Random/Questions from 300 question exam Flashcards
At what age are males screened for dyslipidemia if no risk factors?
All males 40-75
25 if risk factors which include obesity, smoking history, hypertension, Type 2 diabetes and a family history of cardiovascular disease.
When does colon cancer screening for low risk individuals begin?
Colonoscopy at age 50
How do you differentiate conduct disorder from oppositional defiance disorder?
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
What is the best initial medication for african american male after no improvement with lifestyle modifications?
First line = CCB or diuretic
Amlodipine often first line
Tibial tubercle tenderness should prompt you to think of which disease (average age 10yo)
Osgood Schlatter disease = Tibial apophysitis. Seen in adolescents with growth spurts and overuse
What are the rule of 9s?
Anterior torso = 18% (chest + abdomen)
Arms = 9% (front 4.5% + back arms 4.5%)
Full leg = 9%
Perineum = 1%
Hands = 1%
MCC bacteria involved in postop surgical site infections
Staph aureus
What population is most at risk for spontaneous pneumothorax?
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
How does coal worker’s pneumoconiosis present?
Small opacities in the upper lung fields
How does silicosis present?
Small round opacities throughout lung fields, calcified lymph nodes
What are common xray findings associated with asbestososis?
Interstitial fibrosis and thickened pleura
What is the test of choice to confirm diagnosis of intussception?
Barium enema is diagnostic and therapeutic
What is the best test to confirm bladder cancer?
Cystoscopy + biopsy has rate of almost 100% and is definitive diagnostic procedure
What is the salter- harris classification
S- Slipped
M- Metaphysis
A- Articular
C - Complete
K - Krushed
What is the MC type of kidney stone? What is the MC type of infected kidney stone associated with UTIs and urease-producing bacteria?
Calcium oxylate
MC infected = Struvite stones
Which congenital abnormality is commonly associated with tracheoesophageal fisula?
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
What is the medication of choice for those who desire medication for insomnia during pregnancy
Doxylamnie = Unisom
Benadryl
*melatonin isnt studied significantly to recommend
First line tx for pertussis?
Zpack = Azithromycin
Alternative = Bactrim
Vertigo lasting one minute or less and are provoked by head movements; “room is spinning”
BPPV -
Dx = Dix hallpike
Tx = epley maneuver
*Due to calcium debris within the posterior semicircular canals
What are the MCC of acute respiratory distress syndrome?
Sepsis, multiple trauma, aspiration of gastric contents = 75% of cases
Signs and symptoms of acute respiratory distres syndrome?
Tachypnea, dyspnea, frothy pink or red sputum, diffuse crackles, hypoxemia that doesn’t respond to O2
Short stature, webbed neck, prominent ears, low posterior hairline, broach chest with widely spaced nipples should indicate which syndrome?
Turner syndrome (monosomy x)
Which leads are posterior?
V1, V2
Which leads are anterior?
V1-V3; Artery = Left anterior descending
Which leads are lateral?
I, AVL, V5, V6; Circumflex artery
What is the most likely complication associated with Kawasaki disease?
Coronary artery aneurysm = occurs in 25% of cases
Radiographs of what area are best for evaluating bone age?
Distal radius
Ossifications of the hand and wrist including the distal radius are the most predictable and sensitive for determining bone age
What is first line medication for social phobias>
SSRI - first line for social phobias
Short term benzo or TCA are less effective
Idiopathic adolescent scoliosis should be monitored based on curve of degree. How often should 10-15 degrees be monitored? 15-20? 20 or greater?
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)
Which type of lung cancer has the most aggressive clinical course, is likely to spread early, and is rarely amenable to surgery?
Small cell lung cancer
What is the test to confirm celiac disease?
Initial test = IgA antiendomysial and anti-TTg antibodies
Confirm with small bowel biopsy
What does a positive (HBsAg) indicate?
Ongoing infection of any duration
What does a positive (anti-HBs) indicate
Immunity by past infection or vaccination
What does a positive Hep B core antibody (anti-HBc) indicate
Acute hepatitis
What does a positive hep b envelope antigen indicate (HBeAg)
Indicates active infection that is highly contagious
MC type of shoulder dislocation?
Anterior = MC
If seizure or electrocution is involved = Posterior
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
Wilms tumor
Transmural inflammation is associated with UC or Crohns?
Crohns
MC location terminal ileum
String sign seen on barium xray
Passage of intestine through the internal ring down the inguinal canal describes what type of hernia?
Inguinal hernia
Indirect = passage through INTERNAL inguinal ring
Direct - Passage through external ring at hesselbachs triangle
What is charcots triad vs reynold pentad?
RUQ pain, jaundice, fever
Pentad includes hypotension + AMS
Hip dysplasia occurs is MC in what population?
Increased incidence in firstborn infants
Unequal thigh folds on exam due to ligament laxity
Herpangina is caused by what virus? What other disease does this virus cause?
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
If a baby <3 weeks contracts pneumonia, what is the MCC?
Group B strep
E.Coli
Chlaymydia
If a baby 3 weeks -3 months contracts pneumonia, what is the MCC?
Bacterial = Strep pneumo
If a preschool child (4yo) contracts pneumonia, what is the MCC?
Virus = RSV, parainfluenza, influenza
What is the MCC of atypical pneumonia in age 5 and up?
Mycoplasma pneumonia
What cervical myotome affects the biceps and flexion of the arm?
C6
What cervical myotome affects the triceps and extension of the arm?
C7
What cervical myotome affects the interossei including the thumb?
C8
What cervical myotome affects the deltoid and aBduction of the arm?
C5
Which type of insulin has an onset of 30-60min, peaks around 2 hours, and lasts 6-8 hours?
Regular insulin
Which type of insulin has a rapid onset of 5-15 minutes, peaks at 60-90 min and lasts 3-4 hours?
Lispro aka Humalog or Novolog
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?
NPH (Humalin)
What clotting factors are inhibited by warfarin?
2, 7, 9, 10
Warfarin inhibits the vitamin K dependent synthesis of these
Hodgkins disease is diagnosed by the presence of which cells?
Reed-sternberg
JAK-2 mutation is a diagnostic for what?
Primary polycthemia vera
Auer rods are associated with what?
AML
G6PD is x-linked recessive disorder which causes chronic hemolysis and is associated with what cells?
Heinz bodies
If a patients father was diagnosed with colorectal cancer at 45, at what age should that patient recieve their first colonoscopy?
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
What is the cause of increased risk of preeclampsie?
Multifetal gestation (twins), nulliparity, advanced maternal age, AA race, obesity
Which drugs have an effect on the INR of a patient taking Warfarin?
TMP.Sulfa = Bactrim
Metronidazole
Fluconazole
Sudden, unilateral painless blurry vision or vision loss
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
What are retinal findings associated with retinal vein occlusion?
Venous hemorrhage, disc swelling, cotton wool spots, dark, dusky retinal background
DM and HTN are risk factors
MCC of overuse injury of the elbow
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
Which vaccines are contraindicated in an immunosupressed patient?
Live vaccines such as MMR
Which type of meningitis presents with an increased opening pressure, increased cell count, decreased glucose, and increased protein?
Bacterial meningitis = Strep pneumo
Patient has barky cough and cxr revelas subglottic tracheal narrowing, what is the most likely diagnosis?
Laryngotracheobronchitis aka CROUP
“Steeple sign” on CXR
Renal artery stenosis is the MC 2ndary cause of HTN, but what are some other causes?
Pheochromocytoma
Cushings
Hyperthyroid
Hyperaldosteronism
Chronic steroid use
Estrogen use
OSA
Coarctation of Aorta
Describe PCN mechanism of action?
Inhibits cell-wall synthesis
What is a common side effect of statin therapy?
Muscle pain (myalgias) rarely patients will develop rhabdo
Which cardiac marker initially rises in 1-4 hours, peaks at 6-7 hours and returns to normal after 24hours?
Myoglobin
What is the first line tx for endometritis (most likely developed a few days postpartum, patient will have pelvic pain + fever)
Clindamycin and gentamicin
Ampicillin can be added if there is no response and metronidazole added if patient is septic
Which medication lowers blood glucose by slowing gastric emptying, stimulating pancreatic insulin response to glucose and reducing glucagon release after meals?
Liraglutide (victoza/saxenda) which is a GLP-1
How do DDP-4 inhibitors (aka -gliptans) work?
Reduce the breakdown of endogenous GLP-1; Work similarly to GLP-1s but do not have the higher effect on gastric emptying
A lesion present on the right optic tract posterior to the optic chiasm will have what effect?
Left homonymous hemianopsia
An elevated BUN to creatinine ratio >20:1 indicates what?
Prerenal cause of acute renal failure most likely due to hypovolemia, hypotension, HF, aortic aneurysm, renal artery stenosis
Is cystic fibrosis autosomal dominant or recessive?
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)
Which vaccine significantly decreased the incidence of epiglottitis?
Hib (haemophilus influenza type B)
Patients w/ epiglottitis present with “tripoding”, fever, drooling
Thumb sign on lateral soft tissue xray
EKG findings of a RBBB and ST elevation in leads V1-V3 should may you think of what diagnosis?
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
If a 20yo sexually active female presents for wellness exam, what is recommended?
Chlamydia/Gonorrhea screening
*Pap smear not recommended until age 21 regardless of sexual activity and every 3 years after
Which test is used to determine cortisol excess in patients suspected of having Cushings syndrome?
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
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?
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
What are signs/symptoms of lower motor neuron lesions?
Hyporeflexia, absent Babinski, weakness, muscle atrophy
*Lower motor neuron symptoms are caused by Guillain Barre or spinal radiculopathy
What are signs/symptoms of upper motor neuron lesions?
Hyperreflexia, positive Babinski, spastic weakness
*Upper motor neuron symptoms are caused by multiple sclerosis or cerebral palsy
The Centor criteria is used in diagnosing strep pharyngitis, what are the 4 criteria?
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
Which antiarrhythmic inhibits conversion of T4 to T3?
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
Which labs are increased in acute pancreatitis?
Serum lipase
Often liver enzymes are indicating biliary obstruction (gallstone, MCC)
Patellar reflex is caused by stimulation of which nerve roots?
L3/L4
Topical anesthetic agents are MCC of methemoglobinemia which causes which symptoms?
Cyanosis, low pulse ox, normal ABG
Check a methemoglobin level
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
Aseptic necrosis or avascular necrosis
MRI = preferred imaging
Crescent sign = linear area of subchrondral lucency
MCC of first trimester pregnancy losses?
Congenital abnormality
If acetaminophen overdose is suspected and patient is alert and vitals are normal, how should the patient be managed?
Obtain immediate acetaminophen levels and if normal repeat in 4 hours
If overdose and patient is symptomatic tx = acetylcysteine (NAC)
What is the treatment for PDA?
Indomethacin = treatment
If pt is going to have surgery and we want to keep it open use prostaglandin E1 to maintain patency
What type of hernia is more prevelant in females and is highly susceptible to incarceration?
Femoral hernias
Bullous myringitis and cold agglutinins is associated with which type of pneumonia?
Mycoplasma
What is the treatment of choice for treating cystitis in pregnant female?
Nitrofurantoin
What is the initial tx of dacrostenosis?
Digital massage
If symptoms persist longer than 6-10 months lacrimal duct probing can be performed
What physical exam findings would raise suspicion in abuse in a child?
Abdominal bruising = most suspicious
Boxer fracture is fracture of what?
Metacarpal neck fracture
Common in patients punching a wall
*5th metacarpal is MC affected
Tx = Ulnar/Gutter splint
What lab finding is most consistent with B12 deficiency?
Elevated MCV (Macrocytic anemia)
Other findings could include thrombocytopenia, low WBC, low reticulocytes
What is the MC bacteria associated with dog bites?
Pasteurella
Eikenella is MC associagted with what type of bite?
Human
Bartonella bacteria is MC associated with what type of bite?
Infected cats
When is there a surge in LH for a female with a 28 day menstrual cycle?
Day 12
24-36 hours after the LH surge, follicular rupture occurs releasing oocyte from follicle at the surface of the ovary (ovulation)
What is the MOA of metformin?
Decrease hepatic glucose production and increase peripheral uptake
What is the MOA of SLG-2? (-Flozins)
Lower renal glucose threshold and increase glucose excretion in urine
FLO = Increased risk of UTI
What is the treatment of chlamydia/gonorrhea?
Azithromycin 1000mg single dose and doxycycline 100mg BOD for 7 days
8mm TB reaction in a patient with an HIV would be positive or negative?
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
Diagnostic study to confirm PE?
Chest CT
Most common fracture after FOOSH?
Colles = Distal radius fracture
Colle = Dog = Distal
Smith = opposite Colle
Which ligament is injured in a gamekeeper’s thumb?
Ulnar collateral ligament
When testing for accomodation, what is the expected result?
As the person shifts gaze from far object to a near object, pupils constrict
What happens in all phases of clinical trials?
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
What are symptoms of Parkinsons caused by?
Imbalance of dopamine and acetylcholine
Degeneration of substantia nigra
DX - Clinical; MRI not needed but may be helpful in identifying structural lesions
Which test is helpful in diagnosing De Quervains tendinopathy?
Finklestein - Thumb into hand, pressure on wrist causes pain
Which test is used to assess for blood flow in hands?
Allens test
Tinel and Phalens test evalute what?
Carpal tunnel
What is the MC innocent murmur of early childhood?
Stills murmur
Heard between ages 2-7
Severe attack of orbital, supraorbital, or temporal pain accompanied by restlessness or agitation, what type of HA?
Cluster = Pain begins quickly reaches a crescendo within minutes
What sign is associated with idiopathic intracranial hypertension (aka pseudotumor cerebri)
Papilledema
What lab finding is suggestive of subclinical hypothyroidism?
Elevated TSH and normal T4
What is first line treatment for primary dysmenorrhea?
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
What congenital abnormality presents with an absent or delayed femoral pulse when compared to brachial pulse?
Coarcation of aorta
Stable angina is defined as
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
When does the follicular phase begin?
Onset of menses and ends on the day before the LH surge
Progressive prolongation of PR interval culminating in a nonconducted P wave is what type of block?
Mobitz I
Inadequate drainage of aqueous humor and painful red eye
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
Ottawa ankle rules used to r/o fracture includes what 2 main rules?
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
25yo female with weight gain + depression, what lab should be checked?
TSH
Weight gain my be a symptom of hypothyroid + small percent of patients have depression
What is the role of Oxytocin in breastfeeding? What about Prolactin?
Oxytocin = milk ejection and flow
Prolactin = Increase during feedings but doesnt regulate milk production
What is a common heart med that should be monitored for hypokalemia?
Furosemide
What is a common finding on peripheral smear in a patient with extreme iron deficiency?
Poikilocytosis = abnormally shaped RBCs
For complicated abscess or patients with DM, what is the treatment?
I&D + abx (clindamycin)
What is the most common PE sign for appendicitis?
Rovsings = Rosings = Across abdomen (RLQ pain with palpation of LLQ)
Mcmurrays test is used in evaluation of what?
Meniscal tear
What does the Romberg test evaluate?
Loss of balance when eyes are closed to assess for neurological function
E.coli is what type (cocci, rod, negative, positive?)
Gram negative rods
Unilateral chest expansion should make you think of what diagnosis?
Pneumothorax
Also presents with decreased breath sounds on affected area, decreased tactile fremitus, hyperresonance to percussion
What impairs absorption of iron?
Calcium impairs
Vitamin C helps absorption
Which patients should not use stool DNA test for colorectal cancer?
Patients with hx of inflammatory bowel disease
Which condition presents commonly in patients with cystic fibrosis?
Bronchiectasis
Chronic cough, purulent sputum, hemoptysis, recurrent pneumonia
Hutchinsons sign presents as vesicles on tip or side of nose in herpes zoster, what cranial nerve does that affect?
5- Trigeminal nerve
Which lab value predicts severe pancreatitis with increased risk of mortality?
Glucose >250
Ransons criteria
Hernia of the bladder into the vagina causing a soft anterior fullness
Cyctocele
RF = pelvic organ prolapse from vaginal birth with pelvic floor injury, prior pelvic surgery, advancing age, straining, constipation
MC muscle entrapped in blowout fracture?
Inferior rectus
Causes limited ability for upward gaze
What vaccination can be given to infants prior to leaving the hospital after birth?
Hep B
What is the treatment for outpatient management of diverticulitis?
Metronidazole + Cipro
What type of fracture is associated with positive “fat pad” sign
Radial head
Most common congenital heart defect
VSD
What are the diseases associated with HLA-B27?
PAIR
P-Psoriasis/Psoriatic arthritis
A- Ankylosing Spondylitis
I-Inflammatory Bowel
R-Reactive arthritis
What is potential adverse effect of bisphosphonates
Osteonecrosis
Ptosis and weakness should make you think of which diagnosis?
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
MCC of postpartum hemorrhage
Uterine atony
Diagnosis of ADHD requires what?
Qualifying symptoms must be present in 2 or more settings (School and home)
What is an indication for induction of labor?
PROM - must occur within 24hr of membrane rupture
Contraindications:
Placenta previa or transverse lie are ABSOLUTE contraindications
Fetal macrosomia and oligohydroaminos are contraindications
Which joints are usually spared in RA?
DIP joints; Most commonly involves MCP and PIP joints
What are the main causes of hypermagnesium?
Supplementation
Laxatives
Antacids
Which antibiotic have a high risk of ototoxicity?
Aminoglycosides - Gentamicin
“cloudy” vision with halos around lights especially at night should make you think of what diagnosis?
Cataracts
On exam patients have absence of red reflex
Which lab value is associated with acromegaly?
IGF-1 Insulin growth factor
Gastrin secreting gastrinoma causing hypergastrinemia and acid hypersecretion
Zollinger-Ellison syndrome
High risk of peptic ulcers
Sx: Pts present with GERD symptoms + diarrhea
Elevated gastrin is most sensitive above 150
Pain, clicking, and locking sensation as well as pain with squatting should make you think of what diagnosis?
Mensical injury
MRI best diagnostic imaging
What are the biggest risk factors for stroke?
AV malformation and aneurysms = biggest risk for hemorrhagic stroke
Majority of CVAs are ischemic
What is the most significant treatable risk factor for stroke?
Hypertension
What arrhythmia increases risk of embolic stroke from a clot?
A.fib
How is natural menopause defined?
Absence of menses for 12 months with no pathologic cause
Estradiol and FSH are often measured to aid diagnosis but not required
Mid-systolic murmur that decreases with squatting
HOCM
Which murmur gets louder with standing from a squatted position and softer with valsava?
Aortic stenosis
Painless testicular swelling for 2 weeks
Testicular cancer
Order ultrasound
Huntington disease is what type of inherited disease?
Autosomal dominant
Philadelphia chromosome should make you think of what?
CML
Genetic abnormality of chromosome 22
In what disease would you see Bence jones proteins?
Multiple myeloma
Catecholamines are synthesized in the
Adrenal medulla
Catecholamines include: Dopamine, epinephrine, norepinephrine
A patient with a seizure disorder is noted to have gingival hyperplasia, which medication is most likely responsible?
Phenytoin
What is a potential complication of cryptorchidism?
Infertility
Chest pain that occurs at rest, not provoked by exercise, and is accompanied by transient ST segment elevation?
Prinzmetal angina
Intermittent focal spasms of a coronary artery, often associated with atherosclerotic lesions near the spasm site
MC of erectile dysfunction
Vascular disease - claudication
The best way to prevent rabies is
Postexposure prophylaxis
Nobody gets rabies vaccines unless they’re in a high risk occupation or area
Blowing holosystolic murmur along the lower left sternal margin which intensifies with inspiration and decreases with valsalva
Tricuspid regurg
Regurge = Blowing
Functional incontinence is described as:
Inability to get to the bathroom due to a physical or cognitive disability (patients with dementia)
Involuntary bladder contractions causes what type of incontinence
Urge
Increased intra-abdominal pressure causes which type of incontinence
Stress
Urinary retention and bladder distention causing overflow of urine through urethra is which type of incontinence
Overflow
Which stage of syphilis includes a painless ulcer on genital, perianal or rectal area?
Primary, this is a chancre
Which stage of syphilis includes a maculopapular rash (palms and soles), mucous membrane lesions, systemic inflammation?
Secondary which occurs a few weeks to 6 months later
What happens in latent syphillis?
Clinically inactive period without primary or secondary lesions
When does tertiary syphillis occur?
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
Most common neoplasm in men aged 20-35?
Testicular cancer
Painless testicular nodule
Red cell casts are seen on microscopy with which disease?
Poststrep glomerulonephritis
Patients often present with edema, hypertension, and occur 2-3 weeks post infection
What is the most likely cause of anemia in a patient with alcohol dependence?
Folate deficiency
Acid-fast bacilli is diagnostic of which condition?
TB
What is the best contraception method for a 42yo women with hx of hypertension and known coronary artery disease?
Depo because it has progestin and no estrogen
What is the MC diagnosed form of botulism?
Infant
Poor growth and bowing of legs should make you think of which diagnosis? What lab value would be elevated?
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
When is a hepatitis C screening recommended?
One-time screening for Hep C is recommended for anyone age 18 and over
MCC of painful thryroid gland
Subacute thryoiditis
Result of preceding viral infection in most cases
Tx = supportive
Newborns with PKU if not detected and treated with a phenylalanine-restricted diet will exhibit what?
Intellectual diasbility
What is the pathophysiology behind PKU
Decreased activity of phenylalanine hydroxylase which converts phenylalanine to tyrosine
Retrograde urine flow from bladder into kidneys which causes recurrent cystitis is caused by
Vesicoureteral reflux
Ohio + Mississippi river are associated with
Histoplasmosis
Which test evaluates LCL vs MCL?
Valgus = MCL
Varus = LCL
Which tests evaluated meniscal tears?
McMurray and Apley test
Complex pain syndrome symptoms
Autonomic and vasomotor instability causing chronic pain in affected limb following injury
Hand is most commonly affected
Less than 5th percentile for weight would be considered? What about 6-85%? Over 95th% is considered?
Under 5% = Underweight
6-85% = Normal weight
95% + = Overweight
What is associated with long bone and pelvic fractures and includes petechial rash?
Fat embolism syndrome
What are the cardinal movements of labor?
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Blue irises, long narrow protruding ears, large protruding jaw, flat feet, should make you think of which syndrome?
Fragile X
Platelet count less than 150,000 + elevated WBC should make you think of which diagnosis?
Acute leukemia
What differentiates parkinsons from essential tumors?
Essential tumor is most likely to be bilateral, postural, without co-occurring neurologic symptoms
Plasmodium falciparum is most likely to be resistant to which malaria drug?
Chloroquine
Which type of hernia passes through the internal ring and potentially into the scrotum
Indirect
What medication is appropriate treatment for hyperthyroidism in pregnancy?
PTU
Which alpha1 agonist is dosed twice daily in treatment of BPH?
Prazosin (short-acting)
70% of Guillain-barre symptoms are caused by what bacteria
Campylobacter jejuni
Diarrheal disease transmitted by contaminated or undercooked foot, person to person or fecal oral
What are contraindications for TPA management in stroke?
BP greater than 185/110
Intracranial bleeding
Amenorrhea and osteopenia are both seen in which eating disorder
Associated with anorexia
Patient with ASD is most likely to present with which symptoms?
Asymptomatic
Larger defects may cause dyspnea or heart failure
ASD = Left to Right shunting
Elevated alk phos and elevated antimitochondrial antibody test should make you think of which diagnsois
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
Which medication may falsely lower PSA levels?
Finasteride
How does pericarditis present on EKG?
Diffuse ST segment elevation
Delta wave is associated with what
WPW
Absent red reflex in a child is called?
Leukocoria = Urgent optho referral for Retinoblastoma
Which labs would help differentiate aplastic crisis from vasoocclusive crisis?
Reticulocyte count
P-P and R-R intervals are constant but the p wave may hide in the QRS which indicated what type of block
3rd degree block
If a 4cm abdominal aortic aneurysm is found what is the next step?
> 3cm is considered an aneurysm; Repeat ultrasound in one year
Rupture is rare for diameters <5cm
What are manic symptoms?
Flight of ideas, grandiosity, irritability, decreased need for sleep, pressured speech, distractibility, impaired judgement or psychomotior agitation
Which pathogens are considered “atypical” when discussing pneumonia
Mycoplasma, step pneumo, h.flu, moraxella catarrhalis
These lack a cell-wall therefore do not color with gram stain
Syphilis requires two types of tests for diagnsosi what are they?
If RPR is positive check FTA-ABS testing
Shortness of breath and wheezing with a failed trial of albuterol should make you think of which diagnosis?
Vocal cord dysfunction
Symptoms mimic asthma
Laryngoscopy is gold standard for diagnosis
MCC of hemolytic uremic syndrome?
E.coli
Also MCC of kidney injury in children
Which hypertensive medication must be tapered when discontinued?
Beta-blockers - can cause rebound hypertension
At 20 weeks where is the uterus?
12 weeks palpable at pelvic rim
20 weeks = umbilicus
1inch above umbilicus every week following
A rust ring on the cornea from a metallic foreign body can cause permanent staining, how do you remove it?
Rotating burr
Acute otitis media treatement
Amox
Donut-shaped protrusion of mucosal tissue
Urethral prolapse
Common in prepubertal girls which may cause bleeding, dysuria, difficulty urinating
Diabetes insipidus is excessive production in dilute urine and is associated with
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
Unstable patient with pneumothorax treatment?
Needle decompression on the side with absent lung sounds
Flaggellated motile organisms is associated with which STD
Trich
Main difference between HHS and DKA
SEVERELY elevated plasma glucose (900s)
Tx = Volume replacement and insulin
MCC of hypercalcemia in adults
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
What type of pituitary tumor causes weight loss and palpitations?
TSH-secreting adenomas present with symptoms of hyperthyroidism including weight loss and palpitations. On physical exam, patients may have arrhythmias, tremor, or goiter
SIADH causes an elevation in which lab value and a decrease in another?
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.
Tx of choice for patients with OA and hx of gastric bleeds
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
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?
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
Cataplexy, an event where an emotional trigger causes a sudden decrease or loss of voluntary muscle tone, this is highly suggestive of which diagnosis?
Narcolepsy
MCC of cellulitis
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.
N. meningitidis and S. pneumoniae are the most common causative pathogens in bacterial meningitis, what is the first line tx?
Until the causative organism is confirmed, empiric therapy with vancomycin and ceftriaxone should be administered
What is the MC pathogen in reactive arthritis?
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
What is the first step in management of a patient with PAD with decreased ABI?
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
For symptomatic patients who are not surgical candidates due to age or comorbidities, what is the tx of cholelithiasis if stonesare less than 5mm?
Oral dissolution therapy with ursodeoxycholic acid is appropriate if they have a functioning gallbladder and small stones (<5 mm)
Initial study for secondary menorrhea?
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
What is first line tx in a pt with polycythemia vera?
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.
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
Alcoholic liver disease + esophageal varices if vomiting blood
Symptomatic = EGD
What is the primary MOA of oral contraceptive pills
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
Elevated liver function tests and high triglycerides in a patient that does not drink alcohol, should make you think of what diagnosis?
Nonalcoholic fatty liver disease
Must rule out viral hepatitis early in the workup
Fever, malaise, headache, orchitis, and parotitis should make you think of which diagnosis?
Mumps
Usually in patients from foreign countries who are unvaccinated
Treatment = Self-resolving + Supportive
Smudge cells, or basket cells, are ruptured lymphocytes commonly found
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.
A digital rectal examination would most likely show an enlarged, nontender, firm, and smooth prostate would most likley be what diagnosis?
BPH
Anything other than that on exam should make you suspicious of malignancy
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?
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
Hypertension + epigastric bruit in younger patient should make you think of what diesease?
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.
First line therapy for alcohol use disorder
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.
First line tx for outpatient pyelonephritis
Cipro
Initial tx of benign prostatic hyperplasia with lower urinary tract symptoms (LUTS)
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
First line tx for cystocele
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.
Posterior cervical lymphadenopathy should make you think of which diagnosis
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
Biggest risk factor for TIA
Smoking
Where does SCC generally present on xray
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.
First line tx for IBS?
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.
Hilar lymphadenopathy is a hallmark finding in initial diagnosis of
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.
First line tx for fibromylagia
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
Pain with passive dorsiflexion of the foot, or the windlass test, is an expected finding in the physical exam of an individual with
Plantar fasciitis
What is a bedside test used to diagnose myasthenia gravis
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
First line tx of prostatitis in patient over 60
A fluoroquinolone, such as ciprofloxacin, should be used for treatment. Trimethoprim-sulfmethaxazole is also a reasonable option
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?
Adductor longus
Translocation between chromosomes 9 and 22 results in a BCR-ABL1 oncogene; this finding is called the Philadelphia chromosome and is pathognomonic for
CML
Most common leukemia in adults and is characterized by the proliferation of myeloid blasts
AML
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
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%
Why is ferritin increased in anemia of chronic disease?
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
MCC of aseptic meningitis
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
Fluctuating weakness that improves with rest and often affects the swallowing muscles, extraocular muscles, and limbs should make you think of which disease?
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
Perihilar infiltrates are the common x-ray findings in patients with
PJP pneumonia
Upper lobe cavitary lesions should cause suspicion for
Acute TB
What is Addisons disease?
Primary adrenal insufficiency and causes deficiencies in adrenal androgens, glucocorticoids, and mineralocorticoids
Sx = Hyperpigmentation/bronzing of skin ;Hyponatremia and hyperkalemia are also common findings
Which of the portions of the brain is most likely responsible for the initial regulation of TSH causing hyperthyroidism (graves)
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
Tx of acute alcoholic hepatitis
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
What are the MC organisms seen in hospital acquired pneumo?
Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa
Common electrolyte findings in a patient taking HCTZ
Common side effects include hypercalcemia, as noted in this patient, as well as hyponatremia, hypokalemia, hyperuricemia, and hyperglycemia
What is the difference between 5-alpha reductase inhibitors and Phosphodiesterase-5 inhibitors?
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
Fibromylagia is associated with which GI condition?
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
ST elevation in leads V1 through V4 correlates to what location and which artery?
Anterior - Left anterior descending
