Rapid Review 1 Flashcards
1
Q
Classic ECG finding in atrial flutter.
A
“Sawtooth” P waves
2
Q
Definition of unstable angina.
A
Angina is new, is worsening, or occurs at rest
3
Q
Antihypertensive for a diabetic patient with proteinuria.
A
ACEI
4
Q
Beck’s triad for cardiac tamponade.
A
Hypotension, distant heart sounds, and JVD
5
Q
Drugs that slow AV node transmission.
A
β-blockers, digoxin, calcium channel blockers
6
Q
Hypercholesterolemia treatment that → flushing and pruritus.
A
Niacin
7
Q
Treatment for atrial fibrillation.
A
Anticoagulation, rate control, cardioversion
8
Q
Treatment for ventricular fibrillation.
A
Immediate cardioversion
9
Q
Autoimmune complication occurring 2–4 weeks post-MI.
A
Dressler’s syndrome: fever, pericarditis, increased ESR
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
11
Q
Diagnostic test for hypertrophic cardiomyopathy.
A
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
12
Q
A fall in systolic BP of > 10 mmHg with inspiration.
A
Pulsus paradoxus (seen in cardiac tamponade)
13
Q
Classic ECG findings in pericarditis.
A
Low-voltage, diffuse ST-segment elevation
14
Q
Definition of hypertension.
A
BP > 140/90 on three separate occasions two weeks apart
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
16
Q
Evaluation of a pulsatile abdominal mass and bruit.
A
Abdominal ultrasound and CT
17
Q
Indications for surgical repair of abdominal aortic aneurysm.
A
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
18
Q
Treatment for acute coronary syndrome.
A
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
19
Q
What is the metabolic syndrome?
A
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
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
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)
22
Q
Signs of active ischemia during stress testing.
A
Angina, ST-segment changes on ECG, or ↓ BP
23
Q
ECG findings suggesting MI.
A
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
24
Q
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
A
Prinzmetal’s angina
25
Common symptoms associated with silent MIs.
CHF, shock, and altered mental status
26
The diagnostic test for pulmonary embolism.
V/Q scan
27
An agent that reverses the effects of heparin.
Protamine
28
The coagulation parameter affected by warfarin.
PT
29
A young patient with a family history of sudden death collapses and dies while exercising.
Hypertrophic cardiomyopathy
30
Endocarditis prophylaxis regimens.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after
31
The 6 P’s of ischemia due to peripheral vascular disease.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
32
Virchow’s triad.
Stasis, hypercoagulability, endothelial damage
33
The most common cause of hypertension in young women.
OCPs
34
The most common cause of hypertension in young men.
Excessive EtOH
35
“Stuck-on” appearance.
Seborrheic keratosis
36
Red plaques with silvery-white scales and sharp margins.
Psoriasis
37
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
Basal cell carcinoma
38
Honey-crusted lesions.
Impetigo
39
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
Cellulitis
40
+ Nikolsky’s sign.
Pemphigus vulgaris
41
- Nikolsky’s sign.
Bullous pemphigoid
42
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
43
Skin lesions in a dermatomal distribution.
Varicella zoster
44
Flat-topped papules.
Lichen planus
45
Iris-like target lesions.
Erythema multiforme
46
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Contact dermatitis
47
Presents with a herald patch, Christmas-tree pattern.
Pityriasis rosea
48
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Alopecia areata (autoimmune process)
49
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a “spaghetti-and-meatballs” appearance.
Pityriasis versicolor
50
Four characteristics of a nevus suggestive of melanoma.
Asymmetry, border irregularity, color variation, large diameter
51
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Actinic keratosis
52
“Dewdrop on a rose petal.”
Lesions of 1° varicella
53
“Cradle cap.”
Seborrheic dermatitis. Treat with antifungals
54
Associated with Propionibacterium acnes and changes in androgen levels.
Acne vulgaris
55
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Herpes simplex
56
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Lichen sclerosus
57
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma
58
The most common cause of hypothyroidism.
Hashimoto’s thyroiditis
59
Lab findings in Hashimoto’s thyroiditis.
High TSH, low T4, antimicrosomal antibodies
60
Exophthalmos, pretibial myxedema, and ↓ TSH.
Graves’ disease
61
The most common cause of Cushing’s syndrome.
Iatrogenic steroid administration. The second most common cause is Cushing’s disease
62
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.
Hypoparathyroidism
63
“Stones, bones, groans, psychiatric overtones.”
Signs and symptoms of hypercalcemia
64
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.
1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)
65
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
Pheochromocytoma
66
Should α- or β-antagonists be used first in treating pheochromocytoma?
α-antagonists (phentolamine and phenoxybenzamine)
67
A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI)
68
Treatment of central DI.
Administration of DDAVP ↓ serum osmolality and free water restriction
69
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress
70
An antidiabetic agent associated with lactic acidosis.
Metformin
71
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1° adrenal insufficiency (Addison’s disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids
72
Goal hemoglobin A1c for a patient with DM.
< 7.0
73
Treatment of DKA.
Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
74
Why are β-blockers contraindicated in diabetics?
They can mask symptoms of hypoglycemia
75
Bias introduced into a study when a clinician is aware of the patient’s treatment type.
Observational bias
76
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
Lead-time bias
77
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 _____.
Confounding variable
78
The number of true positives divided by the number of patients with the disease is _____.
Sensitivity
79
Sensitive tests have few false negatives and are used to rule _____ a disease.
Out (SnOut and SpIn)
80
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?
Highly sensitive for TB
81
Chronic diseases such as SLE—higher prevalence or incidence?
Higher prevalence
82
Epidemics such as influenza—higher prevalence or incidence?
Higher incidence
83
Cross-sectional survey—incidence or prevalence?
Prevalence
84
Cohort study—incidence or prevalence?
Incidence and prevalence
85
Case-control study—incidence or prevalence?
Neither
86
Describe a test that consistently gives identical results, but the results are wrong.
High reliability, low validity
87
Difference between a cohort and a case-control study.
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
88
Attributable risk?
The incidence rate (IR) of a disease in exposed minus the IR of a disease in unexposed
89
Relative risk?
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed
90
Odds ratio?
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
91
Number needed to treat?
1 ÷ (rate in untreated group − rate in treated group)
92
In which patients do you initiate colorectal cancer screening early?
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
93
The most common cancer in men and the most common cause of death from cancer in men.
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths
94
The percentage of cases within one SD of the mean? Two SDs? Three SDs?
68%, 95.5%, 99.7%
95
Birth rate?
Number of live births per 1000 population
96
Fertility rate?
Number of live births per 1000 women 15–44 years of age
97
Mortality rate?
Number of deaths per 1000 population
98
Neonatal mortality?
Number of deaths from birth to 28 days per 1000 live births
99
Postnatal mortality?
Number of deaths from 28 days to one year per 1000 live births
100
Infant mortality?
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
101
Fetal mortality?
Number of deaths from 20 weeks’ gestation to birth per 1000 total births
102
Perinatal mortality?
Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births
103
Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
104
True or false: Once patients sign a statement giving consent, they must continue treatment.
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
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
106
A doctor refers a patient for an MRI at a facility he/she owns.
Conflict of interest
107
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
108
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
109
When can a physician refuse to continue treating a patient on the grounds of futility?
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
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.
Treat immediately. Consent is implied in emergency situations
111
Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
112
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
When treatment noncompliance represents a serious danger to public health (e.g., active TB)
113
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child’s life. Then seek a court order
114
A son asks that his mother not be told about her recently discovered cancer.
A patient’s family cannot require that a doctor withhold information from the patient
115
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus, likely stomach
116
The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
117
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
HIDA scan
118
Sentinel loop on AXR.
Acute pancreatitis
119
Risk factors for cholelithiasis.
Fat, female, fertile, forty, flatulent
120
Inspiratory arrest during palpation of the RUQ.
Murphy’s sign, seen in acute cholecystitis
121
Identify key organisms causing diarrhea: ■ Most common organism
Campylobacter
122
Identify key organisms causing diarrhea: ■ Recent antibiotic use
Clostridium difficile
123
Identify key organisms causing diarrhea: ■ Camping
Giardia
124
Identify key organisms causing diarrhea: ■ Traveler’s diarrhea
ETEC
125
Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise
S. aureus
126
Identify key organisms causing diarrhea: ■ Uncooked hamburgers
E. coli O157:H7
127
Identify key organisms causing diarrhea: ■ Fried rice
Bacillus cereus
128
Identify key organisms causing diarrhea: ■ Poultry/eggs
Salmonella
129
Identify key organisms causing diarrhea: ■ Raw seafood
Vibrio, HAV
130
Identify key organisms causing diarrhea: ■ AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)
131
Identify key organisms causing diarrhea: ■ Pseudoappendicitis
Yersinia
132
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.
Crohn’s disease
133
Inflammatory disease of the colon with ↑ risk of colon cancer.
Ulcerative colitis
134
Extraintestinal manifestations of IBD.
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis
135
Medical treatment for IBD.
5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations
136
Difference between Mallory-Weiss and Boerhaave tears.
Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture
137
Charcot’s triad.
RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis
138
Reynolds’ pentad.
Charcot’s triad plus shock and mental status changes, with suppurative ascending cholangitis
139
Medical treatment for hepatic encephalopathy.
↓ protein intake, lactulose, neomycin
140
First step in the management of a patient with acute GI bleed.
Establish the ABCs
141
A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
142
Post-HBV exposure treatment.
HBV immunoglobulin
143
Classic causes of drug-induced hepatitis.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline
144
A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Biliary tract obstruction
145
Hernia with highest risk of incarceration—indirect, direct, or femoral?
Femoral hernia
146
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?
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
Four causes of microcytic anemia.
TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia
148
An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
149
Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides, antimalarial drugs, fava beans
150
The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
151
The most common inherited hemolytic anemia.
Hereditary spherocytosis
152
Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
153
Pure RBC aplasia.
Diamond-Blackfan anemia
154
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.
Fanconi’s anemia
155
Medications and viruses that → aplastic anemia.
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV
156
How to distinguish polycythemia vera from 2° polycythemia.
Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels
157
Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTP—“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities
158
HUS triad?
Anemia, thrombocytopenia, and acute renal failure
159
Treatment for TTP.
Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs
160
Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
161
Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.
162
An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
163
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?
von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate
164
A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones
165
Reed-Sternberg cells
Hodgkin’s lymphoma
166
A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
Non-Hodgkin’s lymphoma
167
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
Anemia of chronic disease
168
Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.
Iron deficiency anemia
169
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
170
A late, life-threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever, bone pain, splenomegaly, pancytopenia)
171
Auer rods on blood smear.
Acute myelogenous leukemia (AML)
172
AML subtype associated with DIC.
M3
173
Electrolyte changes in tumor lysis syndrome.
↓ Ca2− , ↑ K− , ↑ phosphate, ↑ uric acid
174
Treatment for AML M3.
Retinoic acid
175
A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
CML
176
Heinz bodies?
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy
177
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
Glanzmann’s thrombasthenia
178
Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
179
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2, analgesia, hydration, and, if severe, transfusion
180
A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
181
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease
182
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough
183
A nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection.
Postinfectious glomerulonephritis
184
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms––pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella
185
The number of bacterial culture on a clean-catch specimen to diagnose a UTI.
105 bacteria/mL
186
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
187
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
188
Nonpainful chancre.
1° syphilis
189
A “blueberry muffin” rash is characteristic of what congenital infection?
Rubella
190
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin
191
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin
192
What should always be done prior to LP?
Check for ↑ ICP; look for papilledema
193
CSF findings: ■ Low glucose, PMN predominance
Bacterial meningitis
194
CSF findings: ■ Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
195
CSF findings: ■ Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
196
CSF findings: Increased gamma globulins
Multiple sclerosis
197
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7–10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
198
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms
199
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis
200
Cold agglutinins.
Mycoplasma
201
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
202
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with clarithromycin/azithromycin)
203
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones
204
Neutropenic nadir postchemotherapy.
7–10 days
205
Erythema migrans.
Lesion of 1° Lyme disease
206
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots
207
Aplastic crisis in sickle cell disease.
Parvovirus B19
208
Ring-enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
209
Name the organism: ■ Branching rods in oral infection.
Actinomyces israelii
210
Name the organism: ■ Painful chancroid.
Haemophilus ducreyi
211
Name the organism: ■ Dog or cat bite.
Pasteurella multocida
212
Name the organism: ■ Gardener.
Sporothrix schenckii
213
Name the organism: ■ Pregnant women with pets.
Toxoplasma gondii
214
Name the organism: ■ Meningitis in adults.
Neisseria meningitidis
215
Name the organism: ■ Meningitis in elderly.
Streptococcus pneumoniae
216
Name the organism: ■ Alcoholic with pneumonia.
Klebsiella
217
Name the organism: ■ “Currant jelly” sputum.
Klebsiella
218
Name the organism: ■ Infection in burn victims.
Pseudomonas
219
Name the organism: ■ Osteomyelitis from foot wound puncture.
Pseudomonas
220
Name the organism: ■ Osteomyelitis in a sickle cell patient.
Salmonella
221
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?
Legionella pneumonia
222
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?
Lyme disease, Ixodes tick, doxycycline
223
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
224
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
All-compartment fasciotomy for suspected compartment syndrome
225
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
226
Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
227
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
228
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
229
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27
230
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
231
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
232
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
Pseudogout
233
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.
Polymyalgia rheumatica
234
An active 13-year-old boy has anterior knee pain. Diagnosis?
Osgood-Schlatter disease
235
Bone is fractured in fall on outstretched hand.
Distal radius (Colles’ fracture)
236
Complication of scaphoid fracture.
Avascular necrosis
237
Signs suggesting radial nerve damage with humeral fracture.
Wrist drop, loss of thumb abduction
238
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy
239
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
240
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
