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Step 2CK > Rapid Review > Flashcards

Rapid Review Flashcards

1
Q

Classic ECG findings in atrial flutter

A

“Sawtooth” P waves

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2
Q

Definition of unstable angina

A

Angina that is new or worsening with no increase in troponin level

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3
Q

Antihypertensive for a diabetic patient with proteinuria

A

Angiotensin-converting enzyme inhibitor

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4
Q

Beck’s triad for cardiac tamponade

A
  1. Hypotension
  2. Distant heart sounds
  3. Jugular venous distension (JVD)
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5
Q

Drugs that slow heart rate

A
  1. Beta-blockers
  2. Calcium channel blockers (CCBs)
  3. Digoxin
  4. Amiodarone
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6
Q

Hypercholesterolemia treatment that leads to flushing and pruritus

A

Niacin

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7
Q

Murmur-hypertrophic obstructive cardiomyopathy

A

A systolic ejection murmur heard along the lateral sternal border that increases with decreased preload (Valsalva maneuver)

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8
Q

Murmur-aortic insufficiency

A

Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increased afterload (handgrip maneuver)

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9
Q

Murmur-mitral regurgitation

A

A holosystolic murmur that radiates to the axilla; increases with increased after load (handgrip maneuver)

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10
Q

Murmur-aortic stenosis

A

A systolic crescendo/decrescendo murmur that radiates to the neck; increases with increased preload (squatting maneuver)

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11
Q

Murmur-mitral stenosis

A

A diastolic, mid-to late, low-pitched murmur preceded by an opening snap

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12
Q

Treatment for atrial fibrillation and atrial flutter

A

If unstable –> cardiovert

If stable or chronic –> rate control with CCBs or Beta-blockers

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13
Q

Treatment for ventricular fibrillation

A

Immediate cardioversion

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14
Q

Dressler syndrome

A

An autoimmune reaction with fever, pericarditis and increased ESR occurring 2-4 weeks post MI

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15
Q

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

A

Treat existing heart failure and replace the tricuspid valve.

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16
Q

Diagnostic test for hypertrophic cardiomyopathy

A

Echocardiogram (showing a thickened left ventricular wall and outflow obstruction).

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17
Q

Pulsus paradoxus

A

A decrease in systolic BP of >10 mmHg with inspiration; seen in cardiac tamponade

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18
Q

Classic ECG findings in pericarditis

A

Low-voltage, diffuse ST-segment elevation

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19
Q

Eight surgically correctable causes of hypertension

A
  1. Renal artery stenosis
  2. Coarctation of the aorta
  3. Pheochromocytoma
  4. Conn syndrome
  5. Cushing syndrome
  6. Unilateral renal parenchymal disease
  7. Hyperthyroidism
  8. Hyperparathyroidism
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20
Q

Evaluation of a pulsatile abdominal mass and bruit

A

Abdominal ultrasound and CT

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21
Q

Indications for surgical repair of abdominal aortic aneurysm

A
  1. > 5.5 cm
  2. rapidly enlarging
  3. symptomatic, or ruptured
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22
Q

Treatment for acute coronary syndrome

A
  1. ASA
  2. Heparin
  3. Clopidogrel
  4. Morphine
  5. O2
  6. sublingual Nitroglylcerin
  7. IV beta-blockers
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23
Q

Metabolic syndrome

A
  1. Abdominal obesity
  2. High triglycerides
  3. Low HDL
  4. Hypertension
  5. Insulin resistance
  6. Prothrombotic or pro-inflammatory state
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24
Q

Appropriate diagnostic test?

A 50-year-old man with stable angina can exercise to 85% of maximum predicted heart rate.

A

Exercise stress treadmill with ECG

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25
Q

Appropriate diagnostic test?

A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina

A

Pharmacologic stress test (eg, dobutamine echo).

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26
Q

Signs of active ischemia during stress testing

A
  1. Angina
  2. ST-segment changes on ECG
  3. Decreased blood pressure
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27
Q

ECG findings suggesting MI

A
  1. ST-segment elevation (depression means ischemia)
  2. Flattened T-waves
  3. Q waves
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28
Q

Coronary territories in MI:

  1. Anterior wall
  2. Inferior wall
  3. Posterior wall
  4. Septum
A
  1. LAD/diagonal
  2. PDA
  3. Left circumflex/oblique, RCA/marginal
  4. LAD/diagonal
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29
Q

A young patient with angina at rest and ST-segment elevation with normal cardiac enzymes

A

Prinzmetal angina

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30
Q

Common symptoms associated with silent MIs

A
  1. CHF
  2. Shock
  3. Altered mental status
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31
Q

Diagnostic test for pulmonary embolism

A

Spiral CT with contrast

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32
Q

Protamine

A

Reverses the effects of heparin

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33
Q

Prothrombin time

A

The coagulation parameter affected by warfarin

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34
Q

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

A

Hypertrophic cardiomyopathy

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35
Q

Endocarditis prophylaxis regimens:

  1. Oral surgery
  2. GI or GU procedures
A
  1. Amoxicillin for certain situations

2. Not recommended

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36
Q

Virchow triad

A
  1. Stasis
  2. Hypercoagulability
  3. Endothelial damage
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37
Q

The most common cause of hypertension in young women

A

OCPs

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38
Q

The most common cause of hypertension in young men

A

Excessive EtOH

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39
Q

Figure 3 sign

A

Aortic coarctation

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40
Q

Water bottle-shaped heart

A

Pericardial effusion. Look for pulsus paradoxus.

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41
Q

“Stuck-on” waxy appearance

A

Seborrheic keratosis

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42
Q

Red plaques with silvery-white scales and sharp margins

A

Psoriasis

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43
Q

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

A

Basal cell carcinoma

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44
Q

Honey-crusted legions

A

Impetigo

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45
Q

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

A

Cellulitis

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46
Q

+ Nikolsky sign

A

Pemphigus vulgaris

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47
Q
  • Nikolsky sign
A

Bullous pemphigoid

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48
Q

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

A

Acanthosis nigricans. Check fasting blood glucose to rule out diabetes.

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49
Q

Dermatomal distribution

A

Varicella zoster

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50
Q

Flat-topped papules

A

Lichen planus

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51
Q

Irislike target lesions

A

Erythema multiforme

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52
Q

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

A

Contact dermatitis

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53
Q

Presents with one large patch and many smaller ones in a treelike distribution

A

Pityriasis rosea

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54
Q

Flat, often hypo pigmented lesions on the chest and back; KOH prep has a “spaghetti-and-meatballs” appearance

A

Tinea (pityriasis) versicolor

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55
Q

Five characteristics of a nevus suggestive of melanoma

A
  1. Asymmetry
  2. Border irregularity
  3. Color variation
  4. Large diameter
  5. Changing appearance
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56
Q

A premalignant lesion from sun exposure the can lead to squamous cell carcinoma

A

Actinic keratosis

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57
Q

Crusting vesicles in all stages of evolution on entire body

A

Lesions of primary varicella

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58
Q

“Cradle cap”

A

Seborrheic dermatitis. Treat conservatively with bathing and moisturizing agents.

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59
Q

Associated with Propionibacterium acnes and changes in androgen levels, and the treatment of last resort

A

Acne vulgaris. Last-resort treatment is oral isotretinoin (requires monthly blood tests)

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60
Q

A painful, recurrent vesicular eruption of mucocutaneous surfaces

A

Herpes simplex

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61
Q

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

A

Lichen sclerosis

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62
Q

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

A

Squamous cell carcinoma

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63
Q

The most common cause of hypothyroidism

A

Hashimoto thyroiditis

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64
Q

Lab findings in Hashimoto thyroiditis

A
  1. High TSH
  2. Low T4
  3. Antibodies to thyroid peroxidase (TPO)
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65
Q

Exophthalmos, pretibial myxedema and decreased TSH

A

Graves disease

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66
Q

The most common cause of Cushing syndrome

A

Iatrogenic corticosteroid administration. The second most common cause is Cushing disease

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67
Q

A patient post-thyroidectomy presents with signs of hypocalcemia and increase phosphorus

A

Hypoparathyroidism (iatrogenic)

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68
Q

“Stones, bones, groans, psychiatric overtones”

A

Signs and symptoms of hypercalcemia

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69
Q

Hypertension, hypokalemia, and metabolic alkalosis

A

Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)

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70
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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71
Q

Which should be used first in treating pheochromocytoma, alpha-antagonist or beta-antagonists?

A

Alpha-antagonists (Phenoxybenzamine)

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72
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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73
Q

Treatment of central DI

A

Administration of DDAVP and free-water restriction

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74
Q

A post-operative patient with significant pain presents with hyponatremia and normal volume status

A

Syndrome of inappropriate antidiuretic hormones (SIADH) due to stress

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75
Q

An anti diabetic agent with lactic acidosis

A

Metformin

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76
Q

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

A

Primary adrenal insufficiency (Addison disease). Treat with glucocorticoids, mineralocorticoids, and IV fluids

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77
Q

Goal HbA1c for a patient with diabetes mellitus (DM)

A

<7.0%

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78
Q

Treatment for DKA

A

Fluids, insulin, and electrolyte repletion (eg, K+)

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79
Q

Bone pain, hearing loss, increased alkaline phosphatase

A

Paget disease

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80
Q

Increased IGF-1

A

Acromegaly

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81
Q

Galactorrhea, amenorrhea, bitemporal hemaniopsia

A

Prolactinoma

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82
Q

Increased serum 17-hydroxyprogesterone

A

Congenital adrenal hyperplasia (21-hydroxylase deficiency)

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83
Q

Pancreas, pituitary parathyroid tumors

A

Multiple endocrine neoplasia type 1 (MEN 1)

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84
Q

How do you interpret the following 95% confidence interval (CI) for a relative risk (RR) of 0.582: 95% CI 0.502, 0.673?

A

These data are consistently with RRs ranging from 0.502 to 0.672 with 95% confidence (ie, we are confident that, 95 out of 100 times, the true RR will be between 0.502 and 0.673).

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85
Q

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

A

Observational bias

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86
Q

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death, but does not improve survival.

A

Lead-time bias

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87
Q

If you want to know if geographic location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a

A

Confounding variable

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88
Q

The proportion of people who have the disease and test + is the

A

Sensitivity

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89
Q

Sensitive test have few false -s and are used to rule __ a disease.

A

OUT

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90
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. Screening test with high sensitivity are good for disease with low prevalence.

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91
Q

Chronic disease such a systemic lupus erythematous_higher prevalence or incidence?

A

Higher prevalence

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92
Q

Epidemics such as influenza- high prevalence or incidence?

A

Higher incidence

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93
Q

What is the difference between incidence and prevalence?

A

Prevalence is the percentage of cases of disease in a population at one point in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk. (Prevalence=Incidence x Duration)

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94
Q

Cross-sectional survey–incidence or prevalence?

A

Prevalence

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95
Q

Cohort study—incidence or prevalence?

A

Incidence and prevalence

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96
Q

Case-control study—incidence or prevalence?

A

Neither

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97
Q

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

A

High reliability (precision), low validity (accuracy).

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98
Q

Difference between a cohort and a case-control study.

A

Cohort divides groups by an exposure and looks for development of disease. Case-Control divides groups by a disease and assigns controls, and then goes back and looks for exposures.

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99
Q

Attributable risk?

A

The difference in risk in the exposed and unexposed groups (ie, the risk that is attributable to the exposure)

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100
Q

Relative risk?

A

Incidence in the exposed group divided by the incidence in the nonexposed group.

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101
Q

The results of a hypothetical study found an association

between ASA intake and risk of heart disease. How do you interpret an RR of 1.5?

A

In patients who took ASA, the risk of heart disease was 1.5 times that of patients who did not take ASA.

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102
Q

Odds ratio in cohort studies?

A

In cohort studies, the odds of developing the disease in the exposed group divided by the odds of developing the disease in the nonexposed group.

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103
Q

Odds ratio in case-control studies?

A

In case-control studies, the odds that the cases were exposed divided by the odds that the controls were exposed.

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104
Q

Odds ratio in cross-sectional studies?

A

In cross-sectional studies, the odds that the exposed group has the disease divided by the odds that the non exposed group has the disease.

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105
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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106
Q

The percentage of cases within 1 standard deviation (SD) of the mean? 2 SDs? 3 SDs?

A

68%, 95.4%, 99.7%

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107
Q

Birth rate?

A

Number of live births per 1000 population in 1 year.

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108
Q

Mortality rate?

A

Number of deaths per 1000 population in 1 year

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109
Q

Neonatal mortality rate?

A

Number of deaths from birth to 28 days per 1000 live births in 1 year.

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110
Q

Infant mortality rate?

A

Number of deaths from birth to 1 year of age per 1000 live births (neonatal + postnatal mortality) in 1 year.

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111
Q

Maternal mortality rate?

A

Number of deaths during pregnancy to 90 days postpartum per 100, 000 live births in 1 year.

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112
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.

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113
Q

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Is parental consent required?

A

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

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114
Q

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

A

Conflict of interest

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115
Q

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

A
  1. Danger to self
  2. Danger to others
  3. Gravely disabled (unable to provide for basic needs)
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116
Q

True or False: It is more difficult to justify the withdrawal of-care than to have withheld the treatment in the first place.

A

False. Withdrawing non-beneficial treatment or treatment a patient no longer wants is ethically equivalent to withholding care.

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117
Q

A mother refuses to allowed her child to be vaccinated

A

A parent has the right to refuse treatment for his/her child as long as it does not pose a serious threat to the well-being of the child.

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118
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.

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119
Q

An 8-year-old child is in a serious accident. She requires emergent transfusion, but her patients are not present.

A

Treat immediately. Consent is implied in emergency situation.

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120
Q

A 15-year-old girl seeking treatment for an STD asks that her parents not be told about her condition.

A

Minors may consent to care for STDs without parental consent or knowledge.

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121
Q

Conditions in which confidentiality must be overridden.

A

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

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122
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 (eg, active TB).

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123
Q

A 10-year-old child presents in status epileptics, 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.

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124
Q

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

A

A physician can withhold information from the patient only in the rare case of therapeutic privilege or if the patient requests not to be told.

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125
Q

A patient presents with sudden onset of severe, diffuse abdominal pain. Examination reveals peritoneal signs, and abdominal radiograph reveals free air under the diaphragm. Management?

A

Emergent laparotomy to repair a perforated viscus.

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126
Q

The most likely cause of acute lower GI bleeding in patients >40 years of age.

A

Diverticulosis

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127
Q

Diagnostic modality used when ultrasonography is equivocal for cholecystitis?

A

Hepatobiliary iminodiacetic acid (HIDA) scan

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128
Q

Risk factors for cholelithiasis

A

Fat, female, fertile, forty, flatulent

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129
Q

Inspiratory arrest during palpation of the RUQ

A

Murphy sign, seen in acute cholecystitis

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130
Q

The most common cause of small-bowel obstruction (SBO) in patients with no history of abdominal surgery.

A

Hernia

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131
Q

The most common cause of SBO in patients with a history of abdominal surgery.

A

Adhesions

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132
Q

What is the key organism likely causing diarrhea:

Most common bacterial organism

A

Campylobacter

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133
Q

What is the key organism likely causing diarrhea:

Recent antibiotic use

A

Clostridium difficile

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134
Q

What is the key organism likely causing diarrhea:

Camping

A

Giardia

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135
Q

What is the key organism likely causing diarrhea:

Traveler’s diarrhea

A

Enterotoxigenic Escherichia coli (ETEC)

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136
Q

What is the key organism likely causing diarrhea:

Church picnics/mayonnaise

A

S aureus

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137
Q

What is the key organism likely causing diarrhea:

Uncooked hamburgers

A

E coli O157:H7

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138
Q

What is the key organism likely causing diarrhea:

Fried rice

A

Bacillus cereus

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139
Q

What is the key organism likely causing diarrhea:

Poultry/eggs

A

Salmonella

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140
Q

What is the key organism likely causing diarrhea:

Raw seafood

A

Vibrio, hepatitis A virus (HAV)

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141
Q

What is the key organism likely causing diarrhea:

AIDS

A

Isospora, Cryptosporidium, Mycobacterium avian complex (MAC)

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142
Q

What is the key organism likely causing diarrhea:

Pseudoappendicitis

A

Yersinia, Campylobacter

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143
Q

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

A

Crohn disease

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144
Q

Inflammatory disease of the colon with an increased risk of colon cancer

A

Ulcerative colitis (greater risk than Crohn)

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145
Q

Extraintestinal manifestations of IBD

A

Uveitis, ankylosing spondylitis, pyoderma gangrenous, erythema nodosum, primary sclerosing cholangitis

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146
Q

Medical treatment for IBD

A

5-ASA agents and steroids during acute exacerbations

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147
Q

A 30-year-old man with ulcerative colitis presents with fatigue, jaundice and pruritus

A

Primary sclerosing cholangitis

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148
Q

Difference between Mallory-Weiss and Boerhaave tears.

A

Mallory-Weiss: superficial tear in the esophageal mucosa;

Boerhaave: full thickness esophageal rupture

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149
Q

Charcot triad

A
  1. Fever/Chills
  2. Jaundice
  3. RUQ pain
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150
Q

Reynolds pentad

A

1-3. Charcot triad (fever/chills, jaundice, RUQ pain)

  1. Hypotension
  2. Mental status change
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151
Q

Medical treatment for hepatic encephalopathy

A

Decreased protein intake, lactulose, rifaximin

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152
Q

The first step in the management of a patient with an acute GI bleeding episode.

A

Manage ABCs

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153
Q

A 4-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

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154
Q

Treatment after exposure to hepatitis B virus (HBV).

A

HBV Immunoglobulin

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155
Q

Classic causes of drug-induced hepatitis.

A

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

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156
Q

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

A

Biliary tract obstruction

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157
Q

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

A

Femoral hernia

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158
Q

Severe abdominal pain out of proportion to the examination

A

Mesenteric ischemia

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159
Q

Diagnosis of ileus

A

Abdominal radiographs (could also perform CT scan).

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160
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 increase amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and “tincture of time”.

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161
Q

Colon cancer region based on symptoms:

  1. Anemia of chronic disease, occult blood loss, vague abdominal pain
  2. Obstructive symptoms, change in bowel movements
A
  1. Right sided: rare to have an obstruction

2. Left-sided: “apple-core” lesion

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162
Q

Presents with watery diarrhea, dehydration, muscle weakness and flushing.

A

VIPoma (replace fluids and electrolytes, may need to surgically resect tumor or use octreotide)

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163
Q

Presents with palpable, nontender gallbladder

A

Courvoisier sign (suggests pancreatic cancer)

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164
Q

Four causes of microcytic anemia

A

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

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165
Q

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

A

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

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166
Q

Precipitants of hemolytic crisis in patient with G6PD deficiency

A

Sulfonamides, antimalarial drugs, fava beans

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167
Q

The most common inherited cause of hypercoagulability

A

Factor V Leiden mutation

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168
Q

The most common inherited hemolytic anemia

A

Hereditary spherocytosis

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169
Q

Diagnostic test for hereditary spherocytosis

A

Osmotic fragility test

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170
Q

Pure RBC aplasia

A

Diamond-Blackfan anemia

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171
Q

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

A

Fanconi anemia

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172
Q

Medications and viruses that lead to aplastic anemia

A
  1. Chloramphenicol
  2. Sulfonamides
  3. Radiation
  4. Chemotherapeutic agents
  5. HIV
  6. Hepatitis
  7. Parvovirus B19
  8. EBV
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173
Q

How to distinguish polycythemia vera from secondary polycythemia

A

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

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174
Q

Thrombotic Thrombocytopenic Purpura (TTP) pentad?

A

“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

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175
Q

Hemolytic uremic syndrome (HUS) triad?

A
  1. Anemia
  2. Thrombocytopenia
  3. Acute renal failure
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176
Q

Treatment for TTP

A
  1. Emergent large-volume plasmapheresis
  2. Corticosteroids
  3. Antiplatelet drugs

Platelet transfusion is CONTRAINDICATED!!!!

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177
Q

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

A

Usually resolves spontaneously; may require IVIG and/or corticosteroids

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178
Q

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

A

Increased: Fibrin split products and D-dimer
Decreased: Platelets, fibrinogen and hematocrit

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179
Q

An 8-year-old boy presents with hemarthrosis and increased 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.

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180
Q

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

A

von Willebrand disease; treat with desmopressin, FFP or cryoprecipitate

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181
Q

A 60-year-old African American man presents with bone pain. What might a workup for multiple myeloma reveal?

A

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

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182
Q

Reed-Sternberg cells

A

Hodgkin lymphoma

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183
Q

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

A

Non-hodgkin lymphoma

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184
Q

Microcytic anemia with decreased serum iron, decreased total iron-binding capacity (TIBC) and normal or increased ferritin

A

Anemia of chronic disease

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185
Q

Microcytic anemia with decreased serum iron, decreased ferritin and increased TIBC

A

Iron-deficiency anemia

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186
Q

An 80-year-old man presents with fatigue. lymphadenopathy, splenomegaly and isolated lymphocytosis. What is the suspected diagnosis?

A

Chronic lymphocytic leukemia (CLL)

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187
Q

Patient with fatigue is found to have a decreased hemoglobin and increased mean corpuscular volume. What are potential causes for this anemia?

A

Decreased B12 (pernicious anemia, vegetarian diet, Crohn/GI disorders) or folate (alcoholics).

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188
Q

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

A

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

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189
Q

Auer rods on blood smear.

A

Acute myelogenous leukemia (AML)

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190
Q

AML subtype associated with DIC. Treatment?

A

M3. Retinoic acid.

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191
Q

Electrolyte changes in tumor lysis syndrome

A 
Decreased 
1. Ca2+
Increased
2. K+
3. Phosphate
4. Uric acid
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192
Q

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

A

CML

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193
Q

A patient on the chemotherapy service with an absolute neutrophil count (ANC) of 1000 is noted to have a fever of 38.8C (102.1 F). Next best step?

A

Neutropenic fever is a medical emergency. Start broad-spectrum antibiotics.

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194
Q

Virus associated with aplastic anemia in patients with sickle cell anemia

A

Parvovirus B19.

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195
Q

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

A

O2, analgesia, hydration, and if severe, transfusions

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196
Q

A significant cause of morbidity in thalassemia patients. Treatment?

A

Iron overload; use deferoxamine

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197
Q

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

A
  1. Infection
  2. Cancer
  3. Autoimmune disease
198
Q

Four signs and symptoms of streptococcal pharyngitis

A
  1. Fever
  2. Tender anterior cervical lymphadenopathy
  3. Tonsillar exudate
  4. Lack of cough
199
Q

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

A

Postinfectious glomerulonephritis

200
Q

The most common predisposing factor for acute sinusitis

A

Viral URI

201
Q

Asplenic patients are particularly susceptible to these organisms

A

Encapsulated organisms

  1. pneumococcus
  2. meningococcus
  3. Haemophilus influenzae
  4. Klebsiella
202
Q

The number of bacteria needed on a clean-catch specimen to diagnose a UTI

A

10^5 bacterial/mL

203
Q

Which healthly population is susceptible to UTIs?

A

Pregnant women. Treat this group aggressively because of high risk of complications

204
Q

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

A

Coccidioidomycosis; amphotericin B

205
Q

Nonpainful chancre

A

Primary syphillis

206
Q

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

A

Rubella

207
Q

Meningitis in neonates. Causes? Treatment?

A

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

208
Q

Meningitis in infants. Causes? Treatment?

A

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

209
Q

What should always be done prior to LP?

A

Check for increased ICP; look for papilledema

210
Q

CSF findings:

Low glucose, PMN predominance

A

Bacterial meningits

211
Q

CSF findings:

Normla glucose, lymphocytic predominance

A

Aseptic (viral) meningitis

212
Q

CSF findings:

Numerous RBCs in serial CSF samples

A

Subarachnoid hemorrhage (SAH)

213
Q

CSF findings:

Increased gamma globulins

A

Multiple Sclerosis (MS)

214
Q

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

A

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.

215
Q

Findings in tertiary syphillis.

A
  1. Tabes dorsalis
  2. General paresis
  3. Gummas
  4. Argyll Robertson pupil
  5. Aortitis
  6. Aortic root aneurysms
216
Q

Characteristics of secondary Lyme disease

A
  1. Arthralgias
  2. Migratory polyarthropathies
  3. Bell palsy
  4. Myocarditis
217
Q

Cold agglutinins

A

Mycoplasma.

218
Q

A 24-year-old man 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.

219
Q

At what CD4 counts should Pneumocystis jiroveci pneumonia prophylaxis be initiated in an HIV-positive patient? Mycobacterium avium-complex (MAC) prophylaxis?

A

= 200 for P jiroveci (with TMP-SMX); = 50-100 for Mac (with clarithromycin/azithromycin)

220
Q

Risk factors for pyelonephritis

A
  1. Pregnancy
  2. Vesicoureteral reflux
  3. Anatomic anomalies
  4. Indwelling catheters
  5. Kidney stones
221
Q

Neutropenic nadir postchemotherapy.

A

7-10 days

222
Q

Erythema migrans

A

Lesion of primary Lyme disease

223
Q

Classic physical findings for endocarditis

A
  1. Fever
  2. Heart murmur
  3. Osler nodes
  4. Splinter hemorrhages
  5. Janeway lesions
  6. Roth spots
224
Q

Aplastic crisis in sickle cell disease.

A

Parvovirus B19

225
Q

Name the organism:

Branching rods in oral infection

A

Actinomyces israelii

226
Q

Name the organism:

Weakly gram+, partially acid-fast in lung infection

A

Nocardia asteroides

227
Q

Name the organism:

Painful chancroid

A

Haemophilus ducreyi

228
Q

Name the organism:

Dog or cat bite

A

Pasteurella multocida

229
Q

Name the organism:

Gardener

A

Sporothrix schenckii

230
Q

Name the organism:

Raw pork and skeletal muscle cysts

A

Trichinella spiralis

231
Q

Name the organism:

Sheepherders with liver cysts

A

Echinococcus granulosus

232
Q

Name the organism:

Perianal itching

A

Enterobius vermicularis

233
Q

Name the organism:

Pregnant women with pets

A

Toxoplasma gondii

234
Q

Name the organism:

Meningitis in adults

A

Neisseria meningitidis

235
Q

Name the organism:

Meningitis in elderly

A

Steptococcus pneumoniae

236
Q

Name the organism:

Meningoencephalitis in AIDs patients

A

Cryptococcus neoformans

237
Q

Name the organism:

Alcoholic with pneumonia

A

Klebsiella

238
Q

Name the organism:

“Currant jelly” sputum

A

Klebsiella

239
Q

Name the organism:

Malignant external otitis

A

Pseudomonas

240
Q

Name the organism:

Infection in burn victims

A

Pseudomonas

241
Q

Name the organism:

Osteomyelitis from a foot wound puncture

A

Psuedomonas

242
Q

Name the organism:

Osteomyelitis in a sickle cell patient

A

Salmonella

243
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 - rods. What is the diagnosis?

A

Legionella pneumonia

244
Q

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

A

Lyme disease, Ixodes tick, doxycycline.

245
Q

A patient develops endocarditis 3 weeks after receiving a prosthetic heart valve. What organism is suspected?

A

S. aureus or Staphylococcus epidermidis

246
Q

A patient develops endocarditis in a native valve after having a dental cleaning. What organism is suspected?

A

Streptococcus viridians.

247
Q

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

A

Spinal stenosis

248
Q

Joints in the hand affected in rheumatoid arthritis.

A

MCP and PIP joints; DIP joints are spared.

249
Q

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

A

Osteoarthritis

250
Q

A genetic disorder that is associated with multiple fractures and blue sclerae and its commonly mistaken for child abuse.

A

Osteogenesis imperfecta

251
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

252
Q

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

A

Reactive arthritis. Most common associated with Chlamydia. Also consider Campylobacter, Shigella, Salmonella, and Ureaplasma.

253
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.

254
Q

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

A

Psuedogout

255
Q

An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot life her arms above her head. Labs show anemia and increased ESR.

A

Polymyalgia rheumatica

256
Q

Bone is fractured in a fall on an outstretched hand.

A

Distal radius (Colles fracture)

257
Q

A complication of scaphoid fracture.

A

Avascular necrosis

258
Q

Signs suggesting radial nerve damage with humeral fracture

A

Wrist drop, loss of them abduction.

259
Q

The most common primary malignant tumor of bone

A

Multiple myeloma

260
Q

Headache, soreness in jaw, pain on scalp, transient monocular blindness

A

Giant cell arteritis

261
Q

Unilateral, severe periorybital headache with tearing and conjunctival erythema

A

Cluster headache

262
Q

Prophylactic treatment for migraine

A

Antihypertensives, antidepressants, anticonvulsants, dietary changes

263
Q

The most common pituitary tumor. Treatment?

A

Prolactinoma. Dopamine agonists (eg, bromocriptine).

264
Q

A 55-year-old patient presents with acute “broken speech” What type of aphasia? What lobe and vascular distribution?

A

Broca aphasia, frontal lob, left MCA distribution

265
Q

The most common cause of subarachnoid hemorrhage (SAH).

A

Trauma; the second most common is berry aneurysm

266
Q

A crescent-shaped hyperdensity on CT that does not cross the midline

A

Subdural hematoma-bridging veins torn

267
Q

A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely source? Treatment?

A

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation.

268
Q

CSF findings with SAH.

A

Increased ICP, RBCs, xanthochromia.

269
Q

Albuminocytologic dissociation

A

Guillan-Barre syndrome (increase protein in CSF without a significant increase in cell count)

270
Q

Cold water is flushed into a patients’ ear, and the fast phase of the nystagmus is toward two opposite side. Normal or pathologic?

A

Normal.

271
Q

The most common primary sources of metastases to the brain.

A

Lungs, breast, skin (melanoma), kidney, GI tract

272
Q

May be seen in children who are accused of inattention in class and are often confused with ADHD.

A

Absence seizures.

273
Q

The most frequent presentation of intracranial neoplasm.

A

Headache. Primary neoplasms are much less common than brain metastases.

274
Q

The most common cause of seizures in children (2-10 years).

A
  1. Infection
  2. Febrile seizures
  3. Trauma
  4. Idiopathic
275
Q

The most common cause of seizures in young adults (18-35 years).

A
  1. Trauma
  2. Alcohol withdrawal
  3. Brain tumor
276
Q

First line medication for status epilepticus

A

IV benzodiazipine

277
Q

Confusion, ophthalmoplegia, ataxia

A

Wernicke encephalopathy due to a deficiency of thiamine

278
Q

What % lesion in a symptomatic patient is an indication for carotid endarterectomy?

A

70%

279
Q

The most common causes of dementia.

A

Alzheimer disease and vascular/multi-infarct

280
Q

A combined upper motor neuron (UMN) and lower motor neuron (LMN) disorder

A

Amotrophilc lateral sclerosis (ALS)

281
Q

Rigidity and stiffness with unilateral resting tremor and masked facies

A

Parkinson disease

282
Q

The mainstay of Parkinson therapy

A

Levodopa/carbidopa

283
Q

Treatment for Guillan-Barre syndrome

A

IVIG or plasmapheresis. Avoid steroids.

284
Q

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior

A

Huntington disease

285
Q

A 6-year-old girl presents with a port-wine stain in the V1 distribution as well as with intellectual disability, seizures and ipsilateral leptomeningeal angioma

A

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe.

286
Q

Multiple cafe au last spots on skin

A

Neurofibromatosis type 1

287
Q

Hyperphagia, hyper sexuality, hyperorality and hyperdocility

A

Kluver-Bucy syndrome (amygdala)

288
Q

May be administered to a symptomatic patient to diagnose myasthenia graves

A

Edrophonium

289
Q

Primary causes of their-trimester bleeding.

A

Placental abruption

290
Q

Classic ultrasonography and gross appearance of complete hydatidiform mole

A

Snowstorm on ultrasonography. “Cluster-of-grapes” appearance on gross examination.

291
Q

Chromosomal pattern of a complete mole

A

46, XX

292
Q

Molar pregnancy counting fetal tissue

A

Partial mole

293
Q

Symptoms of placental abruption

A

Continuous, painful vaginal bleeding

294
Q

Symptoms of placenta previa

A

Self-limited, painless vaginal bleeding

295
Q

When should a vaginal exam be performed with suspected placenta previa?

A

Never.

296
Q

Antibiotics with teratogenic effects.

A

Tetracylcine, fluroquinolones, aminoglycosides, sulfonamides

297
Q

Medication given to accelerate fetal lung maturity.

A

Betamethasone or dexamethasone x 48 hours.

298
Q

The most common cause of postpartum hemorrhage.

A

Uterine atony

299
Q

Treatment for postpartum hemorrhage

A

Uterine massage; if that fails give oxytocin

300
Q

Typical antibiotics for group B streptococcus (GBS) prophylaxis

A

IV penicillin or ampicillin

301
Q

A patient fails to lactate after an emergency C-section with marked blood loss.

A

Sheehan syndrome (post-partum pituitary necrosis)

302
Q

Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os open

A

Inevitable abortion

303
Q

Uterine bleeding at 18 weeks gestation; no products expelled; cervical os closed

A

Threatened abortion

304
Q

The first test to perform when a woman presents with amenorrhea.

A

Beta-hCG; the most common cause of amenorrhea is pregnancy

305
Q

Term for heavy bleeding during and between menstrual periods.

A

Menometrorrhagia

306
Q

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

A

Asherman syndrome

307
Q

Therapy for polycystic ovarian syndrome

A

Weight loss and OCPs. Consider metformin.

308
Q

Medication used to induce ovulation.

A

Clomiphene citrate.

309
Q

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

A

Endometrial biopsy

310
Q

Indications for medical treatment of ectopic-pregnancy.

A

Patient stable; enraptured ectopic pregnancy of <3.5 cm at < 6 weeks gestation

311
Q

Medical options for endometriosis

A
  1. OCPs
  2. Danazol
  3. GnRH agonists
312
Q

Laparoscopic findings in endometriosis

A

Powder burns, “chocolate cysts”

313
Q

The most common location for an ectopic pregnancy

A

Ampulla of the oviduct

314
Q

How to diagnose and follow a leiomyoma

A

Ultrasonography

315
Q

Natural history of a leiomyoma

A

Regresses after menopause

316
Q

A patient has increased vagina discharge and petechial patches in the upper vagina and cervix

A

Trichomonas vaginitis

317
Q

treatment for bacterial vaginosis

A

Oral metronidazole

318
Q

The most common cause of bloody nipple discharge

A

Intraductal papilloma

319
Q

Contraceptive methods that protect agains PID.

A
  1. OCPs

2. Barrier contraception

320
Q

Unopposed estrogen is contraindicated in which cancers?

A

Endometrial or estrogen receptor + breast cancers

321
Q

A patient presents with recent PID with RUQ pain

A

Consider Fitz-Hugh-Curtis syndrome

322
Q

Breast malignancy presenting as itching, burning and erosion of the nipple

A

Paget disease

323
Q

Annual screening for women with a strong family history of ovarian cancer.

A

CA-125 and transvaginal ultrasonography

324
Q

A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?

A

Kegel exercises, estrogen, pessaries for stress incontinence.

325
Q

A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?

A

Anticholinergics (eoxybutynin) or beta-adrenergic (metaproterenol) for urge incontinence

326
Q

Lab values suggestive of menopause

A

increased serum FSH

327
Q

The most common cause of female infertility

A

Endometriosis

328
Q

Two consecutive findings of atypical squamous cells of undetermined significant (ASCUS) on Pap smear. Follow-up evaluation?

A

Colposcopy and endocervical curettage

329
Q

Breast cancer type that increases the future risk of invasive carcinoma in both breasts.

A

Lobular carcinoma in situ.

330
Q

Nontender abdominal mass associated with increased vanillylmandelic acid (VMA) and homovanillic acid (HVA)

A

Neuroblastoma

331
Q

The most common type of tracheoesophageal fistula (TEF). Classic presentation?

A

Esophageal atresia with distal TEF (85%). Unable to pass NG tube.

332
Q

Not contraindications to vaccination

A
  1. Mild illness and/or low-grade fever
  2. Current antibiotic therapy
  3. Prematurity
333
Q

Tests to rule out abusive head trauma

A
  1. Ophthalmologic exam
  2. CT
  3. MRI
334
Q

A neonate has meconium ileum.

A

Cystic fibrosis (Hirschsprung disease is associated with failure to pass meconium for 48 hours).

335
Q

Bilious emesis within hours after the first feeding.

A

Duodenal atresia

336
Q

A 2-month old baby presents with non bilious projectile emesis. Diagnosis? What are the appropriate steps in management?

A

Pyloric stenosis. Hydrate and correct metabolic abnormalities; then correct pyloric stenosis with pyloromyotomy.

337
Q

The most common primary immunodeficiency

A

Selective IgA deficiency

338
Q

An infant has a high fever and onset of rash as fever breaks. What is he at risk for?

A

Febrile seizures (due to roseola infantum)

339
Q

What is the immunodeficiency?

A boy has chronic respiratory infections. Nitroblue tetrazolium test is negative.

A

Chronic granulomatous disease

340
Q

What is the immunodeficiency?

A child has eczema, thrombocytopenia and high levels of IgA

A

Wiskott-Aldrich syndrome

341
Q

What is the immunodeficiency?

A 4-month-old boy has life-threatening pseudomonas infection

A

Bruton’s X-linked agammaglobulinemia

342
Q

Acute-phase treatment for Kawasaki disease.

A

High-dose ASA for inflammation and fever; IVIG to prevent coronary artery aneurysms.

343
Q

Treatment for mild and severe unconjugated hyperbilirubinemia

A

Phototherapy (mild) or exchange transfusion (severe). (Do not use phototherapy for conjugated hyperbilirubinemia.)

344
Q

Sudden onset of mental status changes, emesis and liver dysfunction after ASA intake.

A

Reye syndrome

345
Q

A child has loss of red light reflex (white pupil). Diagnosis? The child has an increased risk of what cancer?

A

Suspect retinoblastoma. Osteosarcoma.

346
Q

Vaccinations at a 6-month well-child visit.

A
  1. HBV
  2. DTaP
  3. Hib
  4. IPV
  5. PCV
  6. Rotavirus
347
Q

Tanner stage 3 in a 6-year old girl.

A

Precocious puberty

348
Q

Infection of small airways with epidemics in winter and spring

A

RSV bronchiolitis

349
Q

Causes of neonatal RDS.

A

Surfactant deficiency

350
Q

Red “currant-jelly” stools, colicky abdominal pain, bilious vomiting and a sausage-shaped mass in the RUQ.

A

Intussusception

351
Q

A congenital heart disease that causes secondary hypertension. What would you find on physical examination?

A

Coarctation of the aorta; decreased femoral pusles

352
Q

First-line treatment for otitis media.

A

Amoxicillin

353
Q

The most common pathogen causing croup

A

Parainfluenza virus type 1

354
Q

A homeless child is small for his age and has peeling skin and a swollen belly.

A

Kwashiorkor (protein malnutrition)

355
Q

Defect in an X-linked syndrome with mental retardation, gout, self-mutilation and choreoathetosis.

A

Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency).

356
Q

A newborn girl has a continuous “machinery murmur”. What drug would you give?

A

Patent ductus arteriosus. Indomethacin is given to close the PDA.

357
Q

A newborn girl with posterior neck mass and swelling of the hands.

A

Turner syndrome

358
Q

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

A

Duchenne muscular dystrophy.

359
Q

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

A

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

360
Q

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

A

Slipped capital femoral epiphysis. AP and for-leg lateral radiographs.

361
Q

An active 12-year-old boy has anterior knee pain. Diagnosis?

A

Osgood-Schlatter disease

362
Q

First-line pharmacotherapy for depression.

A

SSRIs

363
Q

Antidepressants associated with hypertensive crisis.

A

MAOIs

364
Q

Galactorrhea, impotence, menstrual dysfunction and decrease libido

A

Dopamine antagonists

365
Q

A 17-year-old girl has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.

A

Conversion disorder

366
Q

Name the defense mechanism:

A mother who is angry at her husband yells at her child

A

Displacement

367
Q

Name the defense mechanism:

A girl who is upset with her best friend acts overly kind.

A

Reaction formation.

368
Q

Name the defense mechanism:

A man calmly describes a grisly murder.

A

Isolation

369
Q

Name the defense mechanism:

A hospitalized 10-year-old begins to wet his bed.

A

Regression

370
Q

Life-threatening muscle rigidity, high fever, autonomic instability, confusion and elevated creatine phosphokinase

A

Neuroleptic malignant syndrome

371
Q

Amenorrhea, low body weight (<85%), bradycardia, and abnormal body image in a young woman.

A

Anorexia.

372
Q

A 35-year-old man has recurrent episodes of palpitations, diaphoresis, and fear of impending doom.

A

Panic disorder

373
Q

The most serious side effect of clozapine.

A

Agranulocytosis

374
Q

A 21-year-old man has 3 months of social withdrawal, worsening grades, flattened affect and concrete thinking.

A

Schizophreniform disorder (a diagnosis of schizophrenia requires >/= 6 months of symptoms).

375
Q

Key side effects of atypical antipsychotics.

A
  1. Weight gain
  2. Type 2 DM
  3. QT-segment prolongation
376
Q

A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?

A

Acute dystonia (oculogyric crisis). treat with benztropine or diphenhydramine.

377
Q

Medication to avoid in patients with a history of alcohol withdrawal seizures.

A

Neuroleptics, which can lower the seizure threshold.

378
Q

A 13-year-old boy has a history of theft, vandalism, and violence toward family pets.

A

Conduct disorder. Associated with antisocial personality disorder in adults.

379
Q

A 5-month-old girl has decreased head growth, truncal discoordination, and decreased social interaction.

A

Rett disorder. Loss of milestones is commonly described.

380
Q

A patient hasn’t slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?

A

Acute mania. Start a mood stabilizer (eg, lithium).

381
Q

After a minor “fender bender” a man wears a neck brace and request permanent disability.

A

Malingering

382
Q

A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C-peptide.

A

Factitious disorder

383
Q

A patient spends most of his time acquiring cocaine despite losing his job and being threatened with legal charges.

A

Substance use disorder

384
Q

Medication to avoid in patines with PTSD.

A

Benzodiazepines (have high addition potential). Patients commonly have a history of substance abuse.

385
Q

A violent patient has vertical and horizontal nystagmus

A

Phencyclidine hydrochloride (PCP) intoxication

386
Q

A woman who was abused as a child frequently feels outside of or detacher form her body.

A

Depersonalization disorder

387
Q

A schizophrenic patient takes haloperidol for 1 year and develops uncontrollable tongue movements. Diagnosis? Treatment?

A

Tardive dyskinesia. Decrease or discontinue haloperidol and consider another antipsychotic (eg, risperidone, clozapine).

388
Q

A man with major depressive disorder is counseled to avoid tyramine-rich foods with his new medication. What class of medications she taking?

A

MAOIs

389
Q

Risk factors for DVT.

A
  1. Stasis
  2. Endothelial injury
  3. Hypercoagulability

(Virchow triad)

390
Q

Criteria for exudative effusion.

A
  1. Pleural/serum protein >0.5

2. Pleural/serum LDH >0.6

391
Q

Causes of exudative effusion.

A

Think of leaky capillaries.

  1. Malignancy
  2. TB
  3. Bacterial or viral infection
  4. Pulmonary embolism (PE) with infarct
  5. Pancreatitis
392
Q

Causes of transudative effusion.

A

Think of intact capillaries.

  1. CHF
  2. Liver or kidney disease
  3. Protein-losing enteropathy
393
Q

Normalizing PCO2 in a patient having an asthma exacerbation may indicate ___.

A

Fatigue and impending respiratory failure.

394
Q

Treatment for acute asthma and COPD exacerbations.

A

beta2-agonists and corticosteroids (anticholinergics and antibiotics for COPD exacerbation as well).

395
Q

Sarcoidosis

A
  1. Dypsnea
  2. Lateral hilar lymphadenopathy on chest radiographs
  3. Noncaseating granulomas
  4. Increased angiotensin-converting enzyme
  5. Hypercalcemia
396
Q

PFTs of obstructive pulmonary disease

A

Decreased FEV1/FVC

397
Q

PFTs of restrictive pulmonary disease

A
  1. Increase FEV1/FVC

2. Decreased TLC

398
Q

Honeycomb pattern on chest radiograph. Treatment?

A

Diffuse interstitial pulmonary fibrosos. Supportive care; antifibrotic agents may help.

399
Q

Treatment for SVC syndrome.

A

Radiation

400
Q

Treatment for mild persistent asthma

A

Inhaled beta-agonists and inhaled corticosteroids

401
Q

Treatment for COPD exacerbation

A
  1. O2
  2. Bronchodilators
  3. Antibiotics
  4. Corticosteroids with taper
  5. Smoking cessation
402
Q

Treatment for chronic COPD

A
  1. Smoking cessation
  2. Home O2
  3. Beta-agonists
  4. Anticholinergics
  5. Systemic or inhaled corticosteroids
  6. Flu and pneumococcal vaccines
403
Q

Acid-base disorder in PE.

A

Respiratory alkalosis with hypoxia and hypocarbia

404
Q

Non-small cell lung cancer (NSCLC) associated with hypercalcemia

A

Squamous cell carcinoma

405
Q

Lung cancer associated with syndrome of inappropriate antidiuretic hormone (SIADH)

A

Small cell lung cancer (SCLC)

406
Q

Lung cancer associated with Lamber Eaton syndrome

A

SCLS

407
Q

Lung cancers highly related to cigarette exposure.

A

SCLC, SCC

408
Q

A tall Caucasian man presents with acute shortness of breath. Diagnosis? Treatment?

A

Spontaneous pneumothorax. Spontaneous regression; supplemental O2 may be helpful.

409
Q

Treatment of tension pneumothorax

A

Immediate needle thoracotomy (over diagnostic).

410
Q

Characteristics favoring carcinoma in a isolated pulmonary nodule.

A
  1. Age >45-50
  2. Tobacco use
  3. Lesions newer larger in comparison to old films
  4. Absence of calcification or irregular calcification
  5. Size >2cm
  6. Irregular margins
411
Q

ARDS

A

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure (PCWP).

412
Q

Sequelae of asbestos exposure

A
  1. Pulmonary fibrosis
  2. Pleural plaques
  3. Bronchogenic carcinoma (mass in lung field)
  4. Mesothelioma (pleural mass)
413
Q

Increased risk of what infection with silicosis?

A

Mycobacterium tuberculosis

414
Q

Causes of hypoxemia

A
  1. Right-to-left shunt
  2. Hypoventilation
  3. Low inspired O2 tension
  4. Diffusion defect
  5. V/Q mismatch
415
Q

Classic chest radiographic findings for pulmonary edema

A
  1. Cardiomegaly
  2. Prominent pulmonary vessels
  3. Kerley B lines
  4. “Bat’s wing” appearance of hilarity shadows
  5. Perivascular and peribronchial cuffing
416
Q

Chest radiography findings suggestive of PE

A

Westermark sign and Hampton hump

417
Q

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis

A

Type I (distal) RTA

418
Q

RTA associated with abnormal HCO3- reabsorption and rickets.

A

Type II (proximal) RTA

419
Q

RTA associated with low aldosterone state

A

Type IV (distal) RTA.

420
Q

Treatment of hypernatremia

A

NS if unstable vital signs; D5W or 1/2 NS to replace free-water loss

421
Q

Differential diagnosis of hypotonic hypervolemic hyponatremia

A
  1. Cirrhosis
  2. CHF
  3. Nephrotic syndrome
  4. Acute kidney injury (AKI)
  5. Chronic kidney disease (CKD)
422
Q

Chvostek and Trousseau signs

A

Hypocalcemia

Chvostek: tap parotid gland and fascial muscles spasm
Trousseau: pressure to upper arm (BP cuff) causes carpopedal spasm

423
Q

The most common causes of hypercalcemia

A
  1. Malignancy

2. Hyperparathyroidism

424
Q

T-wave flattening and U waves

A

Hypokalemia

425
Q

Peaked T waves and widened QRS

A

Hyperkalemia

426
Q

Treatment of hyperkalemia

A

C BIG K (Calcium gluconate, Bicarbonate, Insulin, Glucose Kayexalate)

427
Q

First-line treatment for moderate hypercalcemia

A

IV hydration

428
Q

Type of AKI in a patient with FeNa <1%

A

Prerenal

429
Q

A 49-year-old man presents with acute-onset flank pain and hematuria

A

Nephrolithiasis

430
Q

The most common type of nephrolithiasis

A

Calcium oxalate

431
Q

Ultrasonography shows bilateral enlarge kidneys with cysts. Associated brain anomaly?

A

Cerebral berry aneurysms; autosomal dominant polycystic kidney disease (PCKD)

432
Q
  1. Hematuria
  2. Hypertension
  3. Oliguria
A

Nephritic syndrome

433
Q
  1. Proteinuria
  2. Hypoalbuminemia
  3. Hyperlipidemia
  4. Hyperlipiduria
  5. Edema
A

Nephrotic syndrome

434
Q

The most common form of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

435
Q

Nephritic syndrome presenting 3 days after URI, normal C3

A

IgA nephropathy (Berger disease)

436
Q

Palpable purpura, arthralgia, abdominal pain

A

Henoch-Schonlein purpura

437
Q

Glomerulonephritis with deafness

A

Alport syndrome

438
Q

Glomerulonephritis with hemoptysis

A

Granulomatosis with polyangitis and Goodpasture syndrome

439
Q

Presence of red cell casts in urine sediment

A

Glomerulonephritis/nephritis syndorme

440
Q

Eosinophils in urine sediment

A

Allergic interstitial nephritis

441
Q

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria)

A

Nephrotic syndrome

442
Q

Muddy brown casts

A

Acute tubular necrosis

443
Q

Drowsiness, asterixis, nausea, and a pericardial friction rub

A

Uremic syndrome seen in patients with renal failure

444
Q

A 55-year-old man is diagnosed with prostate cancer. Treatment options?

A

Wait, surgical resection, radiation therapy and/or androgen suppression.

445
Q

Hematuria in a 50-year-old smoker

A

Bladder cancer

446
Q

Hematuria, flank pain, a palpable flank mass

A

Renal cell carcinoma (RCC)

447
Q

Testicular cancer associated with beta-hCG

A

Choriocarcinoma

448
Q

The most common type of testicular cancer

A

Seminoma, a type of germ cell tumor

449
Q

The most common histology of bladder cancer

A

Transitional cell carcinoma

450
Q

Complication of overly rapid correction of hyponatremia

A

Central pontine myelinolysis

451
Q

Salicylate ingestion occurs in what type of acid-base disorder?

A

Anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation

452
Q

Acid-base disturbance commonly seen in pregnant women

A

Respiratory alkalosis

453
Q

A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?

A

Probably BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)

454
Q

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms

A

Antipsychotics (neuroleptic malignant syndrome)

455
Q

Side effects of corticosteroids

A
  1. Acute mania
  2. Immunosuppression
  3. Thin skin
  4. Osteoporosis
  5. Easy bruising
  6. Myopathies
456
Q

Treatment for DTs

A

Benzodiazepines

457
Q

Treatment for acetaminophen overdose

A

N-acetylcysteine

458
Q

Treatment for opioid overdose

A

Naloxone

459
Q

Treatment for benzodiazepine overdose

A

Flumazenil (monitor for withdrawal and seizures)

460
Q

Treatment for neuroleptic malignant syndrome and malignant hyperthermia.

A

Dantrolene

461
Q

Treatment for malignant hypertension

A

Nitroprusside

462
Q

Treatment for atrial fibrillation.

A
  1. Rate control
  2. Rhythm conversion
  3. Anticoagulation
463
Q

Treatment of supraventricular tachycardia

A

If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine.

464
Q

Causes of drug-induced SLE

A
  1. INH (Tuberculosis)
  2. Penicillamine (Wilsons disease)
  3. Hydralazine
  4. Procainamide
  5. Chlorpromazine
  6. Methyldopa
  7. Quinidine (Malaria)
465
Q

Macrocytic, megaloblastic anemia with neurologic symptoms

A

B12 deficiency

466
Q

Macrocytic, megaloblastic anemia without neurologic symptoms

A

Folate deficiency

467
Q

A burn patient presents with cherry-red, flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment.

A

Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant.

468
Q

Blood in the urethral meatus or high-riding prostate.

A

Bladder rupture or urethral injury

469
Q

Test to rule out urethral injury

A

Retrograde cystourethrogram

470
Q

Radiographic evidence of aortic disruption or dissection

A
  1. Widened mediastinum (>8 cm)
  2. Loss of aortic knob
  3. Pleural cap
  4. Tracheal deviation to the right
  5. Depression of left main stem bronchus
471
Q

Radiographic indications for surgery in patients with acute abdomen.

A
  1. Free air under the diaphragm
  2. Extravasation of contrast
  3. Severe bowel distension
  4. Space-occupying lesions (CT)
  5. Mesenteric occlusion (angiography)
472
Q

The most common organism in burn-related infections

A

Psuedomonas

473
Q

Method of calculating fluid repletion in burn patients

A

Parkland formula: 24-hour fluids= 4 x kg x %BSA

474
Q

Acceptable urine output in a trauma patient.

A

50 cc/hr

475
Q

Acceptable urine output in a stable patient

A

30 cc/hr

476
Q

Signs of neurogenic shock

A
  1. Hypotension

2. Bradycardia

477
Q

Signs of increased ICP (Cushing triad)

A
  1. Hypertension
  2. Bradycardia
  3. Abnormal respirations
478
Q

Decreased CO
Decreased PCWP
Increased peripheral vascular resistance (PVR)

A

Hypovolemic shock

479
Q

Decreased CO
Increased PCWP
Increased PVR

A

Cardiogenic (or obstructive shock)

480
Q

Increased CO
Decreased PCWP
Decreased PVR

A

Distributive (eg, septic or anaphylactic) shock

481
Q

Treatment of septic shock

A
  1. Fluids

2. Antibiotics

482
Q

Treatment of cardiogenic shock

A
  1. Identify cause

2. Ionotropes (eg, dobutamine)

483
Q

Treatment of hypovolemic shock

A
  1. Identify cause

2. Fluid and blood repletion

484
Q

Treatment of anaphylactic shock

A
  1. Epinephrine 1:1000

2. Diphenhydramine.

485
Q

Supportive treatment for ARDS

A

Low tidal volume ventilation

486
Q

Signs of air embolism

A

A patient with chest trauma who was previously stable suddenly dies

487
Q

Signs of cardiac tamponade

A
  1. Distended neck veins
  2. Hypotension
  3. Diminished heart sounds (1-3 = Beck’s triad)
  4. Pulsus paradoxus
488
Q

Absent breath sounds, dullness to percussion shock, flat neck veins

A

Massive hemothorax

489
Q

Absent breath sounds, tracheal deviation, shock, distended neck veins

A

Tension pneumothorax

490
Q

Treatment for blunt or penetrating abdominal trauma in hemodynamically unstable patients

A

Immediate exploratory laparotomy

491
Q

Increased ICP in alcoholics or the elderly following head trauma. Can be acute or chronic; crescent shape on CT.

A

Subdural hematoma

492
Q

Head trauma with immediate loss of consciousness followed by a lucid interval and then rapid deterioration. Convex shape on CT.

A

Epidural hematoma

Step 2CK (10 decks)

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