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My ABFM Important > Rosh Flash Card > Flashcards

Rosh Flash Card

1
Q

Patient with glucose-6-phosphate dehydrogenase deficiency and a recently diagnosed urinary tract infection. Treatment?

A

Risk of hemolysis with medications (antimalarials, sulfonylureas, quinolones, nitrofurantoin), fava beans, infections

Oxidant drugs such as nitrofurantoin, phenazopyridine, dapsone, and sulfonamides can cause hemoglobin precipitation within the RBC, which leads to the removal of the cell from circulation via the spleen. Patients with severe G6PD enzyme deficiency who ingest oxidant drugs can experience severe hemolysis and cardiovascular collapse.

Cipro. is safe.

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2
Q

Treatment for takotsubo cardiomyopathy?

A

Initial management is similar to that of acute coronary syndrome, by first addressing acute complications and then treating stable patients with diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Treatments may be withdrawn once symptoms subside, which usually takes about 1 month.

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3
Q

Acute urinary retention treatment?

A

Using an indwelling catheter for 48–72 hours is an appropriate treatment for acute urinary retention.

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4
Q

Time for excision of hemorrhoids in ED or clinic?

A

Acutely thrombosed hemorrhoids < 72 hours can be excised in the ED or some clinics

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5
Q

Risk factors for hemorroids?

A

Risk factors Pregnancy, genetic predisposition, colon cancer, inflammatory bowel disease, Crohn disease, rectal surgery, chronic diarrhea, and spinal cord injury

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6
Q

Primary amenorrhea age?

A

Absence of menses by the age 15

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7
Q

Work up for primary amenorrhea. What age?

A

No menses by age 15 and no developmental of secondary sexual characteristic by age 13

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8
Q

Common causes of primary amenorrhea?

A

Gonadal dysgenesis, Mullerian agenesis, Physiological delay of puberty, transverse vaginal septum, weight loss or anorexia nervosa and hypopituitarism.

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9
Q

Psoriasis treatment <5% of body

A

<5% of body involved
– Topical corticosteroids
– Calcipotriene (Dovonex)
* Vitamin D3 analog
– Calcitriol (Vectical)
– Tazarotene (Tazorac)
– Anthralin
– Salicylic acid
– Localized UVB phototherapy
– Tacrolimus, Pimecrolimus

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10
Q

Psoriasis treatment >5% of body

A

> 5% of body involved (phototherapy)
– UVB
* Broad band, narrow band (II-III, B-C)
* +/- topical, systemic, biologic agents
– Narrow band UVB
– Excimer laser (IIB)

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11
Q

Postherpetic Neuralgia – Treatment?

A
  • Anticonvulsants
    – Pregabalin (Lyrica)
    – Gabapentin (e.g., Neurontin)
  • Tricyclics
  • Opioid analgesics
  • Sympathetic nerve blocks
    – Bupivacaine
    – Must be given within 2 months of onset to be effective
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12
Q

Herpes Zoster Treatment?

A
  • Analgesics
  • Wet compresses (Burow’s solution – aluminum acetate)
  • Antiviral therapy
    – Acyclovir (e.g., Zovirax)
  • 800 mg 5x/day x 7 days
    – Famciclovir
  • 500 mg TID x 7 days
    – Valacyclovir (e.g., Valtrex)
  • 1 g TID x 7 days
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13
Q

Allergic to lidocaine than what to use?

A

Esters: Procaine or Chloroprocaine

One way to remember which class each anesthetic belongs to is to use the following trick: all of the amides have two i’s in their spelling, whereas the esters have only one i.

Other name for procaine is “Novocaine”

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14
Q

Local anesthetics side effects?

A
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15
Q

Benzocaine side effect?

A

Methemoglobinemia

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16
Q

Lidocaine side effect?

A

Seizures, hypotension

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17
Q

Bupivacaine side effect?

A

Cardiotoxicity

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18
Q

For which two immunizations is it more cost effective to perform serologic testing for immunity than to administer vaccines without serologic testing first?

A

Varicella and hepatitis B

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19
Q

Loud S1 and opening snap murmur?

A

Mitral Stenosis

RSSR. Systolic
TPAM
SRRS. Diastolic

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20
Q

Murmur sounds?

A

AR: Blowing diastolic
AS: Crescendo-decrescendo
MR: Loud holosystolic murmur
PS: Systolic ejection murmur

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21
Q

What is the most commonly associated complication of mitral valve stenosis?

A

Atrial Fibrillation

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22
Q

Hyper vs Hypothyroidism

A

Hypo: Weight gain, constipation and cold intolerance

Hyper: Weight loss, palpitation, increase bowel movement, heat intolerance.

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23
Q

Drugs for hyperthyroidism?

A
  1. Beta blocker (Propranolol)
  2. Methimazole or Propythiouracil
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24
Q

Is PTU safe during pregnancy?

A

PTU in the first trimester of pregnancy

P for P

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25
Q

Management of auricular hematoma?

A

Tx: drainage + conforming pressure

  • Acute (< 48 hr) and small (< 2 cm): needle aspiration
  • Large (> 2 cm) or 48 hrs to 7 days: incision and drainage
  • > 7 days: referral to ENT/plastic surgeon
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26
Q

What is premenstrual syndrome?

A

Premenstrual syndrome (PMS) is a combination of physical and behavioral symptoms that occur monthly in the luteal phase of a patient’s menstrual cycle.

1–2 weeks prior to menstrual cycle

Sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA that resolves after menses begins

Treatment is decreased caffeine intake, exercise, stress reduction, NSAIDs, SSRIs, OCPs

Symptoms do not hinder personal or professional life (unlike premenstrual dysphoric disorder)

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27
Q

Treatment of PMS (premenstrual syndrome)?

A

lifestyle modifications, such as regular exercise, relaxation techniques, and dietary changes, including smaller, more frequent meals and reduced consumption of caffeine, salt, alcohol, and simple carbohydrates.

In patients whose symptoms are not resolved with lifestyle modifications, pharmacologic therapy with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, or citalopram is first-line treatment.

Patients who do not respond to one SSRI may respond to a different agent, so a trial of a second SSRI should occur prior to moving to second-line treatment options.

Additionally, combined oral contraceptives containing drospirenone may be used. SSRIs may be taken daily or during the luteal phase of the menstrual cycle only.

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28
Q

Painless vs Painful penile ulcer?

A

Painless: Chancre (Syphilis)
Painful: Chancroid (H. ducreyi)

HSV 2: Difference is tender inguinal lymphadenopathy.

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29
Q

Left untreated, how long do chancres typically take to spontaneously heal?

A

3-6 weeks.

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30
Q

Treatment for Syphilis.

A

Tx:

Primary or secondary: IM benzathine penicillin G, 1 dose

Tertiary: IM benzathine penicillin G qwk for 3 weeks

Primary: painless chancre

Secondary: lymphadenopathy, condyloma lata, rash on palms and soles

Tertiary: gummas

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31
Q

Which diabetes medication puts patients at a heightened risk for leg and foot amputations?

A

Canagliflozin, a sodium-glucose cotransporter-2 inhibitor.

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32
Q

Following amputation injuries, which replantation finger is most important?

A

Replantation of an amputated appendage is indicated for amputations occurring in children, and for thumb injuries since the thumb is responsible for a significant portion of the function of the hand.

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33
Q

Rapid Bio.

Standard deviation:
Standard error of the mean:
Positive skew:
Negative skew:
Null hypothesis (H0):
Type I error:
Type II error:
Alpha:
Beta:
Power:
Increase power and decrease beta:
Confidence interval:
T-test:
ANOVA:
Chi-square:
P value:

A

Standard deviation: variability from mean
Standard error of the mean: variability between sample mean and true mean
Positive skew: mean > median > mode
Negative skew: mean < median < mode
Null hypothesis (H0): theory that the exposure or intervention that is being studied is not associated with the outcome of interest
Type I error: H0 incorrectly rejected (rejecting H0 when it is true)
Type II error: H0 incorrectly accepted (failing to reject H0 when it is false)
Alpha: probability of type I error
Beta: probability of type II error
Power: probability of correctly rejecting H0
Increase power and decrease beta: increase sample size, increase expected effect size, increase precision of measurement
Confidence interval: range in which real mean expected to fall
T-test: compares means of two groups
ANOVA: compares means of three groups
Chi-square: ≥ 2 percentages or proportions of categorical outcomes
P value: measure of the effect of chance within a study

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34
Q

How is oxygen administered as an acute alternative treatment for cluster headache?

A

Via face mask at 100% FiO2 at a rate of 8–15 L/min for up to 15 minutes.

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35
Q

Pathophysiology behind cluster headache?

A

Hypothalamic and circadian rhythm dysfunction

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36
Q

Severe temporal or periorbital headaches lasting between 15 and 180 minutes associated with ipsilateral trigeminal autonomic signs such as lacrimation, nasal congestion, rhinorrhea, conjunctival injection, eyelid edema, ptosis, miosis, and forehead or facial swelling. Type of headache?

A

Cluster headache

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37
Q

Management of cluster headache?

A

Management includes abortive therapies (e.g., oxygen, sumatriptan, zolmitriptan), prophylaxis (e.g., verapamil), and avoidance of triggers.

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38
Q

Pathophysiology behind migraine headaches?

A

Cortical activation with initial brain hyperemia followed by prolonged oligemia

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39
Q

Pathophysiology behind tension headaches?

A

Multifactorial involving peripheral myofascial factors with central nervous system (pain) response and seem related to central sensitization and lowered threshold for pain in the trapezius, frontalis, and temporalis muscles.

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40
Q

How does PPI work?

A

PPIs work by inhibiting gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium (H-K) ATPase pump.

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41
Q

What is a severe complication that can occur from long-standing chronic gastroesophageal reflux disease (GERD)?

A

Barrett esophagus.

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42
Q

GERD treatment?

A

Gastroesophageal reflux disease (GERD), the first line of therapy typically involves the use of proton pump inhibitors (PPIs).

PPIs are generally indicated in patients who have either failed twice-daily H2-receptor antagonist (H2RA) therapy (with underlying erosive esophagitis), and/or experience frequent (eg, 2 or more episodes per week; as in this case) or severe symptoms of GERD that impair their quality of life.

<2 episode of gerd in a week: H2RA
>2 episode in a week: PPI

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43
Q

Why is the use of topical benzocaine not advised for pain control in patients with oral lichen planus?

A

Due to a rare risk of potentially fatal methemoglobinemia with even one application.

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44
Q

First-line treatment for oral lichen planus?

A

Topical corticosteroids

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45
Q

High specificity will have ?

A

Few false-positive results

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46
Q

High sensitivity will have?

A

Few false-negative results

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47
Q

How should children with severe obstructive sleep apnea be treated?

A

Prompt adenotonsillectomy or positive airway pressure therapy with continuous positive airway pressure or bilevel positive airway pressure.

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48
Q

Which class of antibiotics are contraindicated in patients with risk factors for torsades de pointes?

A

Fluoroquinolones.

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49
Q

Most common root causes of sentinel events?

A

Communication, leadership, and human factors consistently remain the most common root causes of sentinel events.

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50
Q

What reproductive complication can occur in female patients infected with mumps virus?

A

Oophoritis, or inflammation of the ovaries.

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51
Q

Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells, characteristic cells of what pleurisy?

A

Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells, characteristic cells of rheumatoid arthritis, in a background of amorphous debris is diagnostic of rheumatoid pleurisy.

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52
Q

Light’s criteria?

A

Transudate: Pleura : Serum protein <=0.5
Exudate: >0.5

LDH
<=0.6 (Transudate)
>0.6 (Exudate)

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53
Q

Most common genetic cause of chronic kidney disease and is often clinically silent.

A

Autosomal dominant polycystic kidney disease

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54
Q

How often should patients with unruptured intracranial aneurysms that are not treated with endovascular methods or open surgery be radiographically monitored?

A

Serially with computed tomography angiography or magnetic resonance angiography annually for two to three years, then every two to five years thereafter if stable.

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55
Q

What is increased risk in patients with autosomal dominant polycystic kidney disease?

A

Incidence of cerebral aneurysm

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56
Q

Diabetes screening age?

A

35 to 70

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57
Q

Screening for colon cancer age?

A

45 to 75

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58
Q

Screening for cervical cancer?

A

21 to 29: Pap every 3 year
>30 to 65: Cytology + HPV every 5 year

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59
Q

What is the treatment for Chlamydia trachomatis in nonpregnant patients?

A

Doxycycline 100 mg PO BID x 7 days

Azithromycin 1 g PO single dose (pregnancy)

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60
Q

Where do superficial basal cell carcinomas most commonly present?

A

On the trunk.

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61
Q

Perianal itching. Dx and treatment?

A

Enterobiasis, or pinworm.

Treatment option includes mebendazole, albendazole, or pyrantel pamoate
Dose is repeated in 2 weeks

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62
Q

Which dietary vitamin deficiency is associated with an increased risk for complete mole?

A

Vitamin A

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63
Q

What vitamin deficiency, aside from vitamin B12 deficiency, is a common cause of megaloblastic anemia?

A

Folic acid (vitamin B9) deficiency.

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64
Q

What is decreased in a patient with vitamin B12 deficiency anemia?

A

Serum cobalamin levels will be decreased in a patient with vitamin B12 deficiency anemia.

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65
Q

Most common cause of intestinal obstruction in infants?

A

Intussusception

6 months to 3 years old

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66
Q

Periosteal new bone formation with the formation of Codman’s triangle and sunburst pattern. In what type of cancer?

A

Osteosarcoma

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67
Q

Most common opportunistic infection when CD4 counts drop to less than 200 cells/mm3 and treatment?

A

The most common opportunistic infection is Pneumocystis pneumonia, which is likely when CD4 counts drop to less than 200 cells/mm3. It can be prevented with trimethoprim-sulfamethoxazole prophylaxis.

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68
Q

CD4 counts drop below 50 cells/mm3/ prophylactic treatment?

A

Azithromycin is given prophylactically for the prevention of disseminated Mycobacterium avium complex. It is typically seen when CD4 counts drop below 50 cells/mm3.

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69
Q

CD counts less than 150 cells/mm3 prophylactic treatment?

A

Itraconazole is given to those at high risk of occupational or communal exposure to Histoplasmosis capsulatum infection and is typically seen at CD counts less than 150 cells/mm3.

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70
Q

Should patients with HIV get the flu vaccine?

A

They should get the inactivated influenza vaccine annually, however, live-attenuated vaccine is contraindicated in HIV-infected patients.

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71
Q

Dialysis for lithium toxicity?

A
  1. Impaired kidney function with lithium concentration of >4
  2. Lithium concentration of >5
    • Seizure, AMS and dangerous dysrhythmia
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72
Q

What are absolute contraindications to prescribing lithium?

A

Lithium is contraindicated in patients with significant renal impairment, sodium depletion, dehydration, or significant cardiovascular disease.

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73
Q

Hallmark laboratory findings for hemolytic anemia?

A

Hallmark laboratory findings include increased lactate dehydrogenase, reticulocytes, and indirect bilirubin as well as decreased haptoglobin.

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74
Q

What is the most common cause of hemolytic anemia due to a red cell membrane defect?

A

Hereditary spherocytosis.

75
Q

Rice water, and may be profuse, leading to dehydration. Dx and treatment?

A

Cholera and Doxycycline for treatment.

Ciprofloxacin, azithromycin, or tetracycline as reasonable alternatives depending on local patterns of susceptibility and resistance.

76
Q

Which serogroups of Vibrio cholerae cause disease in humans?

A

Serogroups O1 and O139.

77
Q

Abrupt onset of vaginal bleeding after 20 weeks gestation accompanied by abdominal pain, hypertonic uterine contractions with a firm uterus (may be rigid and tender), and a non-reassuring fetal heart rate pattern.

A

Classic clinical manifestations for placental abruption (abruptio placentae)

A classic ultrasound finding is a retroplacental hematoma.

78
Q

Developmental dysplasia of the hip. Risk, Screen?

A

Infants who were breech in utero have an increased risk for mild deformations, including developmental dysplasia of the hip.

All infants should be screened for developmental dysplasia of the hip using the Ortolani and Barlow maneuvers between birth and 3 months of age.

Universal routine screening with ultrasonography is not recommended. However, infants at high risk of developmental dysplasia should have an ultrasonography assessment between four and six weeks of age.

79
Q

In addition to developmental dysplasia of the hip, what other mild deformations are associated with neonates who were breech in utero?

A

Prominent occiput, frontal bossing, torticollis, upward-slanting eyes, and low-set ears.

80
Q

What type of nystagmus is considered hallmark and associated with phencyclidine intoxication?

A

Rotary nystagmus.

81
Q

Caloric testing. Finding both with cold and warm water?

A

When using cold water in the ear canal, the fast beating portion of nystagmus moves toward the opposite ear.

If warm water is used, the fast beating nystagmus moves toward the ipsilateral ear.

The mnemonic COWS is helpful to remember the expected responses with intact brain stem function: Cold Opposite, Warm Same.

82
Q

Immediate knee pain and usually develop a joint effusion over the next 24 to 48 hours. May report feeling that the knee is “locking up,” clicking, or popping. Dx?

A

A meniscal tear is an injury to either the medial or lateral cartilage layer and is usually due to a “twisting” injury with a planted foot.

First-line treatment is NSAIDs and physical therapy; however, early surgical intervention should be considered in young patients with a lack of mobility.

An Apley or McMurray test may be positive, but neither of these is very sensitive or specific.

83
Q

Immediate, severe knee pain followed by an inability to bear weight and the development of a joint effusion. Dx?

A

Anterior cruciate ligament (ACL)

84
Q

Diffuse, anterior knee pain often localized or described as being behind the patella. Pain is aggravated by climbing stairs or squatting. Dx?

A

Patellofemoral pain syndrome (PFPS)

85
Q

What is the best clinical indicator of meniscal tear?

A

Joint line tenderness.

86
Q

What is the autoimmune disorder that causes hyperthyroidism?

A

Graves’ disease.

87
Q

Honeycombing on CT scan of lungs?

A

Classic manifestations include the onset of dyspnea on exertion with nonproductive cough over a period of several months. Fever, fatigue, myalgias, and arthralgias are usually absent. Chest auscultation typically demonstrates bibasilar crackles. Hallmark findings on high-resolution CT include peripheral (subpleural) bibasilar reticular opacities associated with architectural distortion such as honeycombing and traction bronchiectasis.

Prognosis is poor, but pirfenidone and nintedanib appear to slow the course of disease

88
Q

Pleural plaques with linear bands of calcification on high-resolution CT lung. Dx?

A

Asbestosis

89
Q

RA presentation? Lab?

A

Morning stiffness that lasts for at least 30 minutes.
Symptoms should be present for a minimum of 6 weeks.

More classic joint abnormalities associated with rheumatoid arthritis such as ulnar drift, swan neck, and boutonniere deformities, tend to appear with patients who have chronic disease.

Rheumatoid factor, anti-citrullinated protein antibody, C-reactive protein, and erythrocyte sedimentation rate are all recommended laboratory studies to aid in the diagnosis of rheumatoid arthritis.

Rheumatoid factor, however, is not specific for rheumatoid arthritis and may be positive in other diseases as well. Patients do not need a positive rheumatoid factor to be diagnosed with rheumatoid arthritis. Anti-citrullinated protein antibody is much more specific for rheumatoid arthritis.

90
Q

Joints involved in RA?

A

PIP and MCP

91
Q

Positive anti-double-stranded DNA antibodies, and positive antiphospholipid antibody would coincide with a diagnosis of?

A

Positive anti-double-stranded DNA antibodies, and positive antiphospholipid antibody would coincide with a diagnosis of systemic lupus erythematosus.

92
Q

Negative rheumatoid factor, a positive anti-SS-A antibody, and a positive anti-SS-B antibody. Dx?

A

Sjögren syndrome

93
Q

If a young man presented with joint pain following a recent genitourinary infection with Chlamydia trachomatis, what would be the most likely diagnosis?

A

Reactive arthritis.

94
Q

SSI treatment?

A

Evidence of purulence indicates that the patient will require incision and drainage of the infected wound, including debridement of necrotic tissue, followed by dressing of the open wound which can then be closed by secondary intention.

Open wound dressings commonly consist of gauze that is moistened with saline before being placed into the wound.

The surrounding tissue involvement and systemic signs indicate that this patient also requires a course of antibiotics with broad-spectrum coverage.

Although the typical duration of antibiotic therapy for uncomplicated cellulitis is five days, a duration of 14 days is warranted in this patient due to his history of diabetes mellitus.

Topical antiseptic adds NO benefit to wound healing over drainage and debridement.

95
Q

Parkinson disease pathophysiology?

A

It is due to loss of the substantia nigra with resultant depletion of dopamine.

96
Q

Parkinson clinical findings?

A

Clinical findings include tremor, bradykinesia, and rigidity as well as postural instability, shuffling gait, and dementia. Diagnosis of Parkinson disease is clinical.

97
Q

What two prescription drugs can cause drug-induced parkinsonism?

A

Antipsychotics and antiemetics.

98
Q

Campylobacter jejuni is associated with development of?

A

Guillain-Barré syndrome, an immune-mediated polyneuropathy characterized by acute onset of symmetric ascending paralysis. Unlike botulism, Guillain-Barré syndrome usually also presents with sensory deficits.

99
Q

Acute onset of bilateral cranial neuropathies and symmetric descending weakness 24 to 48 hours after ingestion. Dx?

A

Foodborne botulism

100
Q

In what type of angina should beta-blockers not be used?

A

Prinzmetal (vasospastic) angina, as they may increase the risk of coronary vasospasm with unopposed alpha-receptor activity.

101
Q

Therapy for acute stable angina?

A

Nitrates

102
Q

First-line therapy for chronic stable angina?

A

Beta-blockers

103
Q

Types of B- blocker?

A

Beta-blockers are classified into two main groups: non-selective, which act on both beta 1 (cardiac muscle) and beta 2 (cardiac muscle, bronchial tissue, peripheral smooth muscle); and cardioselective, which act primarily on cardiac muscle, although at higher doses, they lose much selectivity).

Cardioselective beta-blockers (e.g., atenolol, metoprolol, bisoprolol) are most commonly used in stable ischemic heart disease.

Carvedilol (with both alpha- and beta-blockade) is also an effective anti-anginal drug.

Dosage is very important in the antianginal efficacy of beta-blockers, as higher doses are often required for maximum benefit. Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.

104
Q

Side effects of beta-blockers?

A

Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.

105
Q

Where does prostate cancer preferentially metastasize?

A

Axial skeletal bones.

106
Q

PSA > 4 (prostate-specific antigen)?

A

Refer to urologist

107
Q

Diagnosis of diabetes in adult?

A

The diagnosis of diabetes can be made with a
fasting plasma glucose level of 126 mg/dL or greater on more than one occasion;
a glycosylated hemoglobin A1C level of 6.5% or greater;
a random plasma glucose level of 200 mg/dL or greater in a patient with classic symptoms of hyperglycemia;
or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg/dL or greater.

108
Q

Diagnosis of diabetes in children?

A

Children have a body mass index greater than the 85th percentile for age and sex, plus two additional risk factors such as
family history,
high-risk ethnicity,
acanthosis nigricans,
polycystic ovary syndrome,
hypertension, or dyslipidemia.

They should be screened every two years with a fasting plasma glucose test.

However, the diagnostic utility of glycosylated hemoglobin A1C is not well-established in children.

109
Q

Distinguish type 1 vs type 2 DM?

A

Antibodies detected against islet cells, tyrosine phosphatase-like protein, and glutamic acid decarboxylase help distinguish between type 1 and type 2 diabetes mellitus.

110
Q

Autoimmune pancreatitis test?

A

Carbonic anhydrase II antibodies

111
Q

Ulcerative colitis antibody test?

A

Perinuclear antineutrophil antibodies

112
Q

Treatment of ulcerative colitis?

A

Treatment of ulcerative colitis involves medications such as 5-aminosalicylates, steroids, azathioprine, cyclosporine, infliximab or vedolizumab, and surgery including proctocolectomy.

113
Q

Children and adolescents with diabetes are at increased risk for what psychiatric complications?

A

Anxiety and depression.

114
Q

What topical therapy is approved by the FDA for the treatment of superficial basal cell carcinomas in low-risk sites?

A

Imiquimod 5% cream.

Low risk site: trunk, limbs, cheeks, forehead, scalp, and neck

115
Q

What teratogenic exposures can result in phenotypic similarities to DiGeorge syndrome?

A

Isotretinoin and ethanol.

116
Q

DiGeorge syndrome findings?

A

Conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia. (CATCH 22) A: Abnormal face, C: Cleft, H: hypocalcemia

Recurrent sinopulmonary infections to severe combined immunodeficiency. Patients may also present with palatal abnormalities and developmental delays.

22q11.2 deletion

117
Q

Metatarsal shaft fracture. Ortho referral indications?

A

Indication for orthopedic consultation or referral for metatarsal shaft fracture.

  1. Fractures of multiple metatarsal
  2. Displaced fracture near the metatarsal head.
  3. Intra articular fracture
  4. Displaced fracture of the first metatarsal, even if displacement is minimal, because anatomic position is necessary for optimal weightbearing function.
  5. Unstable fracture of the first metatarsal, judged by clinical finding on stress radiograph.
  6. Concurrent injury of other structures including injury of the tarsometatarsal that his Lisfranc ligament complex and fracture of other foot or ankle bone.
118
Q

Surgery for aortic stenosis indication?

A

Severe aortic stenosis is identified by an aortic jet velocity ≥ 4.0 m/s, a mean transvalvular pressure gradient ≥ 40 mm Hg, or an aortic valve area ≤ 1.0 cm2

Valve replacement for severe aortic stenosis is recommended for patients who have symptoms by history or on exercise testing, in asymptomatic patients with left ventricular ejection fraction < 50%, and in patients undergoing other cardiac surgery.

Surgical aortic valve replacement and transcatheter aortic valve implantation are the only effective treatments for severe aortic stenosis.

119
Q

Chest pain, Dyspnea and Syncope?

A

Aortic Stenosis

120
Q

Most sensitive diagnostic study for the diagnosis of achalasia?

A

Esophageal manometry is the most sensitive diagnostic study for the diagnosis of achalasia. Achalasia is a primary esophageal motility disorder characterized by loss of peristalsis in the distal esophagus and a failure of the lower esophageal sphincter to relax with swallowing.

121
Q

Which infectious disease can cause loss of esophageal ganglion cells?

A

Chagas disease.

122
Q

Esophageal manometry demonstrating aperistalsis in the distal two-thirds of the esophagus and incomplete lower esophageal sphincter relaxation. Dx?

A

Achalasia

123
Q

Risk factors for both ulcerative colitis and Crohn disease?

A

Risk factors for both ulcerative colitis and Crohn disease include age in the 20s (ulcerative colitis has another peak in the 50s), positive family history of inflammatory bowel disease, and northern European or Ashkenazi Jewish heritage. Studies have shown a link between gastroenteritis and the immune response thereof to the development of inflammatory bowel disease.

124
Q

Management of Acute Bronchitis?

A

Dextromethorphan is a non-opioid antitussive shown to be effective at decreasing cough symptoms, and guaifenesin is an expectorant with some benefit in decreasing cough frequency and intensity. The combination of dextromethorphan with guaifenesin is beneficial for the management of acute bronchitis.

125
Q

What conditions should be included in the differential diagnosis of a patient who presents with plantar heel pain and pain in the sole of the foot?

A

Tarsal tunnel syndrome, neuropathic pain, and S1 radiculopathy.

126
Q

Mucin, the primary substance of mucus, is produced and secreted by ?

A

Goblet cells

127
Q

Type 2 pneumocytes function?

A

Secrete pulmonary surfactant.

128
Q

What is the most common type of jaundice in newborns?

A

Physiologic jaundice.

129
Q

Jaunice during stress, infection. Dx?

A

Most patients with Gilbert disease are asymptomatic however, jaundice and further elevation of the bilirubin level may occur during periods of stress, fasting, or illness.

130
Q

Elevated conjugated bilirubin level?

A

Dubin-Johnson and Rotor syndrome both have elevations in conjugated bilirubin levels.

131
Q

Gilbert Syndrome increased risk for?

A

Increased risk of cholelithiasis

132
Q

Microangiopathic hemolytic anemia, thrombocytopenia, neurologic manifestations, fever, and renal disease. Dx?

A

Classic pentad.
Thrombotic thrombocytopenic purpura

133
Q

Schistocytes, anemia, elevated lactate dehydrogenase, indirect hyperbilirubinemia, and thrombocytopenia. Dx?

A

Thrombotic thrombocytopenic purpura

134
Q

Hemolytic anemia, AKI, Thrombocytopenia. DX?

A

Classic triad
HUS
Caused by E.Coli O157:H7 (Shiga toxin)

135
Q

Ovarian cancer screening?

A

Increased-risk family history is defined by the USPSTF as
1) having two or more first- or second-degree relatives with a history of ovarian cancer or a combination of breast and ovarian cancer, or 2) Ashkenazi Jewish ancestry with a first-degree relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer.

136
Q

Fractures is most commonly nonoperative in adults?

A

Radial head fracture

137
Q

In what age group are supracondylar fractures common?

A

They typically occur in children between 5 and 10 years of age.

138
Q

X-ray: posterior fat pad sail sign. Dx?

A

Radial Head Fracture

139
Q

What level of lead in children needs treatment?

A

Venous blood lead level of 45 ug/dl higher should be treated.

140
Q

Treatment for lead toxicity?

A

Oral succimer or IV EDTA

141
Q

Palpitations, lightheadedness (or near syncopal episodes), hypokalemia, and hypomagnesemia are suggestive of. Dx?

A

Acquired torsades de pointes

142
Q

Torsades de pointes is commonly caused by drugs?

A

antidysrhythmics, antihistamines, macrolide antibiotics, antifungals).

Labs: hypokalemia, hypocalcemia, and hypomagnesemia.

143
Q

Conventional radiography is not as sensitive for detecting acute osteomyelitis, especially if symptoms are of ——– duration?

A

Less than two weeks’ duration.

144
Q

Radiographically, the presence of what is pathognomonic of chronic osteomyelitis?

A

Radiographically, the presence of a sinus tract is pathognomonic of chronic osteomyelitis.

Other radiographic findings include sequestra (separated pieces of dead bone) and involucra (layers of new bone growing from the periosteum).

145
Q

Sudden onset of unilateral warmth, erythema, and swelling over the foot or ankle, often with a history of minor trauma. Dx?

A

Charcot arthropathy

146
Q

What blood test may be helpful in distinguishing restrictive cardiomyopathy from constrictive pericarditis?

A

A plasma brain natriuretic peptide level of 400 pg/mL or greater is suggestive of restrictive cardiomyopathy rather than constrictive pericarditis.

147
Q

Restrictive cardiomyopathy VS Constrictive pericarditis?

A

First, palpation of the left ventricular impulse is usually normal with restrictive cardiomyopathy.
In contrast, a nonpalpable impulse is suggestive of constrictive pericarditis.

Second, a third heart sound (S3 gallop) is frequently present with restrictive cardiomyopathy because of the abrupt cessation of rapid ventricular filling.
This sound is not heard in constrictive pericarditis; instead, a pericardial knock that occurs earlier than a third heart sound can be heard in the majority of patients with constrictive pericarditis.

148
Q

Proteinuria, hypoalbuminemia, edema, and hyperlipidemia are characteristic clinical features of. Dx?

A

Nephrotic syndrome.

149
Q

Episodic hematuria 1-2 days after URI?

A

IgA nephropathy (Berger disease)

150
Q

Hematuria weeks after URI?

A

Post streptococcal glomerulonephritis

151
Q

Classic triad of hypertension, hematuria, and dependent edema. Dx?

A

Nephritic Syndrome

152
Q

What is the leading primary cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis. It is the most common primary glomerular disease leading to end-stage kidney disease in the United States.

153
Q

What are risk factors for developing adhesive capsulitis?

A

Patients at greater risk of developing adhesive capsulitis include those with diabetes mellitus, thyroid disease, prolonged immobilization, stroke, and autoimmune disorders.

154
Q

herpes labialis treatment?

A

Episodic therapy is recommended for patients with an identifiable prodrome because initiation during the prodrome stage (burning, numbness and tingling) or within 72 hours of rash onset has been shown to lessen the duration and severity of the lesions. Recommended episodic therapy includes famciclovir 1,500 mg once by mouth or valacyclovir 2 g twice daily for 1 day by mouth.

In patients with frequent recurrences, defined as more than four episodes per year and with no identifiable prodrome, chronic suppressive therapy is recommended, which includes valacyclovir 500 mg daily.

In this patient with more than four episodes per year, no identifiable prodrome, and presenting within 72 hours of rash onset, the best management option is to treat with valacyclovir 2 g PO bid for 1 day, then suppress with valacyclovir 500 mg PO qd.

155
Q

Hirschsprung disease, or congenital aganglionic megacolon, is a developmental disorder (neurocristopathy) of the enteric nervous system characterized by?

A

Absence of ganglion cells in the submucosal and myenteric plexus.

156
Q

Most common cause of lower intestinal obstruction in neonates,

A

Hirschsprung disease, or congenital aganglionic megacolon

Rectal suction biopsy is the gold standard for diagnosing Hirschsprung disease

157
Q

Parkinson Disease.

A

Decrease of dopamine released from the basal ganglia

158
Q

Management of PDA?

A

Management includes indomethacin, conservative observation, surgical ligation, or percutaneous transcatheter occlusion

159
Q

Which of the following classes of diabetic medication is recommended by most experts to be avoided in patients starting from 3–4 days before surgery because of an increased risk of hypovolemia?

A

Sodium-glucose cotransporter 2 inhibitors.

Sodium-glucose cotransporter 2 inhibitors (e.g., dapagliflozin, canagliflozin, empagliflozin) can increase the risk of hypovolemia since they promote glucose excretion through the kidneys and can result in excess water loss. These medications are recommended to be discontinued 3–4 days before surgery.

160
Q

What unusual complication has been reported in patients with type 2 diabetes mellitus taking sodium-glucose cotransporter 2 inhibitors?

A

Euglycemic diabetic ketoacidosis.

161
Q

Dysmenorrhea, menorrhagia, dyspareunia, post-coital bleeding, pelvic or abdominal pain, and infertility.

A

Endometriosis

162
Q

Endometriosis treatment?

A

Nonsteroidal anti-inflammatory drugs such as naproxen are an appropriate first-line treatment for endometriosis.

163
Q

Which vitamins is used as pharmacotherapy for the treatment of nonalcohol-related fatty liver disease?

A

Vitamin E

164
Q

Vitamin E supplementation should be avoided in patients with a personal or strong family history of what type of cancer?

A

Prostate cancer.

165
Q

Gold standard for the laboratory confirmation of malaria?

A

Microscopy

166
Q

Which malarial parasite is most likely to result in severe infection and, if not promptly treated, can result in death?

A

Plasmodium falciparum.

167
Q

Fever, malaise, headache, and a stiff neck in immunocompromised patients (e.g., AIDS patients) is suggestive of?

A

Cryptococcal meningoencephalitis

168
Q

Name three contraindications to performing a lumbar puncture?

A

Local skin infection at the lumbar site, thrombocytopenia, and vertebral abnormalities.

169
Q

Treatment of cluster headache?

A

100% oxygen
Sumatriptan

170
Q

What medication is recommended for initial preventive treatment of cluster headache?

A

Verapamil.

171
Q

Types of botulism?

A

infantile botulism, foodborne botulism, wound botulism

172
Q

Typical initial presentation for infantile botulism?

A

Typical initial presentation in infants is constipation and poor feeding, followed by hypotonia and weakness.

173
Q

Pathophysiology of infantile botulism?

A

The toxin acts on presynaptic nerve terminals to block the release of acetylcholine by impairing the exocytosis process.

174
Q

Most common atypical presenting complaint in older patients diagnosed with acute coronary syndrome?

A

Dyspnea

175
Q

Target-shaped skin lesions. The most common known causes?

A

Reactivated herpes simplex, Mycoplasma pneumonia, and upper respiratory tract infections.

176
Q

Drugs causing erythema Multiforme?

A

Drugs: sulfa, oral hypoglycemics, anticonvulsants, penicillin, NSAIDs (SOAPS)

177
Q

Ataxia, dysarthria, vision and hearing loss, cardiomyopathy, and diabetes. Dx?

A

Friedreich ataxia

178
Q

Dementia, choreiform movements, and psychiatric manifestations. Dx?

A

Huntington disease

179
Q

Premenstrual disorders treatment?

A

Selective serotonin reuptake inhibitors (SSRIs) (e.g. escitalopram) are first-line. If patients do not wish to take SSRIs, have failed SSRIs or wish to have contraception as an added benefit, oral contraceptive pills can be used instead.

180
Q

Pyoderma gangrenosum is a rare disorder typically associated with an underlying?

A

Systemic disease (e.g., inflammatory bowel disease, hematologic malignancy, arthritis)

181
Q

Most common cause of postpartum hemorrhage?

A

Uterine atony

DDx: uterine atony, lacerations, retained placenta, abnormally adherent placenta, coagulopathy

182
Q

Classic manifestations of idiopathic pulmonary fibrosis?

A

Gradual onset of dyspnea on exertion with nonproductive cough.

183
Q

Slows disease progression in patients with idiopathic pulmonary fibrosis. Medications?

A

Prognosis is poor, but two medications, pirfenidone and nintedanib, seem to slow the course of disease

184
Q

What test best confirms the initial diagnosis of ankylosing spondylitis?

A

Pelvic X-ray of the sacroiliac joint.

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