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USMLE 2 > Rapid Review 1 > Flashcards

Rapid Review 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Classic ECG finding in atrial flutter.

A

“Sawtooth” P waves

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2
Q

Definition of unstable angina.

A

Angina is new, is worsening, or occurs at rest

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3
Q

Antihypertensive for a diabetic patient with proteinuria.

A

ACEI

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4
Q

Beck’s triad for cardiac tamponade.

A

Hypotension, distant heart sounds, and JVD

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5
Q

Drugs that slow AV node transmission.

A

β-blockers, digoxin, calcium channel blockers

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6
Q

Hypercholesterolemia treatment that → flushing and pruritus.

A

Niacin

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7
Q

Treatment for atrial fibrillation.

A

Anticoagulation, rate control, cardioversion

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8
Q

Treatment for ventricular fibrillation.

A

Immediate cardioversion

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9
Q

Autoimmune complication occurring 2–4 weeks post-MI.

A

Dressler’s syndrome: fever, pericarditis, increased ESR

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10
Q

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

A

Treat existing heart failure and replace the tricuspid valve

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11
Q

Diagnostic test for hypertrophic cardiomyopathy.

A

Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

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12
Q

A fall in systolic BP of > 10 mmHg with inspiration.

A

Pulsus paradoxus (seen in cardiac tamponade)

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13
Q

Classic ECG findings in pericarditis.

A

Low-voltage, diffuse ST-segment elevation

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14
Q

Definition of hypertension.

A

BP > 140/90 on three separate occasions two weeks apart

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15
Q

Eight surgically correctable causes of hypertension.

A

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism

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16
Q

Evaluation of a pulsatile abdominal mass and bruit.

A

Abdominal ultrasound and CT

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17
Q

Indications for surgical repair of abdominal aortic aneurysm.

A

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

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18
Q

Treatment for acute coronary syndrome.

A

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin

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19
Q

What is the metabolic syndrome?

A

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states

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20
Q

Appropriate diagnostic test? A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.

A

Exercise stress treadmill with ECG

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21
Q

Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

A

Pharmacologic stress test (e.g., dobutamine echo)

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22
Q

Signs of active ischemia during stress testing.

A

Angina, ST-segment changes on ECG, or ↓ BP

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23
Q

ECG findings suggesting MI.

A

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves

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24
Q

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

A

Prinzmetal’s angina

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25
Q

Common symptoms associated with silent MIs.

A

CHF, shock, and altered mental status

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26
Q

The diagnostic test for pulmonary embolism.

A

V/Q scan

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27
Q

An agent that reverses the effects of heparin.

A

Protamine

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28
Q

The coagulation parameter affected by warfarin.

A

PT

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29
Q

A young patient with a family history of sudden death collapses and dies while exercising.

A

Hypertrophic cardiomyopathy

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30
Q

Endocarditis prophylaxis regimens.

A

Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after

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31
Q

The 6 P’s of ischemia due to peripheral vascular disease.

A

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia

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32
Q

Virchow’s triad.

A

Stasis, hypercoagulability, endothelial damage

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33
Q

The most common cause of hypertension in young women.

A

OCPs

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34
Q

The most common cause of hypertension in young men.

A

Excessive EtOH

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35
Q

“Stuck-on” appearance.

A

Seborrheic keratosis

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36
Q

Red plaques with silvery-white scales and sharp margins.

A

Psoriasis

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37
Q

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

A

Basal cell carcinoma

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38
Q

Honey-crusted lesions.

A

Impetigo

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39
Q

A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

A

Cellulitis

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40
Q

+ Nikolsky’s sign.

A

Pemphigus vulgaris

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41
Q
  • Nikolsky’s sign.
A

Bullous pemphigoid

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42
Q

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

A

Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

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43
Q

Skin lesions in a dermatomal distribution.

A

Varicella zoster

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44
Q

Flat-topped papules.

A

Lichen planus

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45
Q

Iris-like target lesions.

A

Erythema multiforme

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46
Q

A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

A

Contact dermatitis

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47
Q

Presents with a herald patch, Christmas-tree pattern.

A

Pityriasis rosea

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48
Q

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

A

Alopecia areata (autoimmune process)

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49
Q

Pinkish, scaling, flat lesions on the chest and back. KOH prep has a “spaghetti-and-meatballs” appearance.

A

Pityriasis versicolor

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50
Q

Four characteristics of a nevus suggestive of melanoma.

A

Asymmetry, border irregularity, color variation, large diameter

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51
Q

Premalignant lesion from sun exposure that can → squamous cell carcinoma.

A

Actinic keratosis

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52
Q

“Dewdrop on a rose petal.”

A

Lesions of 1° varicella

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53
Q

“Cradle cap.”

A

Seborrheic dermatitis. Treat with antifungals

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54
Q

Associated with Propionibacterium acnes and changes in androgen levels.

A

Acne vulgaris

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55
Q

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

A

Herpes simplex

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56
Q

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

A

Lichen sclerosus

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57
Q

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

A

Squamous cell carcinoma

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58
Q

The most common cause of hypothyroidism.

A

Hashimoto’s thyroiditis

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59
Q

Lab findings in Hashimoto’s thyroiditis.

A

High TSH, low T4, antimicrosomal antibodies

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60
Q

Exophthalmos, pretibial myxedema, and ↓ TSH.

A

Graves’ disease

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61
Q

The most common cause of Cushing’s syndrome.

A

Iatrogenic steroid administration. The second most common cause is Cushing’s disease

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62
Q

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

A

Hypoparathyroidism

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63
Q

“Stones, bones, groans, psychiatric overtones.”

A

Signs and symptoms of hypercalcemia

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64
Q

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.

A

1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)

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65
Q

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

A

Pheochromocytoma

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66
Q

Should α- or β-antagonists be used first in treating pheochromocytoma?

A

α-antagonists (phentolamine and phenoxybenzamine)

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67
Q

A patient with a history of lithium use presents with copious amounts of dilute urine.

A

Nephrogenic diabetes insipidus (DI)

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68
Q

Treatment of central DI.

A

Administration of DDAVP ↓ serum osmolality and free water restriction

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69
Q

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

A

SIADH due to stress

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70
Q

An antidiabetic agent associated with lactic acidosis.

A

Metformin

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71
Q

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

A

1° adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids

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72
Q

Goal hemoglobin A1c for a patient with DM.

A

< 7.0

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73
Q

Treatment of DKA.

A

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)

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74
Q

Why are β-blockers contraindicated in diabetics?

A

They can mask symptoms of hypoglycemia

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75
Q

Bias introduced into a study when a clinician is aware of the patient’s treatment type.

A

Observational bias

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76
Q

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

A

Lead-time bias

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77
Q

If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.

A

Confounding variable

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78
Q

The number of true positives divided by the number of patients with the disease is _____.

A

Sensitivity

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79
Q

Sensitive tests have few false negatives and are used to rule _____ a disease.

A

Out (SnOut and SpIn)

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80
Q

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?

A

Highly sensitive for TB

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81
Q

Chronic diseases such as SLE—higher prevalence or incidence?

A

Higher prevalence

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82
Q

Epidemics such as influenza—higher prevalence or incidence?

A

Higher incidence

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83
Q

Cross-sectional survey—incidence or prevalence?

A

Prevalence

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84
Q

Cohort study—incidence or prevalence?

A

Incidence and prevalence

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85
Q

Case-control study—incidence or prevalence?

A

Neither

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86
Q

Describe a test that consistently gives identical results, but the results are wrong.

A

High reliability, low validity

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87
Q

Difference between a cohort and a case-control study.

A

Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR

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88
Q

Attributable risk?

A

The incidence rate (IR) of a disease in exposed minus the IR of a disease in unexposed

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89
Q

Relative risk?

A

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed

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90
Q

Odds ratio?

A

The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

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91
Q

Number needed to treat?

A

1 ÷ (rate in untreated group − rate in treated group)

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92
Q

In which patients do you initiate colorectal cancer screening early?

A

Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer

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93
Q

The most common cancer in men and the most common cause of death from cancer in men.

A

Prostate cancer is the most common cancer in men, but lung cancer causes more deaths

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94
Q

The percentage of cases within one SD of the mean? Two SDs? Three SDs?

A

68%, 95.5%, 99.7%

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95
Q

Birth rate?

A

Number of live births per 1000 population

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96
Q

Fertility rate?

A

Number of live births per 1000 women 15–44 years of age

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97
Q

Mortality rate?

A

Number of deaths per 1000 population

98
Q

Neonatal mortality?

A

Number of deaths from birth to 28 days per 1000 live births

99
Q

Postnatal mortality?

A

Number of deaths from 28 days to one year per 1000 live births

100
Q

Infant mortality?

A

Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

101
Q

Fetal mortality?

A

Number of deaths from 20 weeks’ gestation to birth per 1000 total births

102
Q

Perinatal mortality?

A

Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births

103
Q

Maternal mortality?

A

Number of deaths during pregnancy to 90 days postpartum per 100,000 live births

104
Q

True or false: Once patients sign a statement giving consent, they must continue treatment.

A

False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity

105
Q

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?

A

No. Parental consent is not necessary for the medical treatment of pregnant minors

106
Q

A doctor refers a patient for an MRI at a facility he/she owns.

A

Conflict of interest

107
Q

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

A

The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)

108
Q

True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.

A

False. Withdrawing and withholding life are the same from an ethical standpoint

109
Q

When can a physician refuse to continue treating a patient on the grounds of futility?

A

When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care

110
Q

An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.

A

Treat immediately. Consent is implied in emergency situations

111
Q

Conditions in which confidentiality must be overridden.

A

Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

112
Q

Involuntary commitment or isolation for medical treatment may be undertaken for what reason?

A

When treatment noncompliance represents a serious danger to public health (e.g., active TB)

113
Q

A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.

A

Treat because the disease represents an immediate threat to the child’s life. Then seek a court order

114
Q

A son asks that his mother not be told about her recently discovered cancer.

A

A patient’s family cannot require that a doctor withhold information from the patient

115
Q

Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?

A

Emergent laparotomy to repair perforated viscus, likely stomach

116
Q

The most likely cause of acute lower GI bleed in patients > 40 years old.

A

Diverticulosis

117
Q

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

A

HIDA scan

118
Q

Sentinel loop on AXR.

A

Acute pancreatitis

119
Q

Risk factors for cholelithiasis.

A

Fat, female, fertile, forty, flatulent

120
Q

Inspiratory arrest during palpation of the RUQ.

A

Murphy’s sign, seen in acute cholecystitis

121
Q

Identify key organisms causing diarrhea: ■ Most common organism

A

Campylobacter

122
Q

Identify key organisms causing diarrhea: ■ Recent antibiotic use

A

Clostridium difficile

123
Q

Identify key organisms causing diarrhea: ■ Camping

A

Giardia

124
Q

Identify key organisms causing diarrhea: ■ Traveler’s diarrhea

A

ETEC

125
Q

Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise

A

S. aureus

126
Q

Identify key organisms causing diarrhea: ■ Uncooked hamburgers

A

E. coli O157:H7

127
Q

Identify key organisms causing diarrhea: ■ Fried rice

A

Bacillus cereus

128
Q

Identify key organisms causing diarrhea: ■ Poultry/eggs

A

Salmonella

129
Q

Identify key organisms causing diarrhea: ■ Raw seafood

A

Vibrio, HAV

130
Q

Identify key organisms causing diarrhea: ■ AIDS

A

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

131
Q

Identify key organisms causing diarrhea: ■ Pseudoappendicitis

A

Yersinia

132
Q

A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

A

Crohn’s disease

133
Q

Inflammatory disease of the colon with ↑ risk of colon cancer.

A

Ulcerative colitis

134
Q

Extraintestinal manifestations of IBD.

A

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis

135
Q

Medical treatment for IBD.

A

5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations

136
Q

Difference between Mallory-Weiss and Boerhaave tears.

A

Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture

137
Q

Charcot’s triad.

A

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis

138
Q

Reynolds’ pentad.

A

Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis

139
Q

Medical treatment for hepatic encephalopathy.

A

↓ protein intake, lactulose, neomycin

140
Q

First step in the management of a patient with acute GI bleed.

A

Establish the ABCs

141
Q

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

A

Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7

142
Q

Post-HBV exposure treatment.

A

HBV immunoglobulin

143
Q

Classic causes of drug-induced hepatitis.

A

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline

144
Q

A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

A

Biliary tract obstruction

145
Q

Hernia with highest risk of incarceration—indirect, direct, or femoral?

A

Femoral hernia

146
Q

A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

A

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and “tincture of time”

147
Q

Four causes of microcytic anemia.

A

TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia

148
Q

An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

A

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

149
Q

Precipitants of hemolytic crisis in patients with G6PD deficiency.

A

Sulfonamides, antimalarial drugs, fava beans

150
Q

The most common inherited cause of hypercoagulability.

A

Factor V Leiden mutation

151
Q

The most common inherited hemolytic anemia.

A

Hereditary spherocytosis

152
Q

Diagnostic test for hereditary spherocytosis.

A

Osmotic fragility test

153
Q

Pure RBC aplasia.

A

Diamond-Blackfan anemia

154
Q

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.

A

Fanconi’s anemia

155
Q

Medications and viruses that → aplastic anemia.

A

Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV

156
Q

How to distinguish polycythemia vera from 2° polycythemia.

A

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels

157
Q

Thrombotic thrombocytopenic purpura (TTP) pentad?

A

Pentad of TTP—“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

158
Q

HUS triad?

A

Anemia, thrombocytopenia, and acute renal failure

159
Q

Treatment for TTP.

A

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

160
Q

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

A

Usually resolves spontaneously; may require IVIG and/or corticosteroids

161
Q

Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.

A

Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.

162
Q

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

A

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

163
Q

A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increased PTT, and increased bleeding time. Diagnosis? Treatment?

A

von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate

164
Q

A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?

A

Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones

165
Q

Reed-Sternberg cells

A

Hodgkin’s lymphoma

166
Q

A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

A

Non-Hodgkin’s lymphoma

167
Q

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

A

Anemia of chronic disease

168
Q

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

A

Iron deficiency anemia

169
Q

An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?

A

Chronic lymphocytic leukemia (CLL)

170
Q

A late, life-threatening complication of chronic myelogenous leukemia (CML).

A

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

171
Q

Auer rods on blood smear.

A

Acute myelogenous leukemia (AML)

172
Q

AML subtype associated with DIC.

A

M3

173
Q

Electrolyte changes in tumor lysis syndrome.

A

↓ Ca2− , ↑ K− , ↑ phosphate, ↑ uric acid

174
Q

Treatment for AML M3.

A

Retinoic acid

175
Q

A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

A

CML

176
Q

Heinz bodies?

A

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy

177
Q

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

A

Glanzmann’s thrombasthenia

178
Q

Virus associated with aplastic anemia in patients with sickle cell anemia.

A

Parvovirus B19

179
Q

A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

A

O2, analgesia, hydration, and, if severe, transfusion

180
Q

A significant cause of morbidity in thalassemia patients. Treatment?

A

Iron overload; use deferoxamine

181
Q

The three most common causes of fever of unknown origin (FUO).

A

Infection, cancer, and autoimmune disease

182
Q

Four signs and symptoms of streptococcal pharyngitis.

A

Fever, pharyngeal erythema, tonsillar exudate, lack of cough

183
Q

A nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection.

A

Postinfectious glomerulonephritis

184
Q

Asplenic patients are particularly susceptible to these organisms.

A

Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella

185
Q

The number of bacterial culture on a clean-catch specimen to diagnose a UTI.

A

105 bacteria/mL

186
Q

Which healthy population is susceptible to UTIs?

A

Pregnant women. Treat this group aggressively because of potential complications

187
Q

A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?

A

Coccidioidomycosis. Amphotericin B

188
Q

Nonpainful chancre.

A

1° syphilis

189
Q

A “blueberry muffin” rash is characteristic of what congenital infection?

A

Rubella

190
Q

Meningitis in neonates. Causes? Treatment?

A

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin

191
Q

Meningitis in infants. Causes? Treatment?

A

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin

192
Q

What should always be done prior to LP?

A

Check for ↑ ICP; look for papilledema

193
Q

CSF findings: ■ Low glucose, PMN predominance

A

Bacterial meningitis

194
Q

CSF findings: ■ Normal glucose, lymphocytic predominance

A

Aseptic (viral) meningitis

195
Q

CSF findings: ■ Numerous RBCs in serial CSF samples

A

Subarachnoid hemorrhage (SAH)

196
Q

CSF findings: Increased gamma globulins

A

Multiple sclerosis

197
Q

Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?

A

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

198
Q

Findings in 3° syphilis.

A

Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms

199
Q

Characteristics of 2° Lyme disease.

A

Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis

200
Q

Cold agglutinins.

A

Mycoplasma

201
Q

A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

A

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

202
Q

Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?

A

≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin)

203
Q

Risk factors for pyelonephritis.

A

Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones

204
Q

Neutropenic nadir postchemotherapy.

A

7–10 days

205
Q

Erythema migrans.

A

Lesion of 1° Lyme disease

206
Q

Classic physical findings for endocarditis.

A

Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots

207
Q

Aplastic crisis in sickle cell disease.

A

Parvovirus B19

208
Q

Ring-enhancing brain lesion on CT with seizures

A

Taenia solium (cysticercosis)

209
Q

Name the organism: ■ Branching rods in oral infection.

A

Actinomyces israelii

210
Q

Name the organism: ■ Painful chancroid.

A

Haemophilus ducreyi

211
Q

Name the organism: ■ Dog or cat bite.

A

Pasteurella multocida

212
Q

Name the organism: ■ Gardener.

A

Sporothrix schenckii

213
Q

Name the organism: ■ Pregnant women with pets.

A

Toxoplasma gondii

214
Q

Name the organism: ■ Meningitis in adults.

A

Neisseria meningitidis

215
Q

Name the organism: ■ Meningitis in elderly.

A

Streptococcus pneumoniae

216
Q

Name the organism: ■ Alcoholic with pneumonia.

A

Klebsiella

217
Q

Name the organism: ■ “Currant jelly” sputum.

A

Klebsiella

218
Q

Name the organism: ■ Infection in burn victims.

A

Pseudomonas

219
Q

Name the organism: ■ Osteomyelitis from foot wound puncture.

A

Pseudomonas

220
Q

Name the organism: ■ Osteomyelitis in a sickle cell patient.

A

Salmonella

221
Q

A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

A

Legionella pneumonia

222
Q

A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis, and how did he get it? Treatment?

A

Lyme disease, Ixodes tick, doxycycline

223
Q

A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

A

S. aureus or S. epidermidis.

224
Q

A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?

A

All-compartment fasciotomy for suspected compartment syndrome

225
Q

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

A

Spinal stenosis

226
Q

Joints in the hand affected in rheumatoid arthritis.

A

MCP and PIP joints; DIP joints are spared

227
Q

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

A

Osteoarthritis

228
Q

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

A

Osteogenesis imperfecta

229
Q

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

A

Suspect ankylosing spondylitis. Check HLA-B27

230
Q

Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?

A

Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma

231
Q

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

A

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

232
Q

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

A

Pseudogout

233
Q

An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.

A

Polymyalgia rheumatica

234
Q

An active 13-year-old boy has anterior knee pain. Diagnosis?

A

Osgood-Schlatter disease

235
Q

Bone is fractured in fall on outstretched hand.

A

Distal radius (Colles’ fracture)

236
Q

Complication of scaphoid fracture.

A

Avascular necrosis

237
Q

Signs suggesting radial nerve damage with humeral fracture.

A

Wrist drop, loss of thumb abduction

238
Q

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

A

Duchenne muscular dystrophy

239
Q

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

A

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction

240
Q

An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?

A

Slipped capital femoral epiphyses. AP and frog-leg lateral view

USMLE 2 (5 decks)

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