder into kidneys which causes recurrent cystitis is caused by

A

Vesicoureteral reflux

200
Q

Ohio + Mississippi river are associated with

A

Histoplasmosis

201
Q

Which test evaluates LCL vs MCL?

A

Valgus = MCL
Varus = LCL

202
Q

Which tests evaluated meniscal tears?

A

McMurray and Apley test

203
Q

Complex pain syndrome symptoms

A

Autonomic and vasomotor instability causing chronic pain in affected limb following injury

Hand is most commonly affected

204
Q

Less than 5th percentile for weight would be considered? What about 6-85%? Over 95th% is considered?

A

Under 5% = Underweight
6-85% = Normal weight
95% + = Overweight

205
Q

What is associated with long bone and pelvic fractures and includes petechial rash?

A

Fat embolism syndrome

206
Q

What are the cardinal movements of labor?

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation

207
Q

Blue irises, long narrow protruding ears, large protruding jaw, flat feet, should make you think of which syndrome?

A

Fragile X

208
Q

Platelet count less than 150,000 + elevated WBC should make you think of which diagnosis?

A

Acute leukemia

209
Q

What differentiates parkinsons from essential tumors?

A

Essential tumor is most likely to be bilateral, postural, without co-occurring neurologic symptoms

210
Q

Plasmodium falciparum is most likely to be resistant to which malaria drug?

A

Chloroquine

211
Q

Which type of hernia passes through the internal ring and potentially into the scrotum

A

Indirect

212
Q

What medication is appropriate treatment for hyperthyroidism in pregnancy?

A

PTU

213
Q

Which alpha1 agonist is dosed twice daily in treatment of BPH?

A

Prazosin (short-acting)

214
Q

70% of Guillain-barre symptoms are caused by what bacteria

A

Campylobacter jejuni

Diarrheal disease transmitted by contaminated or undercooked foot, person to person or fecal oral

215
Q

What are contraindications for TPA management in stroke?

A

BP greater than 185/110
Intracranial bleeding

216
Q

Amenorrhea and osteopenia are both seen in which eating disorder

A

Associated with anorexia

217
Q

Patient with ASD is most likely to present with which symptoms?

A

Asymptomatic

Larger defects may cause dyspnea or heart failure

ASD = Left to Right shunting

218
Q

Elevated alk phos and elevated antimitochondrial antibody test should make you think of which diagnsois

A

Primary biliary cholangitis

Chronic liver disease due to autoimmune destruction of intrahepatic bile ducts

Pts are often asymptomatic intitially and may present with fatigue and pruritus

219
Q

Which medication may falsely lower PSA levels?

A

Finasteride

220
Q

How does pericarditis present on EKG?

A

Diffuse ST segment elevation

221
Q

Delta wave is associated with what

A

WPW

222
Q

Absent red reflex in a child is called?

A

Leukocoria = Urgent optho referral for Retinoblastoma

223
Q

Which labs would help differentiate aplastic crisis from vasoocclusive crisis?

A

Reticulocyte count

224
Q

P-P and R-R intervals are constant but the p wave may hide in the QRS which indicated what type of block

A

3rd degree block

225
Q

If a 4cm abdominal aortic aneurysm is found what is the next step?

A

> 3cm is considered an aneurysm; Repeat ultrasound in one year

Rupture is rare for diameters <5cm

226
Q

What are manic symptoms?

A

Flight of ideas, grandiosity, irritability, decreased need for sleep, pressured speech, distractibility, impaired judgement or psychomotior agitation

227
Q

Which pathogens are considered “atypical” when discussing pneumonia

A

Mycoplasma, step pneumo, h.flu, moraxella catarrhalis

These lack a cell-wall therefore do not color with gram stain

228
Q

Syphilis requires two types of tests for diagnsosi what are they?

A

If RPR is positive check FTA-ABS testing

229
Q

Shortness of breath and wheezing with a failed trial of albuterol should make you think of which diagnosis?

A

Vocal cord dysfunction

Symptoms mimic asthma

Laryngoscopy is gold standard for diagnosis

230
Q

MCC of hemolytic uremic syndrome?

A

E.coli

Also MCC of kidney injury in children

231
Q

Which hypertensive medication must be tapered when discontinued?

A

Beta-blockers - can cause rebound hypertension

232
Q

At 20 weeks where is the uterus?

A

12 weeks palpable at pelvic rim

20 weeks = umbilicus

1inch above umbilicus every week following

233
Q

A rust ring on the cornea from a metallic foreign body can cause permanent staining, how do you remove it?

A

Rotating burr

234
Q

Acute otitis media treatement

A

Amox

235
Q

Donut-shaped protrusion of mucosal tissue

A

Urethral prolapse

Common in prepubertal girls which may cause bleeding, dysuria, difficulty urinating

236
Q

Diabetes insipidus is excessive production in dilute urine and is associated with

A

Decreased production of ADH from posterior pituitary (central) causing decreased serum vasopressin

OR

Kidneys are resistant to ADH (nephrogenic) In nephrogenic vasopressin would be normal or elevated

237
Q

Unstable patient with pneumothorax treatment?

A

Needle decompression on the side with absent lung sounds

238
Q

Flaggellated motile organisms is associated with which STD

A

Trich

239
Q

Main difference between HHS and DKA

A

SEVERELY elevated plasma glucose (900s)

Tx = Volume replacement and insulin

240
Q

MCC of hypercalcemia in adults

A

Hyperparathyroidism is the most common cause of hypercalcemia in adults, and symptoms may include depression, bone pain, and kidney pain, although many cases are asymptomatic. “Groans, bones, stones, moans, thrones and psychic overtones” (GI pain, bone pain, renal stones, fatigue, polyuria/constipation, depression/memory loss) is a good summary and memory tool for the signs and symptoms of hypercalcemia

241
Q

What type of pituitary tumor causes weight loss and palpitations?

A

TSH-secreting adenomas present with symptoms of hyperthyroidism including weight loss and palpitations. On physical exam, patients may have arrhythmias, tremor, or goiter

242
Q

SIADH causes an elevation in which lab value and a decrease in another?

A

Elevation of urine osmolality and decrease in serum osmolality + hyponatremia

Patients with SIADH will have a euvolemic state with decreased serum sodium and osmolality and elevated urine sodium and osmolality.

243
Q

Tx of choice for patients with OA and hx of gastric bleeds

A

Acetaminophen is the preferred analgesic for mild to moderate osteoarthritis, especially in patients with a history of gastrointestinal bleed

Nonsteroidal anti-inflammatory drugs such as ibuprofen are used by many patients with mild to moderate osteoarthritis, but it is a medication to use with caution in patients with a history of a gastrointestinal bleed

244
Q

Benign chest pain that may be accompanied by pleuritic chest pain, worsened pain with movement, and pain with palpation should make you think of which diagnosis?

A

Costochondritis is an inflammatory condition that affects the costal cartilages or sternal articulations that results in benign chest pain that may be accompanied by pleuritic chest pain, worsened pain with movement, and pain with palpation

245
Q

Cataplexy, an event where an emotional trigger causes a sudden decrease or loss of voluntary muscle tone, this is highly suggestive of which diagnosis?

A

Narcolepsy

246
Q

MCC of cellulitis

A

Group A streptococcus in immunocompetent adults, followed by MSSA and MRSA. Treatment is appropriate systemic antibiotics for suspected pathogen. In this case, cephalexin would be appropriate.

247
Q

N. meningitidis and S. pneumoniae are the most common causative pathogens in bacterial meningitis, what is the first line tx?

A

Until the causative organism is confirmed, empiric therapy with vancomycin and ceftriaxone should be administered

248
Q

What is the MC pathogen in reactive arthritis?

A

Campylobacter jejuni

Reactive arthritis is an aseptic, inflammatory arthritis caused by an autoimmune response usually to a genitourinary or gastrointestinal infection such as chlamydia, shigella, salmonella, or campylobacter and classically characterized by urethritis, conjunctivitis, and arthritis

*also responsible for guillain barre = Think AUTOIMMUNE bacteria

treatment is largely supportive with NSAIDS with the exception of antibiotics to treat the caustive infection if it is identified

*Bacteria associated with poultry

249
Q

What is the first step in management of a patient with PAD with decreased ABI?

A

Antiplatelet therapy with aspirin alone or clopidogrel is indicated in patients with peripheral artery disease to prevent myocardial infarction and stroke

*Revascularization is reserved for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease

250
Q

For symptomatic patients who are not surgical candidates due to age or comorbidities, what is the tx of cholelithiasis if stonesare less than 5mm?

A

Oral dissolution therapy with ursodeoxycholic acid is appropriate if they have a functioning gallbladder and small stones (<5 mm)

251
Q

Initial study for secondary menorrhea?

A

Sonogram aka ultrasound

A laparoscopic examination is the most useful procedure, as it allows visualization of the pelvis and reproductive organs. However, it would not be the most appropriate initial study, as it is more invasive

252
Q

What is first line tx in a pt with polycythemia vera?

A

Phlebotomy is typically the first-line intervention for polycythemia vera

UNLESS pt is a drug addict, difficulty with IV access then tx = Hydroxyurea

Phlebotomy is typically performed weekly until the hematocrit reaches a goal of <45%, and then it is performed at intervals to maintain this level.

253
Q

Black tarry stools, vomiting of blood, and light-headedness. This is often accompanied by symptoms of liver disease including jaundice, abdominal distention, and easy bruising

A

Alcoholic liver disease + esophageal varices if vomiting blood

Symptomatic = EGD

254
Q

What is the primary MOA of oral contraceptive pills

A

Progesterone inhibits follicular development and ovulation through negative feedback at the hypothalamus which decreases the pulse frequency of gonadotropin-releasing hormone. Because a follicle does not develop and release estrogen, there is no luteinizing hormone surge at mid cycle which causes ovulation

Progesterone also works to make the cervical mucus such that it does not facilitate passage of sperm up through the cervix

255
Q

Elevated liver function tests and high triglycerides in a patient that does not drink alcohol, should make you think of what diagnosis?

A

Nonalcoholic fatty liver disease

Must rule out viral hepatitis early in the workup

256
Q

Fever, malaise, headache, orchitis, and parotitis should make you think of which diagnosis?

A

Mumps

Usually in patients from foreign countries who are unvaccinated

Treatment = Self-resolving + Supportive

257
Q

Smudge cells, or basket cells, are ruptured lymphocytes commonly found

A

Smudge cells, or basket cells, are ruptured lymphocytes commonly found in chronic lymphocytic leukemia.

It appears that a greater percentage of smudge cells found on peripheral blood smear indicates a better prognosis in terms of time before treatment is required and survival rates.

258
Q

A digital rectal examination would most likely show an enlarged, nontender, firm, and smooth prostate would most likley be what diagnosis?

A

BPH

Anything other than that on exam should make you suspicious of malignancy

259
Q

Symptoms of cough, wheezing, and dyspnea between the ages of 20 to 50 and progressively develop chronic obstructive pulmonary disease (COPD) prematurely, which is expedited by cigarette smoking should make you think of what disease?

A

Alpha1-antitrypsin deficiency is a genetic condition of variable severity in which the alpha1-antitrypsin enzyme is inadequate to prevent the neutrophil elastase enzyme from damaging alveoli and resulting in liver and lung disease

Xray findings = basilar bullae

260
Q

Hypertension + epigastric bruit in younger patient should make you think of what diesease?

A

Renal artery stenosis causing secondary hypertension

When the hypertension is resistant to three or more drugs, when epigastric or renal bruits are noted on physical examination, when there is atherosclerotic disease in the aorta or peripheral arteries, or when there is an increase of >50% in serum creatinine after an ACE inhibitor is initiated. It is commonly caused by fibromuscular dysplasia in young women.

261
Q

First line therapy for alcohol use disorder

A

Naltrexone is first-line therapy

Blocks the opiate receptors in the brain that are involved in the reward effects of drinking and the craving for alcohol

This medication may be started without first having an extended period of alcohol abstinence and will allow the patient to gradually cut back on alcohol use, which is his stated goal.

262
Q

First line tx for outpatient pyelonephritis

A

Cipro

263
Q

Initial tx of benign prostatic hyperplasia with lower urinary tract symptoms (LUTS)

A

Alpha-blockers

The initial therapy in these patients is alpha-blockers such as terazosin or tamsulosin. These medications relax smooth muscle and help improve urinary flow.

5a-reductase inhibitors such as finasteride could be used as an alternative treatment in patients with LUTS secondary to BPH who cannot tolerate alpha-1 blocker

264
Q

First line tx for cystocele

A

Pessary

This patient has a cystocele. A pessary is a plastic or silicone device that is used to support pelvic organs when they have prolapsed. This device, as well as pelvic floor strengthening exercises, are the mainstays of conservative management for a cystocele.

265
Q

Posterior cervical lymphadenopathy should make you think of which diagnosis

A

Epstein-Barr virus, or human herpesvirus 4, is the causative agent of mononucleosis, a self-limited infection characterized by fatigue, pharyngitis, lymphadenopathy, and fever

Posterior cervical lymphadenopathy is particularly characteristic of mononucleosis. About half of patients with active infection will also have splenomegaly and must be advised to avoid contact sports until resolution as the spleen can rupture

266
Q

Biggest risk factor for TIA

A

Smoking

267
Q

Where does SCC generally present on xray

A

Proximal bronchus

Squamous cell carcinoma (SCC) is a type of non—small-cell lung cancer that tends to affect males and is strongly associated with smoking. This type of carcinoma tends to present centrally and with cavitation and cause symptoms of cough, dyspnea, hemoptysis, and wheezing. Hypercalcemia is a commonly associated paraneoplastic syndrome. Despite his risk factor of smoking, history of exposure to mineral/metal particles is also a risk for SCC which this patient has as he is a retired miner.

268
Q

First line tx for IBS?

A

For patients with symptoms of irritable bowel syndrome, dietary measures along with psychological support are appropriate first-line therapy. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols; these foods include wheat, onions and some fruits and vegetables.

269
Q

Hilar lymphadenopathy is a hallmark finding in initial diagnosis of

A

TB

Later in the disease process, caseating granulomas will calcify, known as a Ghon focus, is usually noted to the middle portion of the lungs.

270
Q

First line tx for fibromylagia

A

Duloxetine

Fibromyalgia is a chronic neurosensory disorder characterized by fatigue, poor sleep, cognitive dysfunction, and diffuse musculoskeletal pain that seems to be caused by a hypersensitivity to pain as well as dysfunction of several neurotransmitters and pathways; it most commonly affects females. It is a diagnosis of exclusion, and laboratory studies are usually within normal limits. A regular exercise program and cognitive behavioral therapy are strongly recommended.

Duloxetine, pregabalin, and milnacipran are FDA-approved medications for the treatment of fibromyalgia.

Preferred over fluoxetine

271
Q

Pain with passive dorsiflexion of the foot, or the windlass test, is an expected finding in the physical exam of an individual with

A

Plantar fasciitis

272
Q

What is a bedside test used to diagnose myasthenia gravis

A

In patients with ptosis, the ice pack test can be used as a part of the neurologic examination. This tests works on the principle that neuromuscular transmission improves at lower muscle temperatures, and cooling of the eyelids can overcome ptosis in patients with myasthenia gravis

273
Q

First line tx of prostatitis in patient over 60

A

A fluoroquinolone, such as ciprofloxacin, should be used for treatment. Trimethoprim-sulfmethaxazole is also a reasonable option

274
Q

What is the most commonly affected muscle and is involved in the majority of groin muscle strains, likely because the site of origin has a low tendon-to-muscle ratio?

A

Adductor longus

275
Q

Translocation between chromosomes 9 and 22 results in a BCR-ABL1 oncogene; this finding is called the Philadelphia chromosome and is pathognomonic for

A

CML

276
Q

Most common leukemia in adults and is characterized by the proliferation of myeloid blasts

A

AML

277
Q

What is the biggest risk with home births and infants who are two to 12 weeks old who did not receive a vitamin K injection at birth

A

Late-onset vitamin K deficiency bleeding (VKDB) is a very serious condition. This commonly presents with intracranial bleeding and has a high mortality rate up to 50%

278
Q

Why is ferritin increased in anemia of chronic disease?

A

The patient has enough iron stores to make new red blood cells, but the inflammation prevents the iron stores from being used. Treatment largely lies in treating the underlying condition.

Often normocytic, normochromic anemia with high ferritin

279
Q

MCC of aseptic meningitis

A

Commonly caused by viruses that can also be caused by variety of non-infectious etiologies such as systemic illnesses like system lupus erythematosus or Behcet disease, medications such as NSAIDs or trimethoprim-sulfamethoxazole, and brucellosis

Lumbar puncture is performed, the opening pressure is usually normal with an elevated lymphocyte count; CSF glucose is normal, and CSF protein is usually mildly elevated or normal

280
Q

Fluctuating weakness that improves with rest and often affects the swallowing muscles, extraocular muscles, and limbs should make you think of which disease?

A

Myasthenia gravis

Tx = Pyridostigmine is a acetylcholinesterase inhibitor and would be the first-line treatment in order to prevent the breakdown of acetylcholine in the synapse

281
Q

Perihilar infiltrates are the common x-ray findings in patients with

A

PJP pneumonia

282
Q

Upper lobe cavitary lesions should cause suspicion for

A

Acute TB

283
Q

What is Addisons disease?

A

Primary adrenal insufficiency and causes deficiencies in adrenal androgens, glucocorticoids, and mineralocorticoids

Sx = Hyperpigmentation/bronzing of skin ;Hyponatremia and hyperkalemia are also common findings

284
Q

Which of the portions of the brain is most likely responsible for the initial regulation of TSH causing hyperthyroidism (graves)

A

Hypothalamus produces thyrotropin-releasing hormone (TRH). This then regulates secretion of thyroid-stimulating hormone (TSH) by the pituitary gland, which regulates secretion of T4/T3 by the thyroid gland

285
Q

Tx of acute alcoholic hepatitis

A

Prednisolone

Prednisolone is preferred over prednisone, as it does not require metabolism in the liver. If steroids are contraindicated due another medical issue (ex. active GI bleed, uncontrolled diabetes, active infection), pentoxifylline should be used

286
Q

What are the MC organisms seen in hospital acquired pneumo?

A

Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa

287
Q

Common electrolyte findings in a patient taking HCTZ

A

Common side effects include hypercalcemia, as noted in this patient, as well as hyponatremia, hypokalemia, hyperuricemia, and hyperglycemia

288
Q

What is the difference between 5-alpha reductase inhibitors and Phosphodiesterase-5 inhibitors?

A

5-Alpha-reductase inhibitors such as finasteride and dutasteride are commonly used to treat benign prostatic hyperplasia. This patient has erectile dysfunction and would benefit from phosphodiesterase-5 inhibitors such as sildenafil and tadalafil

Phosphodiesterase-5 inhibitors such as sildenafil and tadalafil, among others, are the appropriate management for erectile dysfunction. This patient is over 40 years of age and has diabetes mellitus, which is a risk factor for erectile dysfunction

289
Q

Fibromylagia is associated with which GI condition?

A

Irritable bowel

As well as anxiety and depression. Studies have shown patients to have an increased incidence of GERD when compared with the general population

290
Q

ST elevation in leads V1 through V4 correlates to what location and which artery?

A

Anterior - Left anterior descending

NICOLE - Pance (2 decks)

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