Random Subject Review Part III Flashcards
1
Q
indications for carotid endarterectomy
A
70 - 99% stenosis symptomatic
80 - 99% stenosis asymptomatic
2
Q
most common leukemia in children (peak age 3-4)
A
ALL
3
Q
most common leukemia in adults (average age of onset 50)
A
CLL
4
Q
philadelphia chromosome is almost always seen in this leukemia
A
CML
5
Q
smudge cells on peripheral smear
A
CLL
6
Q
peripheral blasts are PAS+ and TdT+
A
ALL
7
Q
peripheral blasts are PAS-, myeloperoxidase+, and have Auer rods
A
AML
8
Q
pancytopenia in a Down syndrome patient
A
ALL
9
Q
next step in management of testicular torsion confirmed with US
A
external manipulation followed by surgical pinning bilaterally
10
Q
causes of hypovolemic hyponatremia
A
diuretic use, vomiting, addison’s disease, ACE-I use, fluid sequestration
11
Q
diagnosis: fever, rash, elevated creatinine, eosinophilia
A
acute interstitial nephritis
12
Q
what distinguishes primary biliary cirrhosis from primary sclerosing cholangitis
A
PBC: females, anti-mitochondrial antibodies, intrahepatic duct disease
PSC: males, P-ANCA, intra/extrahepatic duct disease, ERCP “beads on a string”
13
Q
treatment for Whipple disease
A
TMP-SMX x 1 year
14
Q
HBsAg negative
HBsAb negative
HBcAb positive
A
“window period” of acute hepatitis B infection
15
Q
HBsAg positive
HBsAb negative
HBcAb positive
A
chronic hepatitis B infection
16
Q
HBsAg negative
HBsAb positive
HBcAb negative
A
immunized for hepatitis B
17
Q
HBsAg negative
HBsAb positive
HBcAb positive
A
past hepatitis B exposure
18
Q
differential diagnosis for ground-glass infiltrates on CXR
A
interstitial pneumonia, PCP, pulmonary edema (CHF, ARDS) pulmonary hemorrhage, hypersensitivity pneumonitis
19
Q
medication used to close a PDA
A
indomethacin
20
Q
complications arising from electrical burns
A
visceral damage, cardiac dysrhythmias, compartment syndrome, myoglobinuria, bony injuries, various neurologic disturbances
21
Q
eye abnormality seen in lesion to oculomotor nerve
A
down and out, fixed and dilated (interruption of parasympathetics)
22
Q
differing presentations of alzheimer’s dementia, pick’s disease, and lewy body dementia
A
alzheimer’s: most common cause
pick’s: personality changes
lewy body: visual hallucinations, parkinsonian symptoms, unexpected falls
23
Q
diagnosis and management: 55-year-old man has sudden onset of pain in first metatarsophalangeal joint after a night of drinking red wine
A
gout, aspirate joint to find negatively birefringent needle shaped crystals
treat acute exacerbation with colchicine, NSAIDs
treat chronically with prebenicid, colchicine, or allopurinol
24
Q
patient with history of lithium use presents with copious amounts of dilute urine
A
nephrogenic diabetes insipidus
25
most common pituitary tumor and what is the treatment
prolactinoma
dopamine agonist (bromocriptine)
ocreotide or transphenoidal resection
26
diagnosis: male with testicular mass is found to have elevated beta-hCG
testicular choriocarcinoma
27
cardinal movements of labor
engagement, distent, flexion, internal rotation, extension, external rotation, expulsion
28
50 year-old female smoker presents with hematuria
bladder cancer
29
30 year-old female African immigrant presents with hematuria
schistosoma infection
30
therapies used for polycystic ovarian syndrome
weight loss, OCPs (to avoid hyperestrogenism), spironolactone, metformin
31
what type of bone fracture is most likely to result from falling on outstretched hand
```
colles fracture (distal radius fracture)
common in osteoporosis
```
32
two-month-old with projectile, nonbilious emesis, what is the first step in management
pyloric stenosis, correct metabolic abnormalities first
| ultrasound to find hypertrophied pyloric muscle, surgical myomectomy
33
16-year-old female has left arm paralysis after her boyfriend dies in a car crash, no medical cause is found
conversion disorder
34
patient presents to the ER after an MVA with hypertension, bradycardia, and abnormal respirations, what is the next step after ABCs
cushing's triad of elevated ICP
| elevate bed, hyperventilate, give mannitol, consult neurosurgery
35
normalizing PCO2 in a patient having an asthma exacerbation may indicate what problem
fatigue and impending respiratory failure
36
patient has dyspnea, hilar lymphadenopathy on CXR, and hypercalcemia
sarcoidosis
37
chvostek's and trousseau's signs
tap on face and tap on wrist
| hypocalcemia spasms
38
young patient whose father died at age 30 in an MVA suddenly collapses and dies while exercising
hypertrophic cardiomyopathy
39
diagnosis: gynecologic exam of a postmenopausal woman reveals inflammation and epithelial thinning of the anogenital area
lichen sclerosis
40
diagnosis and management: IV drug user has JVD and holosystolic murmur at left sternal border
bacterial endocarditis with tricuspid regurgitation
treat heart failure, replace tricuspid valve
4-6 weeks IV vancomycin
41
classic ECG finding in pericarditis
low voltage diffuse ST segment elevation
42
renal tubular acidosis associated with abnormal bicarbonate and rickets
RTA type II
43
treatment for neuroleptic malignant syndrome
dantrolene, stop offending agent
| also can use dopamine agonist like bromocriptine
44
child has flesh-colored, umbilicated lesions on the face, what are these lesions and where do they appear in adults
molluscum contagiosum, in genital or perianal region in adults
45
medication used more than any other in the treatment for parkinsons
levo-dopa with carva-dopa
46
diagnostic test differentiates central from nephrogenic diabetes insipidus
desmopressin stimulation test and measure urine osmolality
47
post-op patient with significant pain presents with hyponatremia and normal volume status, what is the diagnosis
SIADH due to stress
48
elderly female presents with pain and stiffness of the shoulders and hips, cannot lift arms above her head, lab shows elevated ESR
polymyalgia rheumatica
49
child presents with oliguria, petechias, and jaundice following an illness with bloody diarrhea, what is the most likely diagnosis and infectious cause
HUS from enterohemorrhagic e. coli
50
11-year-old boy with fever, weight loss, and night sweats, radiology reveals anterior mediastinal mass, what do you suspect, what would you suspect if the patient was 30 years old
non-hodgkin's lymphoma, suspect hodgkin's lymphoma if 20-40 or > 60
51
prophylactic medication indicated in HIV patient w/CD4 less than 100
TMP-SMX for PCP prophylaxis
| azithromycin for MAC prophylaxis
52
most common testicular cancer
seminoma
53
child presents with palpable purpura on the legs, abdominal pain, and arthritic pain in numerous joints, what is the diagnosis and treatment
henoch-schloein purpura
treatment: self-limited, may use steroids for severe GI symptoms
54
anti-centromere antibodies
CREST scleroderma
55
diagnosis: hyperphagia, hyperorality, hyperdocility, and hypersexuality
kluver-bucy's syndrome, bilateral amygdala lesion
56
diagnosis: after a minor accident, a woman wears a neck brace and requests permanent disability
malingering
57
what medication is given to accelerate fetal lung maturity, for how long, and at what gestational age is it no longer necessary
betamethasone or dexamethasone (long acting steroids) prior to 34 weeks given for 48 hours
58
patients with silicosis are at higher risk for what type of infection
tuberculosis
59
diagnosis: patient has exopthalmos, pretibial myxedema, and a decreased TSH
grave's disease
60
diagnosis: PFTs show decreased FEV1/FVC
obstructive lung disease
61
postmenopausal female presents with vaginal bleeding for the last 5 days, what is the next step
endometrial biopsy
62
what type of lung cancer is associated with hypercalcemia
squamous cell lung cancer
63
blood cell pathology associated with EBV in africa
burkitt's lymphoma
64
blood cell pathology associated with reed-sternbeg cells, cervical lymphadenopathy, and night sweats
hodgkin's lymphoma
65
blood cell pathology associated with bence-jones proteins, osteolytic lesions, high calcium
multiple myeloma
66
blood cell pathology associated with translocation 14;18
follicular lymphoma
67
most common lymphoma in the US
diffuse large B-cell lymphoma
68
blood cell pathology associated with translocation 8;14
burkitt's lymphoma
69
blood cell pathology associated with translocation 9;22
philadelphia chromosome CML and less commonly adult ALL
70
blood cell pathology associated with "starry-sky pattern" due to phagocytosis of apoptotic tumor cells
burkitt's lymphoma
71
blood cell pathology associated with high H/H, pruritis, burning pain in hands or feet
polycythemia vera
72
blood cell pathology associated with hair-like projections and splenomegaly
hairy-cell leuekemia
73
classic features that distinguish orbital cellulitis from periorbital cellulitis
orbital cellulitis: pain with eye movement, proptosis, opthalmoplegia, double vision, decreased vision
74
in which patients is buproprion contraindicated
history of seizures, bulemics
75
treatment for serotonin syndrome
stop SSRI, benzo sedation
76
how is benign paroxysmal positional vertigo diagnosed and treated
classic history, worse when laying down, getting up
treatment: eply maneuver
77
treatment for acute angle-closure glaucoma
glaucoma drugs: mannitol, acetazolamide, beta-blockers, prostaglandins, alpha-adrenergic agonists, cholinergic agonists
78
antidote: anticholinesterases, organophosphates
atropine, pralidoxime
79
antidote: mercury
dimercaparol, succimer
80
antidote: carbon monoxide
100% or hyperbaric oxygen
81
antidote: heparin
protamine sulfate
82
antidote: isoniazid
pyridoxine (B6)
83
diastolic murmur heard best in left lower sternum that increases with inspiration
tricuspid stenosis
84
late diastolic murmur with an opening snap
mitral stenosis
85
systolic murmur heard best int he second right interspace
aortic stenosis
86
systolic murmur heard best in the second left interspace
pulmonic stenosis
87
late systolic murmur best heart at the apex
mitral prolapse
88
diastolic murmur with a widened pulse pressure
aortic regurgitation
89
holosystolic murmur louder with inspiration at left lower sternal border
tricuspid regurgitation
90
holosystolic murmur heart at the apex and radiates to the axilla
mitral regurgitation
91
blood cell pathology associated with EBV in africa
burkitt's lymphoma
92
blood cell pathology associated with reed-sternbeg cells, cervical lymphadenopathy, and night sweats
hodgkin's lymphoma
93
blood cell pathology associated with bence-jones proteins, osteolytic lesions, high calcium
multiple myeloma
94
blood cell pathology associated with translocation 14;18
follicular lymphoma
95
most common lymphoma in the US
diffuse large B-cell lymphoma
96
blood cell pathology associated with translocation 8;14
burkitt's lymphoma
97
blood cell pathology associated with translocation 9;22
philadelphia chromosome CML and less commonly adult ALL
98
blood cell pathology associated with "starry-sky pattern" due to phagocytosis of apoptotic tumor cells
burkitt's lymphoma
99
blood cell pathology associated with high H/H, pruritis, burning pain in hands or feet
polycythemia vera
100
blood cell pathology associated with hair-like projections and splenomegaly
hairy-cell leuekemia
101
classic features that distinguish orbital cellulitis from periorbital cellulitis
orbital cellulitis: pain with eye movement, proptosis, opthalmoplegia, double vision, decreased vision
102
in which patients is buproprion contraindicated
history of seizures, bulemics
103
treatment for serotonin syndrome
stop SSRI, benzo sedation
104
how is benign paroxysmal positional vertigo diagnosed and treated
classic history, worse when laying down, getting up
treatment: eply maneuver
105
treatment for acute angle-closure glaucoma
glaucoma drugs: mannitol, acetazolamide, beta-blockers, prostaglandins, alpha-adrenergic agonists, cholinergic agonists
106
antidote: anticholinesterases, organophosphates
atropine, pralidoxime
107
antidote: mercury
dimercaparol, succimer
108
antidote: carbon monoxide
100% or hyperbaric oxygen
109
antidote: heparin
protamine sulfate
110
antidote: isoniazid
pyridoxine (B6)
111
diastolic murmur heard best in left lower sternum that increases with inspiration
tricuspid stenosis
112
late diastolic murmur with an opening snap
mitral stenosis
113
systolic murmur heard best int he second right interspace
aortic stenosis
114
systolic murmur heard best in the second left interspace
pulmonic stenosis
115
late systolic murmur best heart at the apex
mitral prolapse
116
diastolic murmur with a widened pulse pressure
aortic regurgitation
117
holosystolic murmur louder with inspiration at left lower sternal border
tricuspid regurgitation
118
holosystolic murmur heart at the apex and radiates to the axilla
mitral regurgitation
119
what does fall in systopic BP > 10 mmHg with inspiration indicate
pulsus paradoxus seen with cardiac tamponade and COPD
120
laparoscopic findings seen in endometriosis
extra-uterine endometrial implants, "chocolate cysts"
121
hypertension, hypernatremia, hypokalemia, and metabolic alkalosis
hyperaldosteronism
122
LDL goal in patient diabetes
< 100
| if concurrent vessel disease, < 70
123
8 year-old child requires emergency blood transfusion, parents are not present, but child states that she is a jehovah's witness
treat child immediately, consent is implied
124
young man presents with pain and watery diarrhea after meals, exam shows fistulas between bowel and skin and nodular lesions on his tibias
crohn's disease
125
40-year-old female presents with discrete area of complete hair loss on the scalp that has worsened over weeks, what is the treatment
alopecia areata, often resolves on its own, or consider intralesional steroids
126
CSF analysis shows low glucose, elevated neutrophils, and gram positive diplococci
strep pneumo meningitis
127
characteristic findings in tertiary syphillis
loss of proprioception, gumma formation, argyl-robertson pupils, thoracic aortic aneurysm, aortic regurgitation
128
young child presents with thigh muscle weakness, waddling gait, and pronounced calf muscles
muscular dystrophy
129
diagnosis and management: female born in breech position is found to have asymmetric inguinal and gluteal skin folds on her newborn exam
developmental dysplasia of the hip, requires pavlik harness
130
seizure prophylaxis medication in severe preeclampsia
magnesium sulfate
131
cause of erythroblastosis fetalis
Rh hemolytic anemia of the newborn, maternal antibodies attacking fetal antigens
132
treatment of hypertension in pheochromocytoma
alpha-blocker and surgical resection
| never give a beta-bocker by itself
133
diagnosis and management: young boy with hemarthrosis, increased PTT
hemophilia, factor supplementation
134
diagnosis and management: tall, white male presents with acute shortness of breath
spontaneous pneumothorax
treatment: oxygen supplementation, will resolve on its own, if large, chest tube placement
135
diagnosis: 22-year-old male has 4 months of social withdrawal, worsening grades, decreased emotional expression, and concrete thinking
schizophreniform
136
diagnosis and management: honeycomb pattern on CT scan of the chest
diffuse interstitial pulmonary fibrosis, steroids, azathioprine/cyclophosphamide, N-acetylcysteine
137
diagnosis: young cihld has loss of the red light reflex
retinoblastoma
138
why is thiamine administered in glucose infusion to alcoholics with hypoglycemia
glucose infusion will worsen wernicke's encephalopathy
139
two most common primary brain tumors in adults
glioblastoma multiform, meningioma
140
three most common primary brain tumors in children
astrocytoma, medulloblastoma, ependymoma
141
medications and interventions for cerebral palsy
dantrolene, baclofen, boutlinum toxin to relax muscles
| exercise and physical therapy, surgery may relieve contractures
142
ACLS treatment for ventircular fibrillation
CPR, defibrillation with monophasic 360 or biphasic 200 followed by epinephrine (or vasopressin first dose)
143
vasopressor theoretically causes renal vasodilation
dopamine
144
vasopressor high doses optimize alpha-1 vasoconstriction
epinephrine
145
vasopressor ADH analogue
vasopressin
146
best vasopressor for anaphylactic shock
epinephrine
147
best vasopressor for septic shock
norepinephrine
148
best vasopressor for cardiogenic shock
dobutamine
149
vasopressor causes vasoconstriction with bradycardia
phenylephrine
150
next step in evaluating injuries in different zones of the neck
```
zone 1 (clavicle to cricoid cartilage): CT angiogram
zone 2 (cricoid cartilage to angle of the mandible): surgery
zone 3 (angle of the mandible upward): CT angiogram and triple endoscope
```
151
how can flushing reaction of niacin be prevented
aspirin
152
EKG finding seen in wolff-parkinson-white syndrome, what causes WPW
delta wave prior to QRS complex, caused by reentry through accessory conduction pathway
153
how does treatment of SVT due to WPW differ from treatment of SVT due to other causes
WPW: treat with procainamide, amiodarone
| other SVT: treat with adenosine
154
most sensitive and specific lab test for chronic pancreatitis
low fecal elastase
155
supplement to be given to women on anticonvulsants during pregnancy
folate 4 mg/day
| also vitamin K supplementation in last month to augment coagulability
156
next step in management of AGUS pap smear
colposcopy and ECC (endocervix likely where glandular cells are coming from)
if > 35, endometrial biopsy
157
first-line treatment for pediculosis pubis and pediculosis capitis
permethrin cream
158
immunodeficiency suspected in patient with recurrent infections, thrombocytopenia, and eczema
wiskott-aldrich syndrome
159
what causes a cild to have mental retardation, microcephaly, short palebral fissures, midfacial hypoplasia, and cardiac defects
fetal alcohol syndrome
160
management: 18 year-old female with no history of abnormal paps now has a first-time ASCUS pap
follow-up pap smear in 6 months - 1 year
in a non-adolescent, perform HPV screening and repeat pap smear in 6 months
161
treatment for clavicle fracture
very conservative management, figure-of-eight or sling, do not treat clavicle fractures at birth, physical therapy okay if associated with erb's palsy
162
diagnosis: 40 year-old female has persistent erythema on her nose and cheeks with recurrent facial flushing especially with alcohol and spicy foods
rosacea
163
diagnosis: patient with cirrhosis presents to ER to have ascites drained, fluid reveals an absolute neutrophil count > 250
spontaneous bacterial peritonitis
164
diagnosis and management: otoscopy in child presenting with acute onset of ear pain reveals large, reddish vesicles on the tympanic membrane
bullous meringitis caused by mycoplasma
treatment: oral macrolides
165
treatment for pilonidal cyst
I&D
166
treatment for rectal fistula
fistulotomy
167
diagnosis: patient on isotretinoin for acne begins to develop daily, persistent, pulsatile headaches, exam reveals papilledema
pseudotumor cerebri
168
18-year-old male found to have systolic heart murmur heard at apex and left lower sternal border, increases in intensity while standing after squatting
hypertrophic cardiomyopathy
169
disorder that classically presents with triad of cognitive impairment, urinary incontinence, and abnormal gait
normal pressure hydrocephalus
170
underlying cause of late fetal decelerations on contraction stress test
uteroplacental insufficiency
171
treatment: middle-aged man presents with knee pain and x-ray reveals bilateral calcifications of the articular cartilage
pseudogout treated with NSAIDs or colchine
172
next step in management of a positive PPD
CXR to look for active infection, INH + B6 for 9 months if no active infection, if active then RIPE therapy
173
25-year-old male diagnosed with solid testicular mass by ultrasound, what is the next step in management
do not biopsy, just remove the mass
174
teenager on antibiotics for acne presents with severe sunburn, what antibiotic was he taking
tetracycline
175
next step in management of female with poor uterine tone after delivery of the placenta
uterine massage and oxytocin
176
breast cancer screening
40-49: mammogram 1-2 years
50-69: mammogram annually
70+: decrease screening when life expectancy < 10 years
177
hypertension screening
begins at age 18, check every 2 years for normotensive patients
178
cholesterol screening
men: begin at age 35
women: begin at age 45
screen every 5 years
179
smoking cessation
counsel to quit at every encounter
ask, assess, advise, assist, arrange
get patients to set a date
nicotine replacement doubles the quit rate
varenicline (chantix): causes nausea and suicidal ideation
bupropion (welbutrin): instruct patients to quit 1 week after starting medication, contraindicated in seizures, eating disorders
180
vitamin deficiency that causes increased RBC fragility
vitamin E
181
vitamin deficiency that causes dermatitis, cheilosis, and glossitis
iron deficiency/B complex deficiency
182
vitamin defeciency that causes peripheral neuropathy, angular chelosis, and glossitis
vitamin B12
183
vitamin deficiency that causes hemorrhagic disease
vitamin K
184
vitamin deficiency that causes neural tube defects
folate
185
vitamin deficiency that causes dermatitis, diarrhea, and dementia
niacin
186
vitamin deficiency that causes megaloblastic anemia
vitamin B12 and folate
187
vitamin deficiency that causes pernicious anemia
vitamin B12
188
vitamin deficiency that causes bitot spots, keratomalacia, and xeropthalmia
vitamin A
189
vitamin deficiency that causes osteomalacia
vitamin D
190
vitamin deficiency that causes rickets
vitamin D
191
vitamin that can be used to treat acne and psoriasis
vitamin A
vitamin D can also treat psoriasis
192
vitamin that is involved in hydroxylation or prolyl residues
vitamin C
193
vitamin that requires intrinsic factor for absorption
vitamin B12
194
vitamin deficiency that may result from kidney disease
vitamin D
195
vitamin that is given prophylactically to newborns
vitamin K
196
vitamin that can be used to elevate HDL and lower LDL
niacin
197
vitamin deficiency that can be caused by isoniazid
vitamin B6
198
cobalt is found in this vitamin
vitamin B12 (cobalamine)
199
how tension pneumothorax induces hypotension
trachea deviation causes high intrathoracic pressure that decreases venous return and causes hypotension
200
calculation for serum osmolality
(2 x Na) + (BUN / 2.8) + (glucose / 18)
201
treatment for infertility in PCOS
weight loss, clomiphene, or metformin
