S2 RR_3 Flashcards
A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension
Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
_ 200 for PCP (with TMP); _ 50-100 for MAI (with clarithromycin/azithromycin)
Risk factors for pyelonephritis.
Pregnancy vesicoureteral reflux anatomic anomalies indwelling catheters kidney stones
Neutropenic nadir postchemotherapy.
7-10 days
Erythema migrans.
Lesion of 1Á Lyme disease
Classic physical findings for endocarditis.
Fever heart murmur Osler’s nodes splinter hemorrhages Janeway lesions Roth’s spots
Aplastic crisis in sickle cell disease.
Parvovirus B19
Ring-enhancing brain lesion on CT with seizures
Taenia solium (cysticercosis)
Name the organism: Branching rods in oral infection.
Actinomyces israelii
Name the organism: Painful chancroid.
Haemophilus ducreyi
Name the organism: Dog or cat bite.
Pasteurella multocida
Name the organism: Gardener.
Sporothrix schenckii
Name the organism: Pregnant women with pets.
Toxoplasma gondii
Name the organism: Meningitis in adults.
Neisseria meningitidis
Name the organism: Meningitis in elderly.
Streptococcus pneumoniae
Name the organism: Alcoholic with pneumonia.
Klebsiella
Name the organism: Currant jelly sputum.
Klebsiella
Name the organism: Infection in burn victims.
Pseudomonas
Name the organism: Osteomyelitis from foot wound puncture.
Pseudomonas
Name the organism: Osteomyelitis in a sickle cell patient.
Salmonella
A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
Legionella pneumonia
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis and how did he get it? Treatment?
Lyme disease Ixodes tick doxycycline
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
A patient presents with pain on passive movement pallor poikilothermia paresthesias paralysis and pulselessness. Treatment?
All-compartment fasciotomy for suspected compartment syndrome
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Spinal stenosis
Joints in the hand affected in rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Osteoarthritis
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Osteogenesis imperfecta
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27
Arthritis conjunctivitis and urethritis in young men. Associated organisms?
Reactive (Reiter’s) arthritis. Associated with Campylobacter Shigella Salmonella Chlamydia and Ureaplasma
A 55-year-old man has sudden excruciating first MTP joint pain after a night of drinking red wine. Diagnosis workup and chronic treatment?
Gout. Needle-shaped negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
Rhomboid-shaped positively birefringent crystals on joint fluid aspirate.
Pseudogout
An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and inc’d ESR.
Polymyalgia rheumatica
An active 13-year-old boy has anterior knee pain. Diagnosis?
Osgood-Schlatter disease
Bone is fractured in fall on outstretched hand.
Distal radius (Colles’ fracture)
Complication of scaphoid fracture.
Avascular necrosis
Signs suggesting radial nerve damage with humeral fracture.
Wrist drop loss of thumb abduction
A young child presents with proximal muscle weakness waddling gait and pronounced calf muscles.
Duchenne muscular dystrophy
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe consider a Pavlik harness to maintain abduction
An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
The most common 1Á malignant tumor of bone.
Multiple myeloma
Unilateral severe periorbital headache with tearing and conjunctival erythema.
Cluster headache
Prophylactic treatment for migraine.
beta-blockers Ca2+ channel blockers TCAs
The most common pituitary tumor. Treatment?
Prolactinoma. Dopamine agonists (e.g. bromocriptine)
A 55-year-old patient presents with acute broken speech. What type of aphasia? What lobe and vascular distribution?
Broca’s aphasia. Frontal lobe left MCA distribution
The most common cause of SAH.
Trauma; the second most common is berry aneurysm
A crescent-shaped hyperdensity on CT that does not cross the midline.
Subdural hematomabridging veins torn
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation
CSF findings with SAH.
Elevated ICP RBCs xanthochromia
Albuminocytologic dissociation.
Guillain-Barre (inc’d protein in CSF with only a modest increase in cell count)
Cold water is flushed into a patient’s ear and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?
Normal
The most common 1Á sources of metastases to the brain.
Lung breast skin (melanoma) kidney GI tract
May be seen in children who are accused of inattention in class and confused with ADHD.
Absence seizures
The most frequent presentation of intracranial neoplasm.
Headache
The most common cause of seizures in children (2-10 years).
Infection febrile seizures trauma idiopathic
The most common cause of seizures in young adults (18-35 years).
Trauma alcohol withdrawal brain tumor
First-line medication for status epilepticus.
IV benzodiazepine
Confusion confabulation ophthalmoplegia ataxia.
Wernicke’s encephalopathy due to a deficiency of thiamine
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic
The most common causes of dementia.
Alzheimer’s and multi-infarct
Combined UMN and LMN disorder.
ALS
Rigidity and stiffness with resting tremor and masked facies.
Parkinson’s disease
The mainstay of Parkinson’s therapy.
Levodopa/carbidopa
Treatment for Guillain-Barr_ syndrome.
IVIG or plasmapheresis
Rigidity and stiffness that progress to choreiform movements accompanied by moodiness and altered behavior.
Huntington’s disease
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation seizures and leptomeningeal angioma.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
Caf_-au-lait spots on skin.
Neurofibromatosis 1
Hyperphagia hypersexuality hyperorality and hyperdocility.
KlÙver-Bucy syndrome (amygdala)
Administer to a symptomatic patient to diagnose myasthenia gravis.
Edrophonium
1Á causes of third-trimester bleeding.
Placental abruption and placenta previa
Classic ultrasound and gross appearance of complete hydatidiform mole.
Snowstorm on ultrasound. Cluster-of-grapes appearance on gross examination
Chromosomal pattern of a complete mole.
46XX
Molar pregnancy containing fetal tissue.
Partial mole
Symptoms of placental abruption.
Continuous painful vaginal bleeding
Symptoms of placenta previa.
Self-limited painless vaginal bleeding
When should a vaginal exam be performed with suspected placenta previa?
Never
Antibiotics with teratogenic effects.
Tetracycline fluoroquinolones aminoglycosides sulfonamides
Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis
Medication given to accelerate fetal lung maturity.
Betamethasone or dexamethasone x 48 hours
The most common cause of postpartum hemorrhage.
Uterine atony
Treatment for postpartum hemorrhage.
Uterine massage; if that fails give oxytocin
Typical antibiotics for group B streptococcus (GBS) prophylaxis.
IV penicillin or ampicillin
A patient fails to lactate after an emergency C-section with marked blood loss.
Sheehan’s syndrome (postpartum pituitary necrosis)
Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.
Inevitable abortion
Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed.
Threatened abortion
The first test to perform when a woman presents with amenorrhea.
beta-hCG; the most common cause of amenorrhea is pregnancy
Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia
Cause of amenorrhea with normal prolactin no response to estrogen-progesterone challenge and a history of D&C.
Asherman’s syndrome
Therapy for polycystic ovarian syndrome.
Weight loss and OCPs
Medication used to induce ovulation.
Clomiphene citrate
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy
Indications for medical treatment of ectopic pregnancy.
Stable unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation
Medical options for endometriosis.
OCPs danazol GnRH agonists
Laparoscopic findings in endometriosis.
Chocolate cysts powder burns
The most common location for an ectopic pregnancy.
Ampulla of the oviduct
How to diagnose and follow a leiomyoma.
Ultrasound
Natural history of a leiomyoma.
Regresses after menopause
A patient has inc’d vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis
Treatment for bacterial vaginosis.
Oral or topical metronidazole
The most common cause of bloody nipple discharge.
Intraductal papilloma
