Step 2 Flashcards

Question

Viral meningitis/aseptic meningitis CSF 1. Leukocytes 2. Protein 3. Glucose

Answer 1

1. <100 (predominant lymphocytes) 2. normal or increased protein (<40) 3. Normal glucose (40-70)

Answer 2

1. Axial skeleton (joints of the cervical spine) - there can be instability and subluxation of the atlantoaxial joint with resulting spinal cord compression 2. This is important to know before general anesthesia and intubation - cervical spine instability + positioning for intubation can lead to paralysis or death

Answer 3

Von Hippel Lindau disease - presents with multiple benign and malignant tumors. Many originate from the vasculature including hemangioblastomas of the retina and cerebellum and angiomatosis of the skin and mucosa 1. Autosomal dominant 2. VHL gene

Answer 4

Shigella toxin producing E. coli - Shiga toxin causes endothelial dysfunction - Also release LDH while haptoglobin is depleted by binding free Hgb

Answer 5

1. oral azithromycin 2. oral doxycycline 3. oral amoxicillin

Answer 6

1. Growth hormone deficiency is typically associated with rapid decline in curve, crossing percentiles while constitutional growth delay has slow but consistent growth

Answer 7

1. Osteochondromas - stop growing when the growth plate closes - tx is not always necessary - If lesion is symptomatic or causing limb deformity or growth disturbance then surgical excision is curative

Answer 8

1. chondroblastoma

Answer 9

Ewing sarcoma

Answer 10

1. Langerhans cell histiocytosis 2. Lytic, "punched out" lesions on x ray

Answer 11

1. osteoid osteoma

Answer 12

Vestibular gland cysts

Answer 13

1. Mesonephric (wolffian) duct cysts /gartner cyst

Answer 14

bartholin gland cyst - typically managed with incision and drainage

Answer 15

aortic valve regurgitation/insufficiency

Answer 16

1. 2 or more weeks of atleast 5 of the following a. depressed mood b. anhedonia c. guilt or worthlessness d. difficulty concentrating e. psychomotor retardation or agitation f. SI g. Neurovegetative symptoms (decreased energy, sleep disturbance, appetite disturbance)

Answer 17

Restrictive lung disease - decreased chest wall compliance, respiratory muscle weakness, or decreased lung parenchyma compliance -ex: ILD, obesity hypoventilation syndrome, neuromuscular disorders (e.g. ALS)

Answer 18

20-37 weeks gestation

Answer 19

1. examples- nifedipine, terbutaline 2. corticosteroids 3. magnesium sulfate 4. GBS

Answer 20

3 months - marked distress out of proportion to the stressor and a significant impairment in daily functioning (does not meet depression) - Tx: brief supportive psychotherapy

Answer 21

Subtype of malignant melanoma that occurs on the fingers and toes - often Asian and African descent, unrelated to sun exposure -Pigmented lesion that demonstrates asymmetry, irregular appearing borders, variable coloration, diameter greater than 6 mm, rapid evolution in characteristics - may begin as a longitudinal brown streak on the nail

Answer 22

Colonic pseudo-obstruction 1. signs and symptoms of colonic obstruction in absence of mechanical cause of obstruction - idiopathic or can be due to abnormal function of GI autonomic NS 2. Abdominal distention and diffuse tenderness. Abdomen tympanic to percussion. Bowel sounds are often decreased but usually present. Perforation or ischemia may lead to severe pain, peritoneal signs, and evidence of shock. 3. Tx: NPO, NG/rectal tube decompression --> pro-cholinergic agent (neostigmine) if no improvement w/in 48 hrs --> if perforation then emergent ex lap

Answer 23

NSAID (e.g. ibuprofen) -- then systemic glucocorticoids for refractory disease

Answer 24

A. Sensitivity (ability of test to detect a dx if it is present) B. Specificity (probability that a test will demonstrate negative result when dx is actually absent)

Answer 25

1. Diuretic - volume and BP management 2. RAAS inhibitor - volume and BP management 3. BB - first assess with 1&2, if repeat echo shows persistent HFrEF despite volume control then BB should be added 4. MRA (spironolactone) -- if additional BP and volume control is needed or if hypokalemia with loop diuretic occurs 5. SGLTi

Answer 26

1. Turner syndrome (45, XO) --Growth hormone and Estrogen replacement to promote increased stature and development of secondary sexual characteristics

Answer 27

1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms (flat affect, apathy, avolition, alogia)

Answer 28

1. Strategies to prevent the effects of the disease before the disease occurs 2. aims to identify disease early in its course through screening efforts 3. aims to slow or ameliorate the progression and complications of a disease through therapeutic intervention

Answer 29

1. 45-75 years 2. 5-10 years 3. 3 years

Answer 30

1. absence or decreased activity of UDP-glucuronosyltransferase (UGT), an enzyme required for glucuronidation of unconjugated bilirubin in the liver. 2. More severe form of above

Answer 31

1. Mutation in the ABCC2 gene -- mutation prevents conjugated bilirubin from leaving liver, collects in liver instead 2. Black liver 3. Serum bilirubin levels - moderately elevated

Answer 32

1. Similar to dubin-johnson just without liver pigmentation --- Both conjugated and unconjugated hyperbilirubinemia due to defective hepatic uptake and storage

Answer 33

1. Common variable immunodeficiency disease 2. IVIG - These patients are at increased risk for the development of autoimmune disease such as RA, autoimmune hemolytic anemia, and non-hodgkin lymphoma

Answer 34

1. FEV1 decreased 2. FVC normal 3. TLC increased

Answer 35

1. amoxicillin (ampicillin for those unable to take oral meds) 2. macrolides (e.g. clarithromycin)

Answer 36

emergent exploration and management in the operating room

Answer 37

1. volume overload 2. Hyperkalemia 3. Hyperphosphatemia 4. Metabolic acidosis 5. Hyperparathyroidism 6. Osteodystrophy 7. Anemia -Patients should minimize intake of fluids, potassium, and phosphate

Answer 38

1. Mixed aerobic and anaerobic bacteria - Pseudomonas may cause osteomyelitis following a puncture wound to foot, particularly if exposure to water or moist environment -Staph aureus is common cause of superficial cutaneous infections

Answer 39

1. 15 yrs w/appropriate secondary sexual characteristics 2. 13 years w/out secondary sexual characteristics 3. 3 months 4. or 6 months in irregular cycle women

Answer 40

1. Nitrofurantoin 2. 3rd gen cephalosporin (ceftriaxone), fluoroquinolone (ciprofloxacin), TMP-SMX, or an oral B lactam (e.g. amoxicillin/claulanate, cefuroxime, cefpodoxime)

Answer 41

1. Gram positive bacteria 2. Strep, staph, and listeria

Answer 42

5. hematologic effects (e.g. leukopenia, thrombocytopenia) check platelet counts 6. Benign increases in transaminases or hepatotoxicity

Answer 43

1. solids and liquids 2. pneumatic dilation or injection of botulinum toxin to relax LES

Answer 44

solid only

Answer 45

1. Beta blocker (propranolol) --also small qty of alcohol 2. anticonvulsants: primidone *sometimes patients self treat with alcohol *worsens with stress, improves with alcohol

Answer 46

pulmonary emboli

Answer 47

1. 40-74 2. 74

Answer 48

1. proteinuria 2. increased WBC/hpf 3. muddy brown casts --often following an ischemic or nephrotoxic insult (cardiac arrest following prolonged resuscitation, shock, heavy metals, myoglobin)

Answer 49

1. proteinuria 2. increased WBC/hpf 3. occasional WBC casts - 4. eosinophiluria --Often secondary to meds (NSAIDs, antibiotics, sulfas) 1. decreased GFR 2. increased Cr

Answer 50

1. Get CBC bc anemia is a potential adverse effect

Answer 51

CT scan of the chest and abdomen to locate metastasis (which occurs via blood) -- pulmonary spread is common

Answer 52

1. Von willebrand disease - recurrent nosebleeds, easy bruising, petechiae, menorrhagia, GI and gingival bleeding --> Tx: supportive care w/bleeding control and transfusions, may involve administration of desmopressin - von willebrand protein acts as a serum transport protein for coagulation factor VIII, factor VIII may be decreased leading to the increase in PTT without affecting PT

Answer 53

Visceral bleeding (e.g. splenic hemorrhage, rectus sheath hematoma, hamarthrosis)

Answer 54

Joint space narrowing, marginal osteophytes, and subchondral sclerosis or bone cysts

Answer 55

1. metoprolol --rate control is preferable to rhythm control in afib as the risks for adverse outcomes has been shown to be lower

Answer 56

1. peptic ulcer 2. perforated peptic ulcer 3. Upright X rays of the chest and abdomen --> can show free air under the diaphragm to confirm diagnosis of the perforated viscus. Perforated peptic ulcer is sx emergency and patients are tx with broad spectrum antibiotics and surgery + lavage.

Answer 57

1. 35 years old who smoke greater than 15 cigarettes daily ***OCP commonly cause a mild elevation in BP and can sometimes lead to overt HTN. Those who develop OCs should d/c medication.

Answer 58

1. Staph aureus and GAS 2. Topical mupirocin (preferred to neomycin or bacitracin which have high likelihood of inducing allergic contact dermatitis where applied) ---> widespread impetigo or immunocompromised host --> may need systemic antibiotics

Answer 59

1. Addison dx/Primary adrenal insufficiency --> destruction of bilateral adrenal cortex (contains aldosterone, cortisol, androgens) --> low aldosterone causes renal salt wasting which can cause salt craving --> Glucocorticoid deficiency leads to fatigue, anorexia, and psychiatric manifestations (irritability, depressed mood) --> Androgen loss leads to loss of libido and suppression of secondary sexual characteristics (e.g. reduced pubic hair)

Answer 60

1. Cosyntropin is a synthetic form of ACTH --> it is given to stimulate cortisol production. Low production of cortisol following stimulation is diagnostic of primary adrenal insufficiency

Answer 61

1. elective total proctocolectomy 2. surgery is delayed in favor of close surveillance with frequent colonoscopy until patients have completed puberty and matured both physically and emotionally --> Urgent total proctocolectomy is performed no matter the patient's age in those with colorectal cancer or adenomas with high grade dysplasia, severe sx like hemorrhage, and a significant increase in polyp # during screening interval

Answer 62

Echinococcus granulosis --Albendazole --Percutaneous therapy (>5 cm or septations) --surgery if cyst ruptures

Answer 63

1. paraesophageal hiatal hernia (PEH) Dx is confirmed with barium swallow or upper endoscopy

Answer 64

1. Chikungunya virus infection 2. supportive care (sx resolve within 7-10 days) --chronic arthralgia/arthritis frequently occurs and can last months or years

Answer 65

1. 1st metatarsophalangeal joint, knee, and ankle 2. heavy alcohol use, intake of urate rich foods (meat, seafod), trauma/surgery, dehydration, and medications that raise uric acid levels (thiazide diuretics, cyclosporine), or lower uric acid levels (e.g. allopurinol)

Answer 66

1. IV glucocorticoids --> decrease vasogenic edema (caused by obstructed epidural venous plexus), help alleviate pain, and may restore neurologic function --> then MRI to diagnose --> Neurosurgery and/or radiation oncology consultation is typically required --> bowel and bladder dysfunction, increased deep tendon reflexes, paralysis

Answer 67

1. Most common cause of action tremor and usually has a medical etiology --> these are action tremors, which may be kinetic, intention, or postural (e.g. holding arms outstretched) 2. Worse with movement, worsened by emotional or physical stress, toxic/metabolic derangements, caffeine, or drug withdrawal [increased sympathetic activity]

Answer 68

1. Resting tremor, decrease with voluntary movement, pill rolling, asymmetric 2. Progressive loss of dopaminergic neurons in the substantia nigra of the basal ganglia 3. worsened when patients are distracted

Answer 69

1. Major sx, traumatic injury, severe infection 2. Electrolyte derangement (decreased K, decreased Mg, decreased Ca) 3. Medications (e.g. opiates, anticholinergics) 4. Neurologic disorders (e.g. dementia, stroke)

Answer 70

1. Urine osmolality >100 mOsm/kg in SIADH <100 mOsm/kg in primary polydipsia

Answer 71

1. presence of amyloid on tissue biopsy (e.g. fat pad) 2. amorphous hyaline material that stains with congo red; green birefringence is noted under polarized light

Answer 72

Normal saline - replenishes body's depleted salt stores, restores euvolemia, and shuts off nonosmotic stimuli (low plasma osmolality) for ADH release

Answer 73

1. aggressive saline hydration to retore intravascular volume and promote urinary calcium excretion --calcitonin can be administered with saline to reduce serum calcium --bisphosphonates can decrease calcium by inhibiting bone resorption but this takes 2-4 days

Answer 74

1. Bartonella henselae/quintana 2. Doxycycline or erythromycin + restart HIV antiretroviral therapy -vascular cutaneous lesions: often begin as small reddish/purple papules and evolve into friable pedunculated or nodular lesions

Answer 75

No bc this requires a high burden of organisms (>10,000) for a positive result. Sensitivity is low ---Sensitivity can be increased by taking 3 samples, 8-24 hours apart

Answer 76

- urinary incontinence/urgency, cognitive dysfunction, wide based ataxia -Normal pressure hydrocephalus -can also have depressed affect and UMN in lower extremities

Answer 77

stress induced ulcer ---risk factors include shock, sepsis, coagulopathy, mechanical ventilation, traumatic spinal cord/brain injury, burns, and high dose corticosteroids

Answer 78

Pancreatic cancer in the body or tail of the organ --> this is referred pain --> Abdominal CT is usually diagnostic (identifying pancreatic cancer)

Answer 79

--Myopathy-- Chronic - slowly progressive proximal muscle weakness Acute: severe proximal and distal weakness; rhabdomyolysis can occur

Answer 80

Myopathy typically causes pronounced muscle tenderness and myalgias; muscle swelling and edema may also happen --Increased creatinine kinase

Answer 81

1. Yes 2. less common 3. increased creatinine kinase

Answer 82

1. Staph aureus 2. Psuedomonas

Answer 83

Upper lobe involvement (upper lung field crackles and infiltrate) --> due to bronchiectasis caused by CF

Answer 84

1. >= 20 pack years 2. 50-80 years

Answer 85

1. Inflammatory disease that includes formation of noncaseating granulomas 2. Hilar LN (upper lobe reticulonodular opacities, diffuse or nodular parenchymal infiltrates), interstitial infiltrates 3. papules, nodules, plaques, erythema nodosum (tender red bumps on shins) 4. anterior/posterior uveitis, keratoconjunctivitis sicca (dryness of conjunctiva and cornea) 5. facial nerve palsy, central DI, hypogonadotropic hypogonadism 6. AV block, dilated or restrictive cardiomyopathy 7. Hepatosplenomegaly, asymptomatic LFT abnormalities, splenomegaly -hypercalcemia is due to vit D conversion/production by macrophages in granulomas

Answer 86

Ischemic hepatic injury --patients who survive the inciting condition have liver enzymes return to normal within a few weeks

Answer 87

1. Polyarteritis nodosa 2. Angiography shows microaneurysms and segmental/distal narrowing ---tissue biopsy shows transmural inflammation

Answer 88

1. young smokers 2. symptoms in distal extremities (e.g. finger ulcers, gangrene, infarction) due to formation of inflammatory thrombi

Answer 89

Stomal stenosis - narrowing of gastrojejunal anastomosis Sx: Nausea, postprandial vomiting, gastric reflux, dysphagia to the point pt cannot tolerate liquids

Answer 90

1. limit alveolar distending volume and pressure 2. tolerate permissive hypercapnia to avoid excessive tidal volume 3. Set lowest feasible FiO2 (goal SpO2 92-96%) to avoid O2 toxicity - youre avoiding higher tidal volumes to prevent excessive stretching of damaged and delicate alveoli

Answer 91

1. emphysema (two types: smoking induced centriacinar/centrilobar emphysema and AAT deficiency induced panacinar/panlobar emphysema) --- inflammation/damage to alveoli. Panacinar is alveoli base and centriacinar is part right before getting end of alveoli. 2. bronchitis - inflammation of bronchial tubes that carry air to alveoli

Answer 92

1. upper lobes of the lungs and age >50 2. lower lobes of the lungs and in their 30- 40s

Answer 93

IV supplementation with pooled human AAT

Answer 94

1. Vibrio vulnificus 2. blood and wound culture 3. empiric in those with likely illness. IV ceftriaxone and doxycycline ---those with liver diseases have increased risk

Answer 95

1. phosphodiesterase (PDE) inhibitor (inhibits cyclic AMP or GMP to become AMP or GMP. cyclic AMP/GMP causes increases cellular response such as smooth muscle relaxation) 2. Causes bronchodilation and is occasionally used for COPD and asthma 3. Undergoes hepatic clearance which can be decreased in elderly patients and by CYP450 inhibitors. Has narrow therapeutic index which can cause the drug to be in high enough levels to cause tremor, seizure, tachyarrhythmias, vomiting, hypotension, neuro sx (anxiety and hallucinations)

Answer 96

Common in elderly patients -- due to age related increased stiffness of the walls of the aorta and other large arteries

Answer 97

D-xylose is a monosaccharide that is absorbed in the proximal small intestine without degradation by pancreatic or brush border enzymes. Patients with small intestinal mucosal disease will have impaired absorption of D-xylose. (celiac disease) Patients with malabsorption due to enzyme deficiencies will have normal absorption of D-xylose. (chronic pancreatitis

Answer 98

1. delayed gastric emptying 2. impaired glomerular filtration 3. small intestinal bacterial overgrowth (alterations in small intestine flora due to abnormal intestinal anatomy or motility leading to bacterial fermentation of D-xylose before it can be absorbed) ---- SIBO can be treated with rifaximin and afterwards D-xylose levels should return to normal

Answer 99

1. pill esophagitis --ab: tetracyclines --anti-inflam drugs: aspirin and NSAIDs --bisphosphonates --KCl, iron

Answer 100

1. difficulty initiating swallowing + cough, choking, nasal regurgitation 2. difficulty with food passing through esophagus and feeling that food gets "stuck" in chest

Answer 101

1. motility disorder - dysphagia with solids and liquids at onset. Barium swallow followed by manometry with endoscopy 2. mechanical obstruction - dysphagia with solids progressing to liquids. Upper GI endoscopy (+/- barium swallow before)

Answer 102

Videofluoroscopic modified barium swallow to evaluate swallowing mechanics, degree of dysfunction, and severity of aspiration

Answer 103

1. vasodilation --> meant to decrease systemic vascular resistance ---NO and other vasodilatory factors are formed during cirrhosis ---- + RAAS system is activated and ADH hormone is released to maintain renal perfusion 2. Hyponatremia (due to ADH release for water uptake) --Hypokalemia may be due to vomiting, diarrhea, or use of diuretics

Answer 104

1. mycoplasma pneumonia - subacute fever, reticulonodular pattern on chest x-ray - limited to 2-3 weeks 2. mycoplasma tuberculosis (miliary TB in lungs) - caused by hematogenous spread during primary or reactivated infection. Diffuse reticulonodular pattern on chest x-ray. - Has fever, night sweats, anorexia, weight loss, malaise, fatigue. Can spread to LN, liver, bones, and CNS - Lasts months

Answer 105

1. cave exploring exposure to bat or bird droppings around Ohio and Mississippi River Valleys, Asia, Africa, and South/Central america 2. 2-4 weeks after exposure - subacute fever, chills, malaise, headache, myalgia, dry cough. --chest x-ray shows mediastinal or hilar LAD with infiltrates 3. dimorphic fungus - granulomas with narrow based budding yeasts 4. antigen testing of the urine or blood 5. W/out intervention can resolve over weeks. With tx they can get oral itraconazole or IV amphotericin B

Answer 106

1. South west US (e.g. Arizona), Mexico, and Centra/South America 2. subacute pulmonary symptoms -- unilateral infiltrate with ipsilateral hilar LAD 3. endospores 4. Tissue biopsy shows spherules with endospores

Answer 107

1. renal clearance 2. During AKI (unable to clear metformin) -- CKD or GFR <30 -- Hepatic insufficiency (liver metabolizes lactic acid) -- Decompensated HF (impairs renal perfusion) - Sepsis and dehydration (increase lactic acid in addition to what metformin creates)

Answer 108

1. Fever 2. Leukocytosis 3. LUQ abdominal pain or left sided pleuritic chest pain (can also have left pleural effusion, and splenomegaly)

Answer 109

1. do surgery 2. Consider surgery only if successful repair is highly likely 3. Consider surgery only if successful repair is highly likely

Answer 110

1. 3-5 days 2. RCA 3. Severe pulmonary edema, new soft systolic murmur, hypotension/cardiogenic shock 4. severe MR

Answer 111

1. 3-5 days 2. LAD (apical septal) or RCA (basal septal) 3. Chest pain, new harsh holosystolic murmur with thrill, hypotension, cardiogenic shock 4. L to R ventricular shunt

Answer 112

1. Within 5 days or up to 2 weeks 2. LAD 3. chest pain, distant heart sounds, shock, rapid progression to cardiac arrest 4. pericardial effusion with tamponade

Answer 113

1. several months 2. LAD 3. heart failure, angina, ventricular arrhythmias 4. thin and dyskinetic myocardial wall

Answer 114

Myotonic dystrophy -CTG repeat in the DMPK gene Other sx: cataracts, frontal balding, insulin resistance, sleep disturbance and testicular atrophy

Answer 115

This is likely a urinary outflow obstruction --intermittent episodes of high volume urination is when obstruction is overcome by a large amount of retained urine (obstruction often being renal calculi) -- Patients with single kidney are more likely to develop

Answer 116

Dengue fever --Prevalence high in Asia and south america -- Manifestations occur 4-7 days after transmission --Dengue shock syndrome: severe capillary leakage leading to capillary collapse and end organ damage

Answer 117

1. inhaled corticosteroid (ICS) - formoterol (long acting short onset beta agonist) PRN ---OR ICS+SABA PRN 2. low does ICS-formoterol daily 3. medium to high dose ICS-formoterol daily 4. high dose ICS-formoterol daily + LAMA (tiotropium) --> PLUS consider biologic therapy

Answer 118

1. Wilson disease, autosomal recessive mutation of ATP7B causes hepatic copper accumulation and then leak from damaged hepatocytes causes deposits elsewhere 2. Chelators (D-penicillamine, trientine) --> Zinc (interferes with copper absorption) 2.

Answer 119

1. has alpha 1 receptor blocking properties which leads to smooth muscle on veins and arterioles to dilate and unable to vasoconstrict --> syncope

Answer 120

1. Toxoplasmosis (toxoplasma gondii) 2. Sulfadiazine and pyrimethamine + leucovorin -->TMP-SMX used as ppx when CD4 < 100

Answer 121

1. Clinical features ---Dermatologic: livedo reticularis, ulcers, gangrene, blue toe syndrome ---Renal: AKI ---CNS: stroke, amaurosis fugax ---Ocular involvement: hollenhorst plaques ---GI: intestinal ischemia, pancreatitis 2. Labs ---LOW complement levels ---cell lines: eonsinophiluria on UA

Answer 122

1. Oral first generation antihistamine (e.g. chlorpheniramine) 2. Combine antihistamine-decongestant (e.g. brompheniramine and pseudoephedrine) --Pts who do not respond after 2-3 weeks may require further investigations or empiric sequential therapy for GERD, cough variant asthma, chronic sinusitis, etc

Answer 123

1. Pheochromocytoma 2. Urine or plasma metanephrines (breakdown products of Epi and NE) 3. Preoperative alpha blockade prior to beta blockade ---lap or sx resection

Answer 124

1. Straw yellow 2. Normal amylase 3. Low total protein (<2.5 g/dL is consistent with cirrhosis or nephrotic syndrome) 4. High SAAG (indicates portal HTN)

Answer 125

1. damage to the pancreatic duct with leakage of pancreatic juice into the peritoneal space 2. serosanguinous or yellow fluid 3. high amylase 4. high total protein 5. low SAAG (indicates no portal HTN)

Answer 126

1. pain 2. pallor 3. paresthesia 4. pulselessness 5. Poikilothermia (cool extremity) 5. paralysis (late sx)

Answer 127

1. embolism of a cardiac or intraarterial thrombus. Seen with sudden onset and likely recent MI. 2. local thrombosis from disruption of a preexisting atherosclerotic plaque (e.g. PAD, hx of claudication or diminished pulses) 3. Traumatic vessel disruption or dissection (due blunt trauma or iatrogenic injury)

Answer 128

Antibody-mediated destruction of intrinsic factor (what allows for B12 absorption in distal ileum) and gastric parietal cells. Damage to the stomach results in gastric atrophy and increases the risk of gastric cancer.

Answer 129

1. dilated 2. <55 3. biventricular enlargement with diffuse ventricular wall hypokinesis *in children this is most commonly due to coxsackievirus B or adenovirus

Answer 130

Splenic abscess --complication of bacteremia from a distant infection (e.g. infective endocarditis, cholecystitis)

Answer 131

1. <300 mOsm/kg H2O 2. <1.006 3. >250 mOsm/kg H2O

Answer 132

1. Shiga toxin producing E coli (E coli O157:H7) -- undercooked beef. (absence of high fever) 2. Shigella --contaminated food/water or outbreaks 3. Campylobacter -- raw or undercooked meat 4. Salmonella -- undercooked chicken

Answer 133

1. fusobacterium necrophorum (part of normal oral flora) 2. begins as an oropharyngeal infection (tonsilitis) - bacterium invades the lateral pharyngeal space through lymphatic system and affects the neurovascular structures causing internal jugular vein thrombosis and infection 3. prolonged sore throat, high fever, rigors, dysphagia, neck pain, swelling along SCM muscle ---septic thromboemboli to lungs mostly

Answer 134

1. Increased (most androgen producing adrenal tumors overproduce DHEAS but have negligible androgenic activity. Clinical features are due to conversion of DHEA/DHEAS into more potent androgens like androstenedione and testosterone. 2. Increased after DHEA/DHEAS is converted to testosterone 3. Testosterone has negative feedback on LH (LH is decreased)

Answer 135

1. Lobar --> due to cerebral amyloid angiopathy, AVM, tumor 2. basal ganglia, pons, thalamus --> due to HTN vs 1. aneurysm (80%) 2. Trauma 3. AVM

Answer 136

1. 1-6 hours within transfusion start (leukocytes are in the blood transfusion package) 2. seconds to minutes (due to recipient having anti-IgA Ab against donation) 3. minutes to hours (ABO incompatibility) 4. minutes to hours (donor antileukocyte antibodies - against recipient)

Answer 137

Hypotension fever, flank pain, hemoglobinuria --within minutes to hours

Answer 138

Squamous cell carcinoma of the lung (the one associated with smoking) Histology: polygonal cells with intercellular bridges, eosinophilic cytoplasm, keratin pearls, and extensive necrosis --> single, large cavitary lesions on chest x-ray, most commonly center of lung

Answer 139

1. cushing syndrome 2. SIADH 3. Lambert-eaton syndrome this is a central location lung cancer

Answer 140

1. A: acidosis (metabolic acidosis): pH<7.1 and refractory to meds 2. E: electrolyte imbalances (hyperkalemia, esp >6.5) 3. I: Ingestion (toxic alcohols, salicylate, lithium sodium valproate, carbamazepine) 4: O: fluid overload refractory to diuretics 5. U: uremia (symptomatic, encephalopathy, pericarditis, bleeding)

Answer 141

Renal vein thrombosis dx: CT scan or MR angiography, renal venography tx: anticoagulation, local thrombolysis/thrombectomy

Answer 142

electroconvulsive therapy

Answer 143

1. moms >= 35, abnormal maternal serum screening, abnormal sonographic findings, prior pregnancy with aneuploidy 2. Trisomy 21, 18, 13, and sex chromosome aneuploidies, fetal sex determination

Answer 144

1. Strep pneumo 2. Staph aureus

Answer 145

1. Behcet syndrome - exaggerated skin ulceration with minor trauma (e.g. needlestick)

Answer 146

yes - they get IV hydration and aggressive pain control

Answer 147

1. L1-L2 2. UMN 3. severe low back pain, mild or absent radicular pain, bowel/bladder dysfunction --motor weakness usually symmetric --Hyperreflexia - Symmetic perianal numbness

Answer 148

1. L2-sacrum 2. LMN 3. 1. due to disc herniation or tumor that causes severe radicular pain. 2. Saddle anesthesia, absent knee/ankle reflex 3. Muscle weakness on one side 4. Loss of anal sphincter control/urination *urinary symptoms*

Answer 149

acute lymphoblastic leukemia dx w/bone marrow biopsy w/multidrug chemo prognosis is favorable in children *bone pain (affects long bones) - due to rampant growth of leukemic cells in bone marrow *Leukocyte count is initially low due to concurrent disease in normal white blood cell production but as dx progresses and lymphoblasts overcrowd then leukocytosis occurs as lymphoblasts spill into periphery

Answer 150

oxygenation ventilation administration of pulmonary vasodilators (eg, inhaled nitric oxide).

Answer 151

1. diuretics 2. No specific one

Answer 152

Central 1. early activation of hypothalamic pituitary gonadal axis leading to premature development of secondary sexual characteristics. 2. elevated gonadotropins (LH, FSH) 3. Elevated LH and FSH after GnRH stimulation 4. GnRH analog to delay further progression Peripheral 1. hormone production outside the HPG axis 2. Low or suppressed gonadotropins due to external source of sex steroids 3. GnRH stimulation test: no significant rise in LH or FSG after GnRH agonist 4. tx underlying cause

Answer 153

1. Necrotizing enterocolitis --> get x ray : shows pneumatosis intestinalis, pneumoperitoneum

Answer 154

1. SNRI (duloxetine, venlafaxine) 2. TCAs 4. Gabapentin, pregabilin

Answer 155

sedation and weight gain

Answer 156

1. conductive hearing loss ---affected ear (bone conduction>air conduction) ---unaffected ear (air conduction >bone conduction) 2. sensorineural hearing loss --air conduction >bone conduction in both affected and unaffected ear

Answer 157

1. lateralizes to affected ear 2. lateralizes to unaffected ear, away from affected ear -wine: place tuning fork on the middle of forehead and determine where sound lateralizes

Answer 158

X-linked agammaglobulinemia --flow cytometry shows decreases CD19 cells tx: IVIG, ppx Ab

Answer 159

second generation antipsychotics

Answer 160

1. gold standard for schizophrenia but due to high risk of agranulocytosis it is reserved for patients who have failed to respond to at least 2 antipsychotic trials

Answer 161

1. Pyramidal/corticospinal tract -- (starts at cortex, goes through internal capsule (posterior limb), down to body)

Answer 162

1. white matter pathway in the brain that controls voluntary motore function. 2. It decussates in the medulla

Answer 163

Group of side effects that affect the motor system - involuntary movements (lip smacking or puckering) - muscle stiffness (rigidity) - tremors - shuffling gait - abrupt spasms - physical restlessness (pacing, shaking legs, rocking) - slowness of movements (bradykinesia) - irregular, jerky movements (dyskinesia)

Answer 164

1. heard with a stethoscope and done while patient rocks back and forth at the hips 2. Retained gastric material for >3 hrs after meal will generate a splash -- can happen with gastric outlet obstruction like pyloric stricture, malignancy, peptic ulcer dx

Answer 165

1. In young women who have been on prolonged estrogen based oral contraception 2. solitary solid lesion in right lobe of liver

Answer 166

1. 3rd trimester 2. Ursodeoxycholic acid - antihistamines for generalized pruritus - Delivery at 37 weeks as normal 3. Increased estrogen and progesterone cause hepatobiliary tract stasis and decreased bile excretion --> causes pruritus on palms and soles

Answer 167

1. diabetics 2. impaired sensation and joint proprioception 3. Acute: inflammatory erythema, warmth, and edema of the foot 1-2 days after minor trauma. No bone involvement on xray ----chronic: osseous fragmentation, new bone formation, and subluxation/dislocation predominantly in the mid and hind foot. Can get ulcers, rocker bottom feet (arch collapse), and callus formation

Answer 168

Group A: inhaled SABA or SAMA (short acting muscarinic antagonist) Group B and Group E: Initial therapy is daily inhaled LABA (e.g. fomoterol) plus a LAMA (e.g. tiotropium) Group E: can also have inhaled corticosteroid

Answer 169

1. > 3 liters 2. Primary polydipsia or diabetes insipidus 3. Osmotic diuresis due to increased solute excretion like glucose, urea, saline

Answer 170

1. intrauterine adhesions that can follow intrauterine surgery --> most often after suction and sharp curettage for delivery complications --> can cause amenorrhea that does not respond to progesterone challenge (progesterone stops endometrial growth and promotes differentiation, once progesterone is stopped this withdrawal mimics the natural pattern of progesterone that signals for uterus to menstruate)

Answer 171

1. Internal is usually not painful and above the dentate line 2. painful and hemorrhoidectomy is done for severely painful thrombosis

Answer 172

bronchial carcinoid tumor

Answer 173

1. chronic granulomatous disease 2. Prophylaxis is w/TMP-SMX, itraconazole, interferon gamma --> active infection is Ab based on culture results --> Hematopoietic cell transplant is curative

Answer 174

psoriatic arthritis (nail pitting is highly specific for this)

Answer 175

1. w/in 2-3 days and resolves within 2 weeks 2. within 4-6 weeks (can be up to a year) 3. days to weeks

Answer 176

1. ultra fast MRI 2. U/S of head (if fontanelle is still open) --hydrocephalus should be considered when head circumference is moving up several growth lines

Answer 177

1. transiently increased testicular production of estrogen compared to testosterone and peripheral conversion of prohormones to estrogen *can be firm, unilateral or bilateral, subareolar mass that may be tender to touch --> managed with reassurance and observation - resolves within a year

Answer 178

1. epidural hematoma 2. Tx with urgent surgical evacuation

Answer 179

Aromatase deficiency --for women you will see normal internal genitalia and external virilization because of excess androstenedione

Answer 180

1. deficiency in 21 hydroxylase leading to decreased cortisol and aldosterone. 2. Hyponatremia because aldosterone is not there for reuptake. --in infancy will have salt wasting and virilization --in childhood you get premature pubarche/adrenarche (without virilization) --advanced bone age expected

Answer 181

1. Impairs synthesis of thyroid hormone and decreases peripheral conversion of T4 to T3. -- AIT type 1: It can also increase synthesis of thyroid hormone in patients with nodular thyroid disease or latent Grave disease --AIT type 2: cause destructive thyroiditis with transient hyperthyroidism. --amiodarone has iodine content

Answer 182

1. place 2 large bore IV to volume resuscitate, IV ocreotide (vasoconstrict), and antibiotics 2. Urgent endoscopic therapy of esophageal varices -further management based on what is found

Answer 183

interstitial fibrosis - get high resolution CT scan of the chest - and full pulmonary function test

Answer 184

1. splenectomy to remove source of platelet destruction and is often curative in patients with ITP 2. pharm interventions: glucocorticoids, anti-D, IVIG

Answer 185

1. 24-28 weeks 2. 50 g glucose load and check serum glucose 1 hour later --- if blood glucose <140 mg/dL then likely no GDM --> if >= 140 mg/dL 3. Check fasting serum glucose + give 100 g oral glucose load and then check blood glucose 3 hrs later. Need >=2 abnormal values to dx GDM --> fasting >= 95 mg/dL or >= 105 (diff sources) --> 3 hr >= 140 mg/dL or >= 145 mg/dL

Answer 186

1. Lazy eye- functional reduction in visual acuity. Usually unilateral and occurs when binocular vision is disturbed while the visual system is developing (age <5) 2. strabismus (ocular malalignment), uncorrected refracted error (eyes optical system fails to properly focus light onto the retina), vision deprivation due to cataracts/ptosis/corneal opacities 3. corrective lenses, encourage use of amblyopic eye, surgery (to remove opacities)

Answer 187

Prolactin suppresses production of GnRH in hypothalamus -this prevents FSH and LH release from anterior pituitary -this diminishes estrogen release from ovary leading to anovulation, amenorrhea, menopausal symptoms (osteoporosis)

Answer 188

1. sudden sustained contraction of the neck, mouth, tongue, eye muscles 2. reducing dose or switching meds -benzos -diphenhydramine

Answer 189

1. Subjective restlessness, inability to sit still 2. dopamine antagonist meds (antipsychotics) and antiemetics (prochlorperazine, promethazine, metoclopramide) 3. . Reducing dose or switching meds - Beta blocker (propranolol) - Benzo (lorazepam) - Benztropine

Answer 190

Reducing dose or switching meds -- Benzotropine --Amantadine

Answer 191

1. gradual onset after prolonged therapy (>6 months) --> dyskinesia of the mouth, face, trunk, and extremities 2. Reducing dose or switching meds - Valbenazine - Deutetrabenazine *switch to antipsychotic with lower tendency to cause TD such as quetiapine or clozapine

Answer 192

1. decreased MSAFP, beta hCG, estriol -normal inhibin A 2. decreased MSAFP, Estriol -increased beta hCG, inhibin A 3. increased MSAFP (alpha fetoprotein) - everything else normal

Answer 193

1. rupture of emissary veins upon scalp traction during delivery. These veins connect the dural sinuses and the scalp and can cause massive bleeding between periosteum and galea aponeurotica. - can happen with vacuum assisted deliveries but also spontaneous vaginal or c-sections 2. diffuse, fluctuant scalp swelling that extends the suture lines and can go into the neck. Expands over 2-3 days

Answer 194

1. periosteum 2. firm, nonfluctuant swelling that DOES NOT cross suture lines or lead to significant blood loss

Answer 195

1. opioid withdrawal (4-48 hours after last use) 2. opioid agonist --> methadone or buprenorphine --> non-opioid: clonidine or adjunctive meds (antiemetics, antidiarrheals, benzos)

Answer 196

1. CBT with exposure 2. short acting benzos may be needed acutely

Answer 197

1. aminoglycoside antibiotics (can also cause nephrotoxicity - can measure trough concentrations to help predict and prevent nephrotoxicity) *can act synergistically with penicillins 2. chemo agents (cisplatin) 3. high dose salicylates 4. high dose loop diuretics

Answer 198

1. foreign body aspiration 2. bronchoscopic removal

Answer 199

1. Diamond blackfan anemia - congenital defect in erythroid progenitor cells which can lead to increased apoptosis --typically presents in infancy w/progressive pallor and poor feeding due to anemia 2. corticosteroids and RBC transfusions

Answer 200

Fanconi anemia

Answer 201

1. Men: finasteride, minoxidil 2. women: minoxidil

Answer 202

2a. hematuria 2b. caused by hemoglobinuria (intravascular hemolysis, decreased Hgb and haptoglobin) --> get CBC to evaluate hemolytic anemia or myoglobinuria (rhabdo causing increased CK)

Answer 203

1. Non-hodgkin 2. elderly patients 3. nodular growth of follicular lymphocytes. --> translocation between chromosome 14 and 18 that leads to overexpression of BCL-2 4. Indolent fashion with months or years of painless peripheral LAD in cervical, axillary, or inguinal region - LAD waxes and wanes

Answer 204

1. placental detachment from the uterus before delivery -- accumulation of blood causes increased intrauterine pressure (lower abdominal or back pain), a firm, tender uterus, and high frequency contractions 2. painful 3. maternal hemorrhage, DIC, fetal hypoxia, preterm birth, mortality

Answer 205

1. ipsilateral fixed and dilated pupil due to compression of oculomotor nerve and parasympathetic fibers --contralateral hemiparesis with respiratory compromise (compression of ipsilateral cerebral peduncle/corticospinal tracts) --homonymous hemianopsia (visual field loss in the same halves of the visual field of each eye) --contralateral decerebrate posturing due to dysfunction of tract below red nucleus 2. fixed, midposition pupils due to disruption of sympathetic and parasympathetic innervation 3. No pupil change but as it progresses can cause ipsilateral anterior cerebral artery compression leading to contralateral leg weakness

Answer 206

1. 2-3 days 2. adequate pain control, deep breathing exercises, incentive spirometry - early mobilization -directed coughing

Answer 207

1. strep pneumo, H influenzae, moraxella catarrhalis 2.1st - amoxicillin 2nd - amoxicillin -clavulante (if pt has already done amoxicillin within past 30 days) --penicillin allergy: azithromycin or clindamycin

Answer 208

retinitis pigmentosa

Answer 209

Normal saline restores intravascular volume and replenishes chloride thereby restoring kidneys ability to excrete bicarbonate (and resolve alkalosis)

Answer 210

taper off medication slowly even though they are not pregnant yet but actively trying

Answer 211

adenomyosis

Answer 212

endometriosis - ectopic implantation of endometrial glands dx with direct visualization and surgical bx 1. tx: first medically (OCPs, NSAIDs) --> then surgical resection

Answer 213

Uterine leiomyomas (fibroids) - proliferation of smooth muscle within the myometrium --> tx: NSAIDs, combined oral contraceptive (estrogen makes them grow), GnRH agonist, and surgical option for severe cases

Answer 214

1. coliform organisms like E coli 2. 6 weeks of TMP-SMX or fluoroquinolone

Answer 215

1. stim: methylphenidate 2. nonstim: atomoxetine

Answer 216

1. Behavioral therapy 2. Antidopaminergic therapy (tetrabenazine/dopamine depletor or antipsychotic/dopamine receptor blocker) ---2nd generation antipsychotics (risperidone, aripiprazole) bc have better adverse effect profile 3. Alpha 2 adrenergic receptor agonists

Answer 217

1. HC below 3rd percentile 2. MRI of brain (then eval for congenital infection or genetic testing)

Answer 218

1. Intraductal papilloma - intraductal papillomas are papillary projections composed of epithelial and myoepithelial cells --> these cells line a fibrovascular stalk that protrudes into the breast duct lumen

Answer 219

1. mammary duct ectasia -- distension of the subareolar ducts with fibrosis and inflammation

Answer 220

1. 1st prenatal visit 2. 3rd trimester and delivery if high risk

Answer 221

1. Hgb/hct 2. antibody screen if Rh negative 3. 1 hr 50 g GCT

Answer 222

1. screened at initial visit

Answer 223

1. Pts can develop hypthyroidism so pts need regular TSH labs a 6-12 months --tx with T4 supplements, dont stop lithium 2. Affects glucose metabolism leading to increased glucose 3. Increase in creatinine (chronic kidney dx after years of use) ---can also cause nephrogenic diabetes insipidus leading to polyuira and state of dehydration and hypernatremia

Answer 224

1. Pneumocystis pneumonia (PCP) and cytomegalovirus (CMV). - PCP: pulmonary sx - CMV: pulmonary sx, GI symptoms, pancytopenia, hepatitis

Answer 225

beta-lactam (eg, cefaclor) and sulfa drugs.

Answer 226

ADEK - due to fat malabsorption from a pancreatic insufficiency -- Vit K is necessary for coagulation factor activation

Answer 227

2, 7, 9, 10

Answer 228

1. pyrantel pamoate 2. ivermectin

Answer 229

1. infective endocarditis 2. Echo to detect intracardiac vegetation or abscess

Answer 230

--> all initial tx should be anticoagulation (hep infusion) 1. mild pain, intact cap refil, audible doppler pulses -- get CT angio and then tx with catheter based or surgical revascularization 2. severe pain, mild/partial sensory/motor deficit, delayed cap refill, inaudible arterial doppler, audible venous doppler -- tx with emergency surgical revascularization 3. variable pain, severe/complete sensory/motor deficit, absent cap refil, inaudible doppler pulses - manage with amputation

Answer 231

appropriate for post stent placement

Answer 232

1. oligohydramnios (cox inhibitor decreases prostaglandin production) --> leads to fetal vasoconstriction and subsequent decreased renal perfusion and fetal oliguria causing oligohydramnios 2. premature closure of the fetal ductus arteriosus *typically only receive indomethacin for <= 48 hrs

Answer 233

Wilms tumor (nephroblastoma) - WAGR, may be associated with wilms tumor, aniridia, GU abnormalities, mental Retardation

Answer 234

1. Neuroblastoma is a tumor that can arise anywhere in the sympathetic nervous system but typically involves the adrenal glands and presents as an abdominal mass. ---Usually affects children age <2 and does not cause hematuria which wilms tumor can ---periorbital ecchymosis (orbital mets) ---spinal compression ---opsoclonus-myoclonus syndrome

Answer 235

1. E coli O157:H7, shigella dysenteriae 2. toxin invades and destroys colonic epithelial lining causing abd pain, bloody diarrhea. --There is also vascular damage and microthrombi formation creating space for shearing forces. --Intrinsic renal injury is renal vascular occlusion by the capillary microthrombi 3. Bloody diarrhea -- Week after diarrhea pt has signs of anemia (fatigue, pallor), thrombocytopenia (bruising, petechiae), AKI (oliguria, edema). 4. Hemolytic anemia (schistocytes, increased bilirubin) --thrombocytopenia - AKI (increased BUN, increased Cr)

Answer 236

1. LDL >= 190 mg/dL 2. Age>= 40 with DM 3. Estimated 10 year risk of ASCVD >7.5-10

Answer 237

1. age <30 --> U/S +/- mammogram ----if simple cyst is apparent then get need aspiration if symptomatic ---if complex cyst/mass then get image guided core biopsy 2. age 30-39 --> can use either 3. age >= 30 --> mammogram +/- U/S ---- if suspicious for malignancy then get core biopsy

Answer 238

1. CHF 2. HTN 3. Age >= 75 (2 pts) 4. DM 5. stroke or TIA (2 pts) 6. Vasc dx (PAD or past MI) 7. Age 65-74 8. Sex category female Male (0, 1, >=2) - 1 = none or oral anticoagulant - >=2 = oral anticoagulant Female (0, 2, >=3) - 2 = none or oral anticoagulant - >=3= oral anticoagulant

Answer 239

1. Dopamine antagonist (antipsychotics, neuroleptics) 2. -- 3. hyperthermia, AMS, autonomic dysregulation --diff from serotonin syndrome: NMS shows severe diffuse muscle rigidity

Answer 240

1. serotonergic agent (lithium, illicit drugs like ectasy, antiemetic medication (ondansetron), migraine medication (e.g. triptans), opioid medications (meperidine, dextromethorphan, oxycodone, fentanyl)) 2. -- 3. autonomic dysregulation (diaphoresis, tachy, HTN, hyperthermia), AMS, neuromuscular hyperactivity (hyperreflexia, tremor, rigidity, myoclonus, ocular clonus, bilateral babinski sings) --diff from NMS: has hyperreflexia, clonus, and N/V *NMS has diffuse muscle rigidity and bradyreflexia

Answer 241

Juvenile myoclonic epilepsy

Answer 242

sodium bicarbonate

Answer 243

systemic inflammatory diseases such as infections, sarcoidosis, spondyloarthritis, and IBD

Answer 244

corticosteroids

Answer 245

1. both will have dilated loops of bowel with air fluid levels on plain film or CT scan a. Partial: will show air in colon b. Complete: shows no air in colon and transition point. This is life threatening and will not resolve with conservative management --> needs emergency lap

Answer 246

1. SBO -- bowel rest, NG tube suction, IV fluids --surgical exlap if signs of complications or complete obstruction

Answer 247

1. VSD 2. Right ventricular hypertrophy 3. narrow RVOT (right ventricular outflow tract) 4. Overriding aorta

Answer 248

- this kinks femoral arteries which increases SVR --> leading to less right to left shunting and improving tet spells

Answer 249

--defect in NADPH oxidase causes this person to have recurrent bacterial and fungal infections --chronic activation of inflammatory cytokines frequently leads to granulomas in GI or GU tract ---When breakthrough infections occur biopsy of area of infection is necessary to identify what resistant bacterial or fungal organisms are at play and then best decide on antibioitc

Answer 250

- limited upward gaze - upper eyelid retraction (collier sign) - pupillary abnormalities like reactive to accommodation but not light --> can also block CSF flow in the aqueduct of sylvius causing hydrocephalus (papilledema, headache, and vomiting) This is all due to pinealoma - children 1-12 are most commonly affected

Answer 251

1. blood vessel narrowing 2. fluid leak into tissues --> swelling 3. pain exacerbation ---NSAIDs

Answer 252

1. diet 2. insulin, glyburide, metformin

Answer 253

1. <=95 mg/dL 2. <= 140 mg/dL 3. <=120 mg/dL

Answer 254

a. free air: emergency exlap b. dilated loops of bowel: ---> first ask is there increased rectal tone and/or delayed passage of meconium -------if yes: get contrast enema: This will show microcolon (meconium ileus) OR rectosigmoid transition zone (hirschsprung disease) --------if no: get upper GI series (follow c) c. normal: get upper GI series ---if shows right sided ligament of treitz then likely malrotation (complication is volvulus) d: double bubble sign: this is likely duodenal atresia

Answer 255

1. HAV 2. HBV 3. HPV (pts age 11-26, can consider up to 45) 4. influenza annually 5. meningococcus all patients >=2 months and then booster q 5 years 6. Tdap once and then Td q 10 years 7. pneumococcal conjugate vaccine (PCV13) first then 23-valent pneumococcal vx (PPSV23)

Answer 256

complicated by infection -- can rapidly progress to pyelonephritis to severe sepsis and shock ---other indications: AKI, refractory pain or vomiting, and anuria

Answer 257

<=5 mm --outpatient urology referral may be needed for stones >10 mm that do not pass within 4-6 weeks

Answer 258

This is a sodium channel blocker in collecting duct --- stops the reabsorption of Na through ENaC. Usually Na is taken in via ENaC and then further reabsorbed into body via Na/K pump (which releases K into urine) ---with this medication this no longer does this and thus spares potassium, keeping K in the body

Answer 259

Category I: --- baseline 110-160/min --- Moderate variability (6-25/min) --- No late/variable decelerations ----+/- early decels, +/- accels Category III: >=1 of the following --- absent variability + recurrent late decels --- absent variability + recurrent variable decels --- absent variability + brady --- sinusoidal pattern -category 2 is indeterminate pattern

Answer 260

severe fetal anemia -- rapid fetal exsanguination and deterioration, mom requires urgent c section

Answer 261

vaccine and immune globulin

Answer 262

1. rapid onset systolic heart failure (fatigue, dyspnea, cough, pedal edema) -- enlarged left ventricle and atrium 2. >36 weeks gestation or early puerperium

Answer 263

Meniere disease - disorder of inner ear characterized by increased volume and/or pressure of endolymph thought to be due to defective resorption of endolymph. Resulting distension causes damage to both the vestibular and auditory components of the inner ear.

Answer 264

Can raise intraocular pressure (IOP) -- can lead to corneal edema and possibly open angle glaucoma --all patients on prolonged therapy should undergo assessment with tonometry

Answer 265

amyotrophic lateral sclerosis (ALS)

Answer 266

Cervical spondylotic myelopathy

Answer 267

1. decreased ADAMTS13 leads to uncleaved vWF multimers --> lead to platelet trapping and activation. Shearing forces can damage RBC 2. Hemolytic anemia causes increased LDH - Decreased haptoglobin --Schistocytes on peripheral blood smear --thrombocytopenia <30,000 (increased bleeding time, normal PT/PTT) ---increased indirect bilirubin, increases AST and ALT 3. plasma exchange -glucocorticoids -rituximab -caplacizumab

Answer 268

1. immune mediated consequence of untreated strep pharyngitis. Abnormal immune response to GAS infections. 2. GAS 3. JONES - joints (migratory arthritis) - carditis - nodules (subcutaneous) - erythema marginatum - sydenham chorea --> Minor (fever, arthralgias, elevated ESR/CRP, prolonged PR interval) 4. can cause mitral regurgitation/stenosis --> if regurge is severe enough then atria can enlarge and cause afib/aflutter

Answer 269

1. Magnesium sulfate --> it can lead to myasthenic crisis 2. Fluoroquinolones 3. Aminoglycosides

Answer 270

1. hospital patients with central venous catheter 2. progressive vision loss with floaters 3. Fundoscopy shows fluffy, yellow white chorioretinal lesions. Candida replicates in the choroid and attacks the retina

Answer 271

1. topical clindamycin 2. oral tetracycline 3. TNFa inhibitors, surgical excision

Answer 272

Yes to both - Rx antibiotic therapy and continue breastfeeding

Answer 273

HIV infection

Answer 274

Cholangiocarcinoma -- jaundice, pruritus, alcoholic stool, dark urine, weight loss, RUQ pain, --Dx with abdominal imaging like U/S or CT scan

Answer 275

1. prematurity 2. involuation of the germinal matrix (fetal structure that eventually gives rise to neurons, has fragile vessels) begins at age 32 weeks so prematurity increases risk that this ruptures --if born <32 then cranial U/S is automatically done -- sx: anemia, tachycardia, and a bulging fontanelle

Answer 276

1. procainamide 2. hydralazine 3. penicillamine 4. minocycline 5. TNFa inhibitors 6. Isoniazid

Answer 277

1. PPV raises the intrathoracic pressure causing a drop in venous return to the right of the hear which decreases R ventricular preload 2. With less blood to RV then less blood to LV 3. PPV decreases MAP (mean arterial pressure) via baroreceptor effects and lowers adrenergic tone. This makes the afterload less overall enhances stroke volume in systole and improves filling in diastole

Answer 278

1. older age, tobacco, alcohol, poor dentition. Young patients with HPV 16. 2. neck mass, ulcerated tonsillar lesion, pharyngitis, dysphagia, and halitosis

Answer 279

1. usually in women 2. bulge located below the inguinal ligament - through a widened or laxed femoral ring (medial to femoral artery and inferior to inguinal ligament)

Answer 280

Active phase 6-10 cm dilation No cervical change for >=4 hours despite adequate contractions (>= 200 montevideo units) OR no cervical change for >=6 hrs with inadequate contractions =next step is c section

Answer 281

1. cervical change slower than expected +/- inadequate contractions <1cm/2hr --tx with oxytocin

Answer 282

1. remove pts clothes and irrigate skin 2. atropine reverses muscarinic symptoms --pralidoxime after atropine (reverses nicotinic and muscarinic sx)

Answer 283

hereditary spherocytosis

Answer 284

low grade astrocytomas --slow growing and benign, causing symptoms to develop over many months --originate in cerebral cortex (supratentorial) --headache, seizures,etc

Answer 285

glioblastoma - causes sx over days to weeks (not months) - much more rare

Answer 286

1. sella turcica (contains pituitary gland) 2. cystic structures with calcifications 3. compression of optic chiasm or pituitary stalk may lead to visual field defects and hormonal deficiencies (DECREASE in hormones coming out of pituitary gland like TSH, GH, LH, FSH, ADH --bc mass gets in the way)

Answer 287

1. reduced SVR - direct vasodilatory effects on endothelium, thus decreasing diastolic blood pressure 2. increased contractility and stroke volume - direct effect on myocardium and reflexive response to peripheral vasodilation. 3. increased HR -complications can be high output heart failure, angina, tachyarrhythmias (afib)

Answer 288

1. delusions or hallucinations for >= 2 weeks in the absence of major depressive or manic episode. Mood episodes are prominent and recur throughout illness. Sx of schizophrenia have to be for >= 6 months. 2. psychotic symptoms related to schizophrenia but >1 month and <6 months

Answer 289

1. connective tissue disorder caused by type V collagen. These patients have joint hypermobility but no fractures 2. defective collagen type I which is common in bone, sclerae, skin, and teeth. Pts often have frequent fractures with type I. Joints are also hypermobile. Blue sclerae. Hearing loss. Short stature. Pts can have easy bruising. (Don't confuse this with toddler's fractures which is seen in children during first few years of walking - will see issues focused on legs)

Answer 290

cyanide poisoning - inhibits oxidative phosphorylation and forces anaerobic metabolism --cherry red skin, headache, confusion, anxiety, seizures, coma, HTN, tachycarida, tachypnea ---> elevated anion gap met acidosis with increased lactic acid

Answer 291

1. initiate exchange transfusion, eval for pathologic causes 2. initiate phototherapy and if unresponsive (rapid rate of rise) then go to exchange transfusion Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 micromol per L) in infants 25 to 48 hours old, 18 mg per dL (308 micromol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 micromol per L) in infants older than 72 hours. 3. increase feed volume/frequency and monitor

Answer 292

SSRI (fluoxetine) -- SNRI (venlafaxine) lacks evidence as good tx for pediatric age group for depression

Answer 293

Neurofibromatosis type 1

Answer 294

meningioma

Answer 295

<6 months - at 6 months then have to refer for orchiopexy

Answer 296

1. TVUS 2. <= 4 mm nothing else req ---> >4 mm need bx

Answer 297

1. <= 2.5 cm, tx with vaginal progesterone (this is for those who have never had prior preterm delivery and after 2nd trimester TVUS) If pt did have preterm delivery before and it was NOT associated with painful contractions --> refer to cerclage if pt did have preterm delivery before and it DID have painful contractions then give IM or vaginal progesterone

Answer 298

1. cerebral palsy - motor delay, early hand preference, spasticity, and hyperreflexia - happens because of ischemia and necrosis in poorly perfused area adjacent to the lateral ventricles --> causes white matter injury

Answer 299

1. growth hormone 2. tetracyclines 3. excessive vitamin A and its derivatives like isoretinoin

Answer 300

1. made of from increased urine ammonia production - from urease producing organisms (proteus, klebsiella) ---> hydrolysis of urea yields ammonia which alkalinizes urine and precipitates stone 2. Sx associated with recurrent UTI (rather than renal colic) 3. antibiotic tx, complete stone removal, urease inhibitor in some patients to prevent recurrence

Answer 301

CN I - olfactory CN II - optic CN III - oculomotor (coordinates eye position during movement) CN IV - Trochlear (SO4 - superior oblique allows eye to look down and move your eye toward your nose) CN V - Trigeminal - sensation in the face (pain, touch, and temp) CN VI - Abducens ( LR6 - lateral rectus) CN VII - facial (facial movement, taste at anterior 2/3 of the tongue) CN VIII - Vestibulocochlear CN IX - Glossopharyngeal CN X - Vagus CN XI - acessory CN XII - hypoglossal

Answer 302

Carotid artery disease - CT angio - similar to stroke tx: ---> Thrombolysis if <= 4.5 hrs ---> Antiplatelet therapy (e.g. aspirin) +/- anticoagulation

Answer 303

1. when the normal developmental process of emotional bonding to primary caregiver is interrupted by inconsistent or inadequate care 2. Do not seek or respond to comfort, poor social responsiveness, limited positive affect, unexplained irritability, fear, sadness even during safe encounters

Answer 304

1. congenital toxoplasmosis - exposure to undercooked meat or cat feces tx wtih pyrimethamine, sulfadiazine, folinic acid

Answer 305

CMV - exposure to infected bodily fluids tx with ganciclovir or valganciclovir

Answer 306

1. rubella

Answer 307

1. maximize expiratory flow -- inhaled bronchodilators (e.g. albuterol) 2. reduce airway inflammation -- systemic glucocorticoids (IV prednisone or methylprednisolone) 3. tx underlying triggers - antibiotics and/or antivirals

Answer 308

1. slow growing benign overgrowth of the choroid plexus (what makes CSF) that results in increased CSF production 2. hydrocephalus, poor feeding, bulging fontanelle, developmental delay, etc

Answer 309

1. Non purulent, TM is not bulging or erythematous. Does not cause fever or severe ear pain 2. observe and follow up

Answer 310

In utero, impaired fetal urinary excretion causes oligohydramnios and subsequent lung hypoplasia which can lead to respiratory distress

Answer 311

1. New onset HTN (SBP >= 140 or DBP >= 90) at >= 20 weeks gestation AND 2. proteinuria (urine protein/cr ratio >= 0.3) or signs/sx of end organ damage

Answer 312

1. severe range HTN (SBP >=160 or DMP >=110) 2. platelets (<100,000) 3. Creatinine (>1.1) or 2X normal

Answer 313

1. expectant 2. delivery 3. IV labetalol, IV hydral, PO nifedipine 4. mg sulfate

Answer 314

2. clear cell renal cell carcinoma 4. endolymphatic sac tumors of the middle ear - hearing loss 5. pheochromocytomas

Answer 315

1. early autonomic failure (severe orthostasis, urinary incontinence) 2. early postural instability 3. cerebellar findings (gait ataxia)

Answer 316

1. vertical gaze palsy 2. early postural instability 3. akinesia (early gait freezing) 4. progressive aphasia

Answer 317

1. early dementia (executive dysfunction) 2. visual hallucinations 3. cognitive fluctuations 4. REM sleep behavior disorder --> Dementia first then parkinsonism

Answer 318

1. rare 2. myoclonus, dystonia 3. alien limb phenomenon 4. cortical sensory loss

Answer 319

1. bloating, flatulence, chronic watery diarrhea, --malabsorption, low vit B12 and folate 2. IBS has chronic abdominal PAIN and sx relief after bowel movement, nocturnal sx are not generally present 3. after ileocecal resection d/t to colonic bacteria entering small intestine. 4. carbohydrate breath test

Answer 320

1. secondary syphilis 2. anogenital warts --> (low risk HPV 6,11)`

Answer 321

1. neutrophils in pulm vasculature activated by antibodies in the transfused blood, lead to release of inflammatory mediators --> pulm edema -risk factors include smoking, alcohol use disorder, critical illness 2. Respiratory supportive care

Answer 322

1. IV calcium gluconate 2. Insulin plus glucose 3. Inhaled beta 2 agonists (avoided in patients with active coronary disease due to tachycardia induced angina)

Answer 323

1. immediate: most cases are caused by tissue damage incurred during a major procedure. Fever and leukocytosis last <3 days and are managed symptomatically. 2. acute (1-7 days)/subacute(7-28 days)/delayed: most often due to bacterial infection

Answer 324

1. elevated catecholamines metabolites -- small, round blue cells on histology -- N-myc gene amplication 2. Tumor involvement of the cervical paravertebral sympathetic chain can lead to horner syndrome 3. neural crest cells (precursors to sympathetic ganglia and adrenal medulla) which is why tumors commonly appear in sympathetic system and adrenal glands

Answer 325

Fragile X syndrome

Answer 326

1. Etox (erythema toxicum neonatorum) --birth to 3 days

Answer 327

1. miliaria rubra - any age but not at birth

Answer 328

1. nonerythematous pustules --> evolve into hyperpigmented macules with collarette of scale. Diffuse, may involve palms and soles. -- at birth --observe and pustules should go away in days but hyperpigmentation may last months. 2. Erythematous papules and pustules on face and scalp only ---around 3 weeks of age --observe and should resolve. If severe, topical corticosteroid and ketoconazole.

Answer 329

1. iron deficiency 2. thalassemia 3. lead intoxication 4. sideroblastic anemia

Answer 330

1. leukemia 2. aplastic anemia 3. anemia of chronic disease

Answer 331

1. hemorrhage 2. hemolysis due to ... --> spherocytosis --> G6PD deficiency --> autoimmune --> microangiopathic

Answer 332

1. acetaminophen 2. antiemetics, codeine, caffeine (can be given in conjunction to #1) 3. NSAIDs (e.g. naproxen) --> BUT ONLY 2ND TRIMESTER 4. Opioids (oxycodone)

Answer 333

1. basal ganglia atrophy - caused by changes in a single gene --mutation in huntington gene with CAG 2. Onset is gradual and in adulthood

Answer 334

adhesive capsulitis (frozen shoulder)

Answer 335

1. life threatening infectious complication of acute otitis externa. Aggressive spread beyond external ear canal into skull base and adjacent tissue. Can show with elevated ESR and cranial nerve palsy. 2. pseudomonas 3. IV antibiotic for pseudomonas like cipro

Answer 336

PCP (phencyclidine)

Answer 337

1. Cardiac outflow tract anomalies (Tet of fallot, persistent truncus arteriosus) 2. Anomalous face (prominent nasal bridge, low set ears, micrognathia) 3. Thymic hypoplasia/aplasia --> decreased T cell immunity 4. Cleft palate 5. Hypoparathyroidism --> leading to hypocalcemia

Answer 338

1. Commonly due to failure of vertebral arch fusion (L5-S1). Skin is intact but underneath skin there is no vertebral piece covering spine. 2. asymptomatic or can have tethered cord syndrome (Neuro: LMN sings, urology: incontinence/retention, Ortho: back pain, scoliosis, foot deformity) --- cutaneous, lumbosacral anomalies like hair tuft, hemangioma, nevus, pit.

Answer 339

Staph toxic shock syndrome --> supportive therapy, removal of foreign body, and antibiotic therapy

Answer 340

>5 contractions/10 min

Answer 341

1. cord compression 2. head compression 3. okay 4. placental insufficiency 1. maternal repositioning (reccurent variable decels can be managed with amnioinfusion to reduce cord compression) 2. identify labor progress 3. no intervention 4. execute interventions

Answer 342

lactose intolerance

Answer 343

1. Crescent sign - arc of ecchymosis is often visible distal to medial malleolus 2. painless bulge behind the knee (more noticeable with knee extension) 3. When cyst ruptures can cause pain in the calf and crescent sign

Answer 344

1. serum IgA levels are low/undetectable due to failure of B cells to differentiate into IgA secreting plasma cells. 2. Recurrent sinopulmonary and GI infections due to lack of secretory IgA on mucosal barrier. --atopic and autoimmune disorders (SLE, celiac) are common 3. low or absent IgA, normal IgG/IgM/B cells 4. In blood transfusion - host can form IgE ab against IgA so when getting blood that contains IgA the host can have anaphylaxis shock

Answer 345

Trisomy 13 (patau syndrome)

Answer 346

This is likely pituitary apoplexy due to hemorrhage or acute ischemia -- Bc of compression or ischemia of the pituitary, deficits of anterior pituitary often occur and loss of ACTH can cause central adrenal insufficiency (cause of hypotension) Tx: parenteral glucocorticoids **not subarachnoid hemorrhage bc no neck stiffness or HTN

Answer 347

1. bacterial meningitis (>1,000) (<40) (<250) 2. TB (100-500) (<45) (100-500) 3. Viral (10-500) (norm) (<150) 4. Guillain barre (norm) (norm) (45-1,000)

Answer 348

1. antiepileptics like phenytoin, valproate, carbamazepine 2. cleft lip/palate, wide ant fontanelle, distal phalange hypoplasia, cardiac anomalies, microcephaly

Answer 349

1. antidiarrheal medicatioin 2. D2 receptor antagonist that increases gastric contractility and motility

Answer 350

Osteosarcoma -- risk is greatest in those with RB1 and TP53

Answer 351

Preterm prelabor rupture of membranes (PPROM)

Answer 352

1. MRI of brain with contrast to visualize intracranial vascular malformation 2. laser therapy can improve port wine stain. Antiepileptic drugs, intraocular pressure reduction

Answer 353

1. If patient is bothered by irregularity 2. If there is significant anemia even between menses

Answer 354

1. increasing age 2. increased estrogen exposure via nulliparity, early menarche (<13), and late menopause (>51) 3. family history - first degree relative

Answer 355

CT scan without contrast --more sensitive than plain radiography

Answer 356

1. kidneys --may increase to toxic levels when patients have renal dysfunction. 2. Valproate - not nephrotoxic but periodic monitoring of liver function tests and platelets is necessary due to medications rare association with hepatotoxicity and thrombocytopenia

Answer 357

Fibrates (fenofibrate) - reduce synthesis of triglycerides and increase their catabolism

Answer 358

1. ezetimibe - selectively inhibit intestinal absorption of cholesterol 2. PCSK9 inhibitors - block PCSK9 protein from breaking down LDL receptors in liver. This way LDL receptors stay open to uptake bad cholesterol and decreases LDL. **statin reduce the amount of cholesterol the liver produces (by inhibiting enzyme used for production) and helps liver remove cholesterol from blood. **1 and 2 can be considered if statins are not tolerated but not as effective in preventing cardiovascular events

Answer 359

1. spinothalamic tract 2. corticospinal 3. dorsal column *immune mediated disorder characterized by infiltration of inflammatory cells into a segment of the spinal cord

Answer 360

- AC joint sprain --> when significant force is applied to lateral or superior shoulder causing a sprain on the ligament that connects the acromion and the clavicle

Answer 361

Olanzapine and clozapine

Answer 362

tricuspid regurgitation

Answer 363

Rare cause of upper GI bleeding - usually occurs as complication of hepatic or biliopancreatic interventions (e.g. liver bx, cholecystectomy, ECRP) -- massive hemobilia results in hemodynamic instability that occurs after procedure. sx: RUQ pain, jaundice, UGIB, -direct hyperbilirubinemia, anemia, leukocytosis

Answer 364

1. symmetric - chromosomal abnormalities - congenital infection 2. asymmetric - uteroplacental insufficiency - maternal malnutrition

Answer 365

1. antenatal corticosteroids (IM betamethasone) to decrease risk of ARDS and promote fetal lung maturity --> Penicillin if GBS+ or unknown --> Tocolysis: indomethacin --> Mg sulfate to decrease risk of cerebral palsy 2. Antenatal corticosteroids --> Penicillin if GBS+ or unknown --> Tocolysis: indomethacin 3. antenatal corticosteroids --> Penicillin if GBS+ or unknown

Answer 366

1. Rectus sheath hematoma 2. Abd CT confirms th edx

Answer 367

1. > 1,500/mm3 2. >= 200/mm3

Answer 368

1. monitored clinically q 6 months 2. brace in a child with growth potential to reduce curve progression 3. surgical fixation

Answer 369

Suppression of hypothalamic-pituitary-ovarian axis by strenuous exercise, calorie restriction, increased stress, or chronic illness ---Decreased GnRH leads to low FSH/LH and thus low estrogen level. Which means proliferation of endometrium does not happen. With progesterone challenge test you don't get bleeding. -Have increased risk of decreased bone mineral density due to low estrogen. Don't have vasomotor sx bc normal yet unstimulated ovaries still make basal estrogen levels

Answer 370

primary ovarian insufficiency

Answer 371

1. sx tend to progress over minutes to hours as hemorrhage expands

Answer 372

1. occiput anterior (back of head facing anterior of mom) when occiput posterior this increases risk of cephalopelvic disproportion in which the fetal head is too large to fit through maternal pelvis

Answer 373

1. invasive pulmonary aspergillosis 2. voriconazole +/- caspofungin *chronic pulmonary aspergillosis is a fungus ball in preexisting lung cavity. usually quiescent with occasional hemoptysis, weight loss, cough/fatigue over 3 months

Answer 374

1. kidneys - common risk factor for toxicity is renal insufficiency 2. calcium gluconate 3. Mild: nausea, flushing, headache, hyporeflexia --mod: areflexia, hypocalcemia, somnolence --severe: respiratory paralysis and cardiac arrest

Answer 375

1. Stool antigen confirms new infection or eradication 2. Urea breath tests confirms new infection or eradication 3. * Endoscopic bx confirms new infection or eradication *serologic test has limited use, cannot distinguish between past and current infection * Endoscopic bx confirms new infection or eradication.

Answer 376

1. Nonbullous - papules and pustules with honey crusted lesions - staph aureus and strep pyogenes (GAS) - tx with topical Ab (mupirocin) or oral Ab if extensive (cephalexin) 2. Bullous -enlarging, flaccid bullae with yellow fluid -ruptured lesions with a collarette of scale at periphery - caused by Staph aureus - producing exfoliative toxin A - tx: oral Ab cephalexin

Answer 377

1. formation of lamellar bone in extraskeletal tissue (hetertropic ossification). - it is triggered by severe or recurrent trauma -- presents as painful, firm, mobile mass with local swelling --Alk phose and inflammatory markers may be elevated

Answer 378

Most common functional movement disorders --involuntary movements that are not consistent w/a neurologic cause AND IMPROVE WITH DISTRACTION

Answer 379

1. obtain venous sample levels. 2. chelation therapy if lead level is >=45 ug/dL --> Dimercaptosuccinic acid (succimer) used at 45-69 --> EDTA and dimercaprol should be administered on emergency levels >= 70

Answer 380

1. accumulation of subepithelial immune complex deposits and podocyte damage 2. malignancy, infection (hep B), autoimmune, Drugs 3. edema, proteinura, hyperlipidemia and hypoalbuminemia. BP and GFR usually normal

Answer 381

1. mitral valve obstruction (middiastolic murmur) - dyspnea, lightheaded, syncope. --embolization of tumor fragments (stroke) --consititutional sx like fever and weight loss 2. benign neoplasm often found in left atrium 3. Echo and then prompt surgery

Answer 382

Left lateral decubitus position because this traps the air bubble in the wall of the right ventricle preventing it from obstructing the RVOT or going anywhere else

Answer 383

1. premature thelarche 2. premature adrenarche

Answer 384

1. Central precocious puberty (idiopathic, CNS tumor) 2. Peripheral precocious puberty (nonclassic congenital adrenal hyperplasia, gonada/adrenal tumor) 3. Central precocious puberty

Answer 385

1. alk phosphatase 2. gamma-glutamyl transpeptidase (GGT)

Answer 386

1. Due to large volume blood transfusion in patients with underlying cardiac disease. --occurs w/in hrs of transfusion 2. Sx of respiratory distress from hypervolemia, dyspnea from pulmonary edema, JVD, widened pulse pressure, HTN 3. Halt further blood transfusions and minimizing other IV fluids followed by diuresis w/a loop diuretic. **does not cause ARDS

Answer 387

1. thrombolytic therapy (e.g. alteplase) 2. aspirin (antiplatelet med) 3. aspirin (antiplatelet med)

Answer 388

Heparin, warfarin, dabigatran

Answer 389

1. Stroke - affects only lower face (broken upper motor neurons that synapse on the facial nerve nucleus but other side of brain recuperates the function of forehead) 2. Bells palsy - affects both lower face and forehead (LMN is broken and affects both forehead and lower face)

Answer 390

---MRI to confirm and exclude epidural abscess or discitis

Answer 391

--> Plain x rays may have you suspecting --> then get MRI to evaluate extent of local invasion and allow for local staging --> then get bone biopsy --> then surgical resection + chemo

Answer 392

1. hypocalcemia 2. hypokalemia 3. Hyponatremia

Answer 393

1. nitates and opioids - These medications lower preload - W/right side of heart not working then heart becomes pre-load dependent so maintaining volume on right side is important. Nitrates and opioids lower preload.

Answer 394

Healthy person >=15 mm is positive Incarcerated or health care worker or foreigner >=10 mm HIV or close contact with someone with TB >= 5 mm

Answer 395

Multiple endocrine neoplasia type 1 Parathyroid adenomas Pituitary adenomas Pancreatic adenomas Multiple endocrine neoplasia type 2A Medullary thyroid cancer Pheochromocytoma Parathyroid hyperplasia Multiple endocrine neoplasia type 2B Medullary thyroid carcinoma Pheochromocytoma Multiple mucosal neuromas Often a marfanoid habitus

Answer 396

1. arises from parafollicular C cells and produces calcitonin sx of hypocalcemia may be present if severe -typically asymptomatic until a nodule is of palpable size

Answer 397

1. CMV (or HHV-5) 2. Ganciclovir - inhibit viral DNA polymerase

Answer 398

AR = (a/(a+b)) - (c/(c+d))

Answer 399

chi-square test

Answer 400

analysis of variance

Answer 401

1. Crohn disease 2. imaging and biopsy --lab shows increased ESR, C reactive protein 3. aminosalicylates (mesalamine, sulfasalazine) --corticosteroids (prednisone) --immunomodulators (azathioprine, 6-MP, methotrexate --biologic therapies (infliximab, adalimumab, certolizumab)

Answer 402

1. 1+ 2. 1+ 3. 0-5 RBC 4. 0-5 WBC 5. pigmented granular (muddy brown casts) 6. renal tubular epithelial cells --> what makes up the muddy brown casts in a Tamm-Horsfall (uromodulin) mucoprotein matrix

Answer 403

Thrombotic thrombocytopenic purpura

Answer 404

Overall Autosomal recessive disorders --> caused by mutations in SMN genes at crhom 5q13 that lead to degeneration of motor neurons, resulting in progressive hypotonia and areflexia 1. Type I - infantile onset SMA (werdnig hoffman disease) --> difficulty with mobility, respiratory distress and difficulty feeding --> leading to death from respiratory failure during infancy 2. Type II - Intermediate SMA (Dubowitz disease) --> never gain ability to stand or walk without assistance. 3. Type III - Juvenile SMA (Kugelberg-Welander syndrome) --> Previous independent ambulation followed by increasing difficulty with ambulation. Proximal muscle weakness affecting both arms and legs. Some may develop scoliosis or lumbar hyperlordosis.

Answer 405

- Duchenne muscular dystrophy --> - Gower sign (child assumes the hands-and-knees position and then climbs to a stand by "walking" his hands progressively up his shins, knees, and thighs)

Answer 406

1. doxycycline 2. ceftriaxone (doxycycline is contraindicated in pregnant women)

Answer 407

1. acetaminophen 2. NSAIDs if not contraindications 3. intra articular injections (cortisone) 4. joint replacement for severe cases

Answer 408

1. weight loss --for q lb lost - BP can decrease by 1 mmHg

Answer 409

1. Chest x-ray: peripheral and basilar honeycombing (clustered cystic air spaces) 2. CT: peribronchial fibrosis, reticular opacities (meshlike/lace pattern), subpleural thickening

Answer 410

Dilated, air filled sigmoid colon -- looks like a coffee bean --cecal volvulus shows small bowel dilation

Answer 411

HIV positive moms - this increases risk of exposing fetus to maternal blood * intrauterine pressure catheter placement can be cautiously used if necessary and clearly indicated -

Answer 412

1. XXY 2. decreased testosterone production and absent sperm production in the setting of fibrotic seminiferous tubules and leydig cells 3. cryptorchidism or small testes, learning disabilities, behavioral issues, delayed pubertal development, signs of androgen deficiency (gynecomastia), and infertility --person can often be tall with disproportionate leg to arm length 4. Increases FSH and LH --Low testosterone 5. dx w/karyotype Tx with testosterone supplementation and counseling

Answer 413

1. micropenis, hypospadias, gynecomastia, minimal body hair 2. female phenotype with virilization to a male phenotype

Answer 414

used to evaluate excessive dryness or watering of the eyes with test strip ---> Used in Sjorgren syndrome

Answer 415

when a fertilized egg implants into the endometrial lining but an embryo fails to develop often bc of severe chromosomal abnormalities --empty gestational sac w/out fetal cardiac activity --tissue is often passed without intervention, supportive care

Answer 416

Constitutional growth delay

Answer 417

Leishmaniasis (infection with Leishmania tropical - caused by sand fly bite) - Middle east, asia, north africa (old world leishmaniasis/leishmania tropica) -Central and south america (new world leishmaniasis/leishmania braziliensis)

Answer 418

1. NSAIDs 2. colchicine

Answer 419

1. internal rotation 2. external rotation when in an adducted position 3. external rotation 4. abduction

Answer 420

Rotator cuff tear typically occurs at the insertion of the tendons of the rotator cuff on the humeral head. --> abduction and external rotation -commonly occurs to supraspinatus tendon - risk factors: heavy labor, repetitive overhead lifting, DM, vascular disease - presentation: pain and weakness in one of the axes of motion and late manifestations include atrophy of corresponding muscle

Answer 421

1. Tropheryma whipplei 2. cardiac sx, arthralgias, and neuro sx --chronic infection shows weight loss, vitamin deficiencies, and foul smelling oily diarrhea occur as a result of the presence of foamy macrophages and inflammation in the intestinal wall causing malabsorption 3. Intestinal bx via upper endoscopy (acid-Schiff positive macrophages in lamina propria) 4. IV ceftriaxone 2 weeks then TMP-SMX for a year

Answer 422

When muscular layer of esophagus is overactive. Spasms cause dysphagia and chest pain, often acutely in the setting of swallowing.

Answer 423

1. deficient peristalsis as a result of impaired neuromuscular transmission and impaired relaxation of the lower esophageal sphincter (LES) 2. dysphagia, odynophagia, weight loss, reflux, halitosis, and regurgitation of undigested food. 3. barium swallow and esophageal manometry. Bird peak sign on barium swallow 4. pneumatic dilation and injection of botulinum toxin to relax LES

Answer 424

1. antimitochondrial 2. biopsy is needed for definitive dx 3. Ursodeoxycholic acid to improve biliary excretion 4. ADEK vit malabsorption, metabolic bone dx (osteoporosis, osteomalacia), hepatocellular carcinoma

Answer 425

1. bile that has a high concentration of cholesterol and is obtained from patients with cholesterol gallstones. 2. Most common nontraumatic cause of acute pancreatitis include gallstones and heavy alcohol use --gallstones form in the setting of lithogenic bile and may subsequently pass out of the gallbladder through the cystic duct and eventually reach the common bile duct (CBD) - main pancreatic duct also connects to distal CBD and if it is occluded then pancreatic enzymes are released into the pancreas and causes acute pancreatitis

Answer 426

beta blocker such as metoprolol or propranolol

Answer 427

1. first line: Dobutamine (beta 1 adrenergic agonist - increased cardiac contractility, stroke volume, heart rate, and CO) or dopamine --> (ionotropic support ) 2. Norepinephrine --> can be used in conjunction to dobutamine

Answer 428

disease prevalence

Answer 429

statistical analysis are conducted after the data has been collected and seen by investigators. - Since these are not originally included in the statistical methodology of the study then they are subject to bias and have a threat to validity

Answer 430

1. glucocorticoid (dexamethasone) 2. Long term disease modifying treatments (interferon beta therapy or monoclonal Ab)

Answer 431

1. HTN (then cigarette smoking) 2. age (then family hx, gender, race/ethnicity)

Answer 432

1. high dose aspirin, IV immunoglobulin 2. echo and electrocardiography dx: Fever ≥5 days plus ≥4 of the following: -Conjunctivitis: bilateral, nonexudative -Mucositis: injected/fissured lips or pharynx, strawberry tongue -Cervical lymphadenopathy: ≥1 nodes >1.5 cm -Rash: perineal erythema & desquamation; polymorphous, generalized -Erythema & edema of the hands/feet, periungual desquamation

Answer 433

1. Hemophilia A: recurrent hemarthrosis and cutaneous bleeding early in childhood. --> vonWB dx: mucocutaneous bleeding, epistaxis, gingival bleeding, petechiae, easy bruising, and menorrhagia 2. Increased bleeding time in vWB dx 3. very prolonged in hemophilia

Answer 434

1. SCID (severe combined immunodeficiency) 2. stem cell transplantation

Answer 435

1. chediak higashi syndrome

Answer 436

Accumulation of blood within the anterior chamber of the eye - most commonly d/t to blunt ocular trauma and damage to the vasculature of the iris

Answer 437

1. More likely to happen in patients with poorly controlled RA who have longstanding disease and positive Rheumatoid factor or anti-citrullinated peptide antibodies ---Neutropenia occurs due to production of antibodies against granulocyte colony stimulating factor or the production of lymphocytes that target neutrophil precursors in the bone marrow 2. New onset fevers, pleurisy, neutropenia, splenomegaly ---underlying infections (particularly lower respiratory tract) 3. Rituximab (Ab against CD20 on B cells) drug of choice for patients already on methotrexate **TNFa antagonists are not efficacious for this!

Answer 438

1. alcohol 2. caffeine 3. exertion 4. stress 5. sympathomimetic medications

Answer 439

Vertebral artery --> to prevent future TIAs/Stroke recommend smoking cessation, BP reduction, blood glucose control, healthy diet, regular exercise, use of statin and aspirin

Answer 440

Anterior and middle cerebral arteries which supply the anterior and middle cerebral lobe

Answer 441

1. Invasive catheter angiographic eval of the pulmonary arteries (going to lungs) 2. images of pulmonary arteries (make up of lungs)

Answer 442

1. Fibromuscular dysplasia - abnormal cell development in the arterial wall that can lead to vessel stenosis, aneurysm, or dissection. Most commonly involves the renal, carotid, and vertebral arteries 2. Dx is made via noninvasive imaging (CT angio of the abdomen or duplex U/S)

Answer 443

1. presence of antibodies toward parietal cells, resulting in atrophy and metaplasia of the gastric corpus, hypochlorhydria, and unchecked gastrin production, and toward intrinsic factor 2. More often in women. --macrocytic anemia - dyspepsia, postprandial abd pain, bloating, nausea, heartburn, or regurgitation, 3. gastric adenocarcinoma and neuroendocrine tumors, routine surveillance with endoscopy is indicated

Answer 444

alpha thalassemia MAJOR (4 gene loss)

Answer 445

1. weeks to months after birth as maternal T4 wanes 2. Hypometabolism causes low HR and temp, lethargy, poor feeding, hypotonia, constipation, jaundice --Mucopolysaccharide accumulation: macroglossia, umbilical hernia --delayed bone maturation, enlarged fontanelles

Answer 446

1. Unstable abdominal aortic aneurysm 2. Obtain CT of abdomen and identify AAA 3. Focused abd U/S

Answer 447

1. harsh crescendo-decrescendo systolic murmur over LUSB reflects stenotic pulmonary artery

Answer 448

1. central: oral cavity lips, tongue, hands, feet, and mucous membranes 2. peripheral: hands, fingertips, or toes, sometimes circumoral and periorbital

Answer 449

1. Umbilical artery Doppler U/S to assess placental perfusion -measures intravascular flow and resistance in the umbilical artery. More resistance = worse hypoxia. --measurement identifies patients who require urgent delivery to minimize the risk of fetal demise -- can be caused by maternal vascular disease (e.g. T1DM, chronic HTN). w/less being provided to baby then fluid is moved away from kidney and moved toward brain which causes oligohydramnios

Answer 450

1. Toddlers (feeding difficulties with solid food, weight loss), school aged (abd pain, vomiting), adolescent (dysphagia, heartburn, food impaction) --> issue with swallowing solids (food sticking in the chest feeling) --> also common in young men 20-30 2. Th2 mediated inflammatory response trigged by food antigen exposure. Comorbid autoimmune diseases common. 3. endoscopy (furrowing, small, whitish exudates and multiple stacked, ringlike esophageal indentations) and esophageal biopsy (eosinophils >15) 4. elimination diety, pharm therapy (PPI, glucocorticoid), feeding therapy --> if not tx can progress to fibrosis leading to strictures that result in progressive dysphagia and food impaction

Answer 451

1. 18 horus 2. penicillin - intrapartum Ab prophylaxis

Answer 452

1. increased biliary cholesterol excretion (due to estrogen) --- decreased gallbladder motility due to progesterone 2. recurrent postprandial epigastric/RUQ pain -RUQ U/S with echogenic foci 3. Conservative (pain control), cholecystectomy for complicated, recurrent cases

Answer 453

1. biliary atresia 2. biliary cyst

Answer 454

1. biliary cyst 2. cyst removal to decrease risk of cholangiocarcinoma

Answer 455

1. hypoglycemia 2. If glucose is normal then check calcium bc hypocalcemia is next cause (osmotic diuresis caused by poorly controlled gestational diabetes causes hypomagnesium which leads to hypocalcemia) --hypocalcemia can present with jitteriness, respiratory symptoms, and if severe seizures too correction involves correcting magnesium first then calcium

Answer 456

1. Severe aortic stenosis (gastrointestinal bleeding from angiodysplasia is a deficiency of high-molecular-weight multimers of von Willebrand factor which is sheared with aortic stenosis) 2. Chronic kidney disease

Answer 457

1. Increases RV preload 2. hydrostatic pressure to force blood through the pulmonary circulation 3. IV normal saline 4. nitrates, diuretics, and opioids

Answer 458

hepatocellular carcinoma (HCC) --AFP is a glycoprotein produced by the fetal liver and yolk sac ---Often occurs in setting of chronic liver disease and presents as solitary mass

Answer 459

Acute pericarditis is a form of this --> results from immune complex deposition in the pericardium. It can occur following any event or intervention (e.g. MI, CABG, perc coronary intervention) that exposes the immune system to cardiac antigens and typically has a latency period of several weeks to months

Answer 460

>3 months to years 1. obliterative endarteritis and chronic mucosal ischemia ---submucosal fibrosis 2. severe bleeding +/- strictures with constipation and rectal pain. --on endoscopy you will see telangiectasias, mucosal pallor and friability

Answer 461

1. when the placenta attaches to deeply into the uterine wall (attachment of placental villi directly onto the myometrium rather than the decidua basalis - found usually in 2nd trimester U/S showing low lying placenta, myometrial thinning, and numerous placental lacunae) 2. Placenta attaches into the uterine muscle 3. Placenta goes through uterine wall and attaches to nearby organs

Answer 462

1. High beta glucuronidase in breast milk deconjugates intestinal bilirubin and increases enterohepatic circulaiton. 2. increased 3. onset is after first week of life and no signs of dehydration

Answer 463

every 2-3 hrs in the first few weeks of life (8-12 feeds a day)

Answer 464

1. Pancreatic adenocarcinoma ---tumors in pancreatic head often cause compression of the pancreatic duct and common bile duct resulting in painless obstructive jaundice with elevations in bilirubin and alk phosphatase ***tumors in pancreatic body or tail often present with progressive abd pain W/OUT jaundice 2. Abdominal CT scan - can be used for staging purposes and preop plans

Answer 465

General: failure to thrive/weight loss, short stature, delayed puberty/menarche Oral: enamel hypoplasia, atrophic glossitis Dermatologic: dermatitis herpetiformis Hematologic: iron deficiency anemia (due to malabsorption) Neuropsychiatric: peripheral neuropathy (stocking glove distribution/distal/symmetric - length dependent axonal polyneuropathy), mood disorders (eg, anxiety, depression) Musculoskeletal: arthritis, osteomalacia/rickets* (due to vitamin D malabsorption)

Answer 466

Avoidance of artificial ROM, fetal scalp electrode, operative vaginal delivery Viral load ≤50 copies/mL: ART + vaginal delivery Viral load >50 copies/mL to ≤1,000 copies/mL: ART ± zidovudine + vaginal delivery Viral load >1,000 copies/mL: ART + zidovudine + cesarean delivery

Answer 467

1. monthly 2. 3 months

Answer 468

1. Hemolysis, Elevated Liver enzymes, Low Platelets 2. LIfe threatening disorder related to preeclampsia w/severe features --etiology is likely abnormal placental development during early pregnancy - placental release of antiangiogenic factors which cause widespread maternal endothelial dysfunction and dysregulation of vascular tone (HTN) 3. Prompt delivery bc removal of placenta is only definitive cure

Answer 469

1. focal nodular hyperplasia 2. Hepatic adenoma 3. HCC 4. Liver mets

Answer 470

1. prostaglandin E1 (PGE1) 2. Indomethacin

Answer 471

1. anesthetic 2. sudden onset fever, tachycardia, tachypnea, and muscle rigidity -- tx by stopping anesthetic and giving dantrolene 3. NMS is caused by neuroleptic agents (haloperidol, promethazine)

Answer 472

early satiety and postprandial emesis

Answer 473

1. Ulcerative colitis *high risk bc placental cytokines worsen colonic inflammation. This can lead to preterm delivery and small for gestational age.

Answer 474

1. FFP (fresh frozen plasma), albumin 2. Concentrate of vit K dependent cofactors (factors 2, 7, 9, 10 and small amounts of protein C and S) - normalizes INR in patients with warfarin in <=10 min but effects are transient 3. given preoperatively to patients with mild hemophilia A. Indirectly increases factor 8 by causing vWF release from endothelial cells which supports factor 8

Answer 475

1. hydatidiform mole 2. Multifetal gestation 3. hx of this --Sx: severe, persistent vomiting >5% loss of prepregnancy weight -dehydration -orthostatic hypotension - Hypoglycemia w/ketonuria

Answer 476

1. No vaginal bleeding, closed cervical os, no fetal activity or emtpy sac 2. vaginal bleeding, closed cervical os, fetal cardiac activity 3. vaginal bleeding, dilated cervical os, products of conception may be seen or felt at or above cervical os 4. Vaginal bleeding, dilated cervical os, some products expelled and some remain in uterus 5. Vaginal bleeding, closed cervical os, products of conception completely expelled

Answer 477

1. colonic dilation >6 cm 2. loss of normal haustra pattern 3. Irregular mucosal pattern, with areas of ulceration alternating with areas of edema tx: in severe cases exploratory laparotomy and total colectomy can be done

Answer 478

1. supportive care, bowel rest, and decompression, broad spectrum Ab and tx of underlying etiology 2. IV glucocorticoids are 1st line therapy

Answer 479

1. postpartum endometritis 2. clindamycin + gentamicin (broad spectrum coverage)

Answer 480

1. At brith RBC have shorted life span and thus have high turnover 2. This leads to increased unconjugated/indirect bilirubin --> UGT (uridine diphosphogluconurate glucuronosyltransferase) activity does not reach adult levels until 2 weeks so you get build up of indirect bilirubin and inability to excrete 3. Enterohepatic recycling is increased bc low bacterial population in newborn gut results in slower conversion of bilirubin to urobilinogen for fecal excretion

Answer 481

Non-IgE mediated allergic reaction 1-4 weeks but up to 6 months *blood and/or mucus streaked stools *Can happen in breastfed and formula fed

Answer 482

1. severe trauma or recent sx, prolonged fasting or TPN, critical illness - These conditions likely cause gallbladder stasis and ischemia leading to distension, necrosis, and 2ndary bacterial infection. These conditions can cause adynamic ileus, and gaseous small and large bowel distension on imaging 2. Fever, RUQ pain, leukocytosis +/- increased LFTs 3. Abd U/S (HIDA or CT if needed) 4. Enteric Ab coverage, cholecystostomy for initial drainage, consider cholecystectomy once stable

Answer 483

1. >= 3 hrs of pushing in primigravida w/out an epidural (>= 4 w/ epidural) OR 2. >=2 hrs of pushing in multigravida w/out an epidural (>= 3 w/epidural)

Answer 484

colorectal cancer - if multiple liver lesions are seen on CT scan consider colonoscopy to rule out colorectal cancer as cause of mets

Answer 485

1. Transposition of the great vessels

Answer 486

1. oral fidaxomicin or vancomycin 2. Metronidazole is now only considered if #1 is not available and only for non-severe dx

Answer 487

1. lipid panel showing TG >1,000 2. IV fluid, pain control, insulin infusion (limits fatty acid release from adipocytes) or apheresis (removes TG rich plasma)

Answer 488

1. ischemic or toxic injury to renal tubular epithelium 2. 7-10 days after initial insult 3. BUN/Cr typically 10-15 (intrinsic renal injury) 4. muddy brown casts

Answer 489

1. fetal renal hypoplasia (bilateral, underdeveloped fetal kidneys) and oligohydramnios

Answer 490

Look at R-R interval (between peaks of QRS) and then look at QT interval. If QT is more than half of the RR interval then it is long QT - prolonged QT is >460 ms Tx: beta blockers, specifically nonselective BB like propranolol and nadolol

Answer 491

1. self limited gastroenteritis

Answer 492

- Viral Hep - drug toxicity (acetaminophen overdose, idiosyncratic) -----> toxicity results from overproduction of toxic metabolite NAPQI which leads to hepatic necrosis. NAPQI is normally safely detoxified through glucuronidation in the liver but if this pathway becomes overwhelmed this can lead to overdose. Chronic alcohol use is thought to potentiate acetaminophen hepatotoxicity. - ischemia - autoimmune hep - wilson disease - malignant infiltration

Answer 493

normal to moderately elevated (<500)

Answer 494

1. stertor (ie. snorting) 2. immediate neonatal period with cyanosis during feeds and crying alleviates respiratory distress by allowing air exchange via mouth

Answer 495

1. great vessels encircle and compress trachea 2. biphasic stridor improved with neck extesnion. Feeding difficulties from esophageal compression

Answer 496

1. CVP is the pressure in the vena cava near the right atrium. This is not inside the heart. 2. This is the volume that is in the right atrium. *If there is increased pressure in CVP then this decreased volume in the right atrium (cardiac preload)

Answer 497

1. topical anesthetics and vasodilators (e.g. nifedipine and NO)

Answer 498

False - this is not typical of athletes heart. This is seen in HOCM. --Strength training: concentric LVH (increased LV wall thickness); unchanged diastolic filling and EF --Endurance training: eccentric LHV (increased LV cavity size); increased diastolic filling and stroke volume, unchanged EF

Answer 499

1. Crohn dx --> fistulae, abscesses, strictures 2. Ulcerative colitis --> toxic megacolon

Answer 500

1. Decrease - there is increased release of peripheral vasodilators (NO, prostacyclin) and decreased sensitivity to vasoconstrictors resulting in overall decrease in BP by 5-10 mmHg from baseline. *effect is more pronounced between 12-20 weeks gestation w/return to prepregnancy BP levels in 3rd trimester

Answer 501

1. systolic pressure >=140 and/or diastolic pressure >=90 mmHg prior to conception or at <20 weeks gestation 2. New onset elevated BP at >=20 weeks getation. NO proteinuria

Answer 502

1. chronic constipation 2. colonic dysmotility

Answer 503

Patient factors: Older age (eg, age >55) Comorbidities, including obesity (BMI >30 kg/m2) Clinical findings: Altered mental status SIRS (eg, leukocytes >12,000/mm3, temperature >38 C [100.4 F]) Laboratory findings of intravascular volume depletion: ↑ BUN (>20 mg/dL) and/or ↑ creatinine (>1.8 mg/dL) ↑ HCT (>44%) Radiologic findings: CXR: pulmonary infiltrates, pleural effusions Abdominal CT scan: severe pancreatic necrosis

Answer 504

1. Polycythemia - chronic hypoxia induces increased EPO 2. Hypoglycemia - chronic nutrient deprivation = lower plasma glucose and insulin concn leading to decreased liver and muscle glycogen stores 3. Hypothermia - shunting blood to vital organs causes decrease in subcutaneous fat and increased heat loss 4. Hypocalcemia - placenta dysfunction decreases calcium transfer to fetus 5. Perinatal asphyxia and meconium aspiraiton: small infants have a difficult respiratory transition

Answer 505

1. glucocerebrosidase deficiency 2. at any age --> splenomegaly (severe), hepatomegaly --> bone marrow infiltration: anemia, thrombocytopenia, bone pain --> failure to thrive, delayed puberty

Answer 506

1. femoral head fracture 2. glucocorticoids 3. excessive alcohol use 4. sickle cell disease 5. systemic lupus erythematosus

Answer 507

1. This is when ptosis (due to paralysis of levator palpebrae superioris) and paralysis of inferior oblique, superior, inferior, and medial recti (all of which are innervated by CN III) can result in a down and out position of eye. --> Pupillary dilation occurs in non-pupil sparing form. --> this is caused by external compression. The somatic (motor) components of CN III run w/in the nerve while parasympathetic nerves run outside of the CN III Fascicle. External compression can affect both. --> dx: MR or CT angiography to evaluate for aneurysm (mass effect) 2. This is caused by microvascular ischemia and often associated with diabetes, HTN, hyperlipidemia, and advanced age. This is ischemia of the inner motor portion so it spares the pupil. --> dx: no other test, just supportive care and tx of underlying condition

Answer 508

HTN due to increased NE reuptake inhibiton at higher dose ranges - BP should be assessed before starting venlafaxine and regularly monitored

Answer 509

1. Aortic coarctation, bicuspid aortic valve --high risk of aortic dilation/dissection in pregnancy --Metabolic syndrome 2. horseshoe kidney 3. Osteoporosis due to lack of ovarian produced estrogen 4. strabismus, myopia --recurrent otitis media, hearing loss 5. Celiac disease --Hypothyroidism

Answer 510

1. alcohol - can cause peripheral vasodilation and volume depletion via diuresis that can lead to hypotension --> this is not commonly seen in benzos 2. Benzos cause slurred speech, ataxia, hyporeflexia, and sedation. Does not cause extreme CNS depression and pts solely on this are still arousable

Answer 511

active metabolites such as morphine 6 glucuronide is renally excreted --> someone with impaired kidney function should avoid this and favor instead opioids that don't go through kidney (methadone) or dont have active metabolites (fentanyl)

Answer 512

1. Renal artery stenosis --can result in chronic kidney disease. Urinalysis is typically bland. 2. Renal U/S with doppler

Answer 513

1. atherosclerotic occlusion at the bifurcation of the aorta into the common iliac arteries restricting blood flow through - External iliac artery - claudication of the hip, thigh, and distal lower extremity - Internal iliac artery - creating gluteal claudication - internal pudendal artery - restricting blood flow to the penis and causing ED 2. bilateral hip, thigh, and gluteal claudicaiton -absent or diminished femoral pulses - erectile dysfunction

Answer 514

nocturnal wrist splinting, holds the wrist in neutral position and prevents excessive flexion during sleep

Answer 515

1. Marfan - autosomal dominant -normal intellect -aortic root dilation -upward lens dislocation 2. Homocystinuria -autosomal recessive - Intellectual disability - Thrombosis - Downward lens dislocaiton - Megaloblastic anemia - Fair complexion

Answer 516

1. primary ciliary dyskinesia. Dysmotile cilia that results from aberrant production or attachment of ciliary dynein arms. Poor clearance of secretions and chronic infecitons. 2. situs inversus, recurrent sinusitis, bronchiectasis

Answer 517

1. low dose aspirin (optimally before 16 weeks) -high risk of preeclampsia include Prior preeclampsia Chronic kidney disease Chronic hypertension Diabetes mellitus Multiple gestation Autoimmune disease

Answer 518

Tx for a dx when standard therapy fails -This is different from adjuvant therapy bc adjuvant therapy is given in addition to standard therapy (afterwards)

Answer 519

1. Plantar fasciitis 2. Achilles tendinopathy 3. Calcaneal stress fracture (confirmed by x-ray or MRI) 4. Tarsal tunnel syndrome

Answer 520

1. Female, asian, age 10-40 2. constitutional, arteriocclusive (claudication, ulcers) in upper extremities, arthralgias/myalgias 3. BP discrepencies, pulse deficits, bruits 4. elevated ESR, chest x-ray (aortic dilation, widened mediastinum), CT/MR angio: wall thickening, narrowing of lumen --tx: systemic glucocorticoids

Answer 521

1. 3rd trimester 2. thrombocytopenia 3. acute right upper quadrant pain (diff from nonalcoholic fatty liver dx which is usually asymptomatic)

Answer 522

1. Bupropion can lower seizure threshold so it is contraindicated in patients with bulimia nervosa, anorexia nervosa, or epilepsy - on lab work if you see hypokalemia and hypochloremia then these are classic signs of self induced vomiting

Answer 523

1. T cell mediated injury to podocytes (cytokine induced) --leading to increased molecular permeability to albumin 2. edema, fatigue, abdominal pain 3. Urine: nephrotic-range proteinuria -serum: hypoalbuminemia +/- hyperlipidemia -kidney bx: diffuse effacement of foot processes on EM

Answer 524

V: Vertebrae (spine) A: Anorectal (anus and rectum) C: Cardiac (heart) - VSD T: Tracheal (windpipe) - tracheoesophageal fistula (TEF) w/esophageal atresia E: Esophagus (food pipe) R: Renal (kidneys and urinary tract) L: Limb (arms, hands, legs, and feet) *commonly seen with duodenal atresia (causing complete bowel obstruction and polyhydramnios)

Answer 525

1. Patients with long-standing chronic kidney disease often have hypocalcemia and hyperphosphatemia, which can lead to chronic parathyroid stimulation. Over time, this can cause parathyroid hyperplasia and autonomous parathyroid hormone (PTH) secretion. 2. hypercalcemia 2. Hyperphosphatemia 3. EXTREMELY HIGH PTH levels

Answer 526

older children >6 months and its associated with complications like obstruction, perforation, intussusception

Answer 527

1. inhibit GnRH 2. leads to low LH, FSH, testosterone, and sperm counts 1. opioids also suppress GnRH and LH secretion leading to reduced Leydig cell testosterone synthesis, decreased spermatogenesis, and testicular atrophy

Answer 528

obstructive azoospermia -sperm cannot be ejaculated due to impaired transport. Disorders primarily include abnormalities of the epididymis and vas deferens.

Answer 529

1. ampicillin-sulbactam, imipenem, meropenem 2. alternate: clindamycin

Answer 530

1. Vulvar lichen sclerosus 2. punch biopsy

Answer 531

1. NO it does not. 2. Scurvy (vit c deficiency) - occurs in setting of severe malnutrition due to alcohol use disorder, substance, psych dx. --> prominent cutaneous findings (follicular hyperkeratosis, perifollciular hemorrhage, ecchymosis, petechiae) --> gingivitis --> impaired wound healing

Answer 532

Trisomy 18 (Edward syndrome)

Answer 533

1. Ultrasound +/- mammogram 2. mammogram +/- ultrasound 3. mammogram + ultrasound if both are negative, can get MRI of breast

Answer 534

1. Nontypeable H influenzae 2. Strep pneumo 3. Moraxellla catarrhalis

Answer 535

Severe stenosis or occlusion in the left subclavian artery before/proximal to the origin of the vertebral artery occurs -when person uses their arm it takes away from the brain and reverses blood flow away from brain and into subclavian artery which leads to dizziness and CNS sx

Answer 536

Clinical manifestations: Fatigue Thrombocytopenia Probable mitral regurgitation (holosystolic murmur heard at cardiac apex) Thrombotic event - DVT or arterial thrombus or pulmonary embolism or ischemic stroke Pregnancy morbidity → fetal loss, severe preeclampsia, placental insufficiency Dx: Positive serology for 1 of 3 Anticardiolipin antibody Anti-beta2-glycoprotein-1 antibody Lupus anticoagulant Lupus anticoagulant effect: PTT prolongation not reversed on plasma mixing studies False positive RPR test is not uncommon (syphilis antigen used in RPR testing contains cardiolipin) Tx: Anticoagulation for life (heparin product or warfarin) With concomitant SLE → hydroxychloroquine is also added

Answer 537

1. Tdap, inactivated influenza, Rho(D) immunoglobulin (around 28 weeks) 2. Hep B, Hep A, pneumococcus, H influnzae, meningococcus, varicella-zoster immunoglobulin 3. HPV, MMR, Live attenuated influenza, varicella

Answer 538

1. copper IUD 2. progesterone IUD 3. Ulipristal 4. Oral levonorgestrel (plan B - high dose of progestin which inhibits LH surge, thereby delaying ovulation + cervical mucus thickening and thinning of endometrial lining) 5. Oral contraceptives

Answer 539

1. normal saline 2. D5 normal saline

Answer 540

Multiple sclerosis * 2 separate neuro deficit that cannot be explained by a single lesion * constitutional sx *worsened by heat exposure dx via MRI of brain and spine to find lesions.

Answer 541

1. De quervain tenosynovitis (fist with fingers covering thumb and then move fist down - toward ulnar side - if pain by thumb then positive test) 2. Tinel - tap on anterior wrist; phalen - bring back of hands together to collapse wrist area. Both determine carpal tunnel syndrome

Answer 542

1. fibroadenoma 2. Observe and repeat exam in adolescents - U/S in adults or patients with persistent mass

Answer 543

1. CMV - will have negative heterophile monospot test - Positive CMV IgM serology

Answer 544

Lesch-Nyhan syndrome

Answer 545

Mallory-Weiss Tear 1. sudden increase in abd pressure causes mucosal tear in esophagus or stomach (submucosal arterial or venous plexus bleeding) 2. vomiting, retching, hematemesis, epigastric pain. Most heal spontaneously. Boerhaave syndrome 1. severe retching, penetrating trauma, or complication of endoscopy causes esophageal rupture 2. Acute chest pain, subcutaneous emphysema, left sided pleural effusion. Often shortly after procedure if caused by endoscopy

Answer 546

1. Hip septic arthritis 2. Psoas abscess

Answer 547

Ludwig angina

Answer 548

1. Only should be checked in women with adnexal masses and who are postmenopausal. (in premenopausal women these benign appearing masses can be managed with reassurance) 2. if post menopausal then CA-125 is checked to risk stratify and be able to decide next steps 3. Elevated CA-125 indicates further imaging has to be done to assess extent of disease and guide management *CA-125 is released by cells from the peritoneum and mullerian structures like uterus and fallopian tubes

Answer 549

1. anticholinergics - such as trihexyphenidyl which is used for parkinson disease --anticholinergic meds cause mydriasis which can precipitate ACG

Answer 550

1. oropharyngeal dysphagia - difficulty initiating swallow, cough, choking, nasal regurgitation esophageal dysphagia-difficulty w/food passing through esophagus. Food gets "stuck" feeling 2. videofluoroscopic modified barium swallow 3. Motility disorder = dysphagia with solids and liquids at onset --mechanical obstruction - dysphagia to solids with progression to liquids 4. --> for esophageal dysphagia get barium swallow followed by manometry w/endoscopy --> for mechanical obstruction get upper GI endoscopy (+/- barium swallow before hand)

Answer 551

1. cystic teratoma 2. endometrioma 3. follicular cysts 4. serous ovarian cancers 5. theca lutein cysts

Answer 552

Pip-tazo, cefepime

Answer 553

Cavernous sinus thrombosis (CST)

Answer 554

Congenital toxoplasmosis 1. toxoplasma serology or PCR 2. Pyrimethamine, sulfadiazine, folinic acid

Answer 555

Bilirubin induced neurologic dysfunction/Kernicterus --> Unbound bilirubin crosses the BBB Other sx Acute encephalopathy ( ± Reversible (treatment: phototherapy, exchange transfusion)): Lethargy or inconsolability Hypotonia (early) or hypertonia (late) Apnea/respiratory failure, feeding difficulties, seizures Chronic encephalopathy (Irreversible) Developmental delay Sensorineural hearing loss Choreoathetoid movements Upward gaze palsy

Answer 556

MECP2 gene 1. speech regression 2. abnormal gait 3. loss of purposeful hand movements (e.g. repetitive hand wringing) - Microcephaly, seizures, breathing abnormalities, sleep disturbance, autistic features

Answer 557

Ovarian thecoma

Answer 558

Septic abortion - medical emergency that requires prompt tx with broad spectrum antibiotics and surgical evacuation of the uterus (e.g. suction curettage)

Answer 559

1. simple analgesics (e.g. NSAIDs, acetaminophen) - antiemetics (metoclopramide, prochlorperazine) - Triptans - Ergotamine, dihydroergotamien - CGRP receptor antagonists (rimegepant) 2. Antiepiileptics (e.g. topiramate, divalproex sodium) - TCAs - BB (propranolol) - CGRP monoclonal Ab (e.g. erenumab) * During pregnancy first line preventative is BB (propranolol, metoprolol), after first line then can consider CCB too (verapamil)

Answer 560

levothyroxine therapy normalizes reproductive function. *Hypothyroidism causes menstrual irregularities bc low TH causes decreased responsiveness of the pituitary to GnRH --> causing decreased FSH, LH --> no estrogen for ovulation --- >Thyrotropin releasing hormone is upregulated in hypothyroidism which stimulates TSH and prolactin production (hyperprolactinemia) from anterior pituitary

Answer 561

1. Early - meningitis - ocular: uveitis and optic neuritis - Otologic: hearing loss and tinnitus - Meningovascular: meningitis + ischemic stroke 2. Late - General paresis: progressive dementia - Tabes dorsalis: sensory ataxia and lacinating pains

Answer 562

Chronic inflammatory demyelinating polyneuropathy - tx: glucocorticoids, IV immunoglobulin, plasmapheresis

Answer 563

1. capillary pressure - which drives fluid from the capillaries into interstitium causing pulmonary edema --> increased permeability promotes decreased serum albumin levels and decreased capillary oncotic pressure --> causing third spacing --> normal diuresis is impeded due to decreased renal function

Answer 564

1. premenopausal women particularly within the first 10 days of the menstrual cycle 2. post menopausal women **all polyps in postmenopausal pts require histologic evaluation

Answer 565

1. choriocarcinoma (ie. gestational trophoblastic neoplasia) - --> vaginal mets include bloody or purulent vaginal discharge. 2. uterine sarcoma

Answer 566

1. perivenular leukocytoclastic (neutrophils and monocytes) vascultitis. Deposition of IgA, C3, and fibrin in small vessels 2. palpable purpura/petechiae on lower extremities (often butt) - arthritis/arthrlagia -abd pain/intussusception -renal disease (similar to IgA nephropathy) 3. supportive care, systemic glucocorticoids for severe symptoms

Answer 567

1. hCG and TSH have similar structure so elevated in hCG can mimic TSH and cause increase in thyroid hormones

Answer 568

1. most common MALIGNANT pediatric brain tumor 2. posterior fossa tumor - originates in cerebellum and often compresses 4th ventricle 3. Cerebellar dysfunction, Obstructive hydrocephalus which increases ICP (headache, vomiting, papilledema, abducens nerve palsy) - CN VI nerve has long intracranial course which makes it particularly vulnerable to compression 4. resection, craniospinal radiation, chemo

Answer 569

Granulosa cell tumors Malignant sex cord-stromal tumors of the ovary that secrete estradiol Large ovarian mass and postmenopausal bleeding due to unopposed estrogen Brennor tumor Epithelial ovarian tumor that is typically found incidentally in asymptomatic patients Embryonal carcinoma Type of ovarian germ cell tumor that occurs in young women Secrete alpha fetoprotein and hCG Yolk sac tumors Germ cell tumor that are more common in young women Secrete alpha fetoprotein Grow rapidly so patients have acute onset of pelvic pain

Answer 570

Acute fatty liver of pregnancy

Answer 571

Pathophysiology: GALT deficiency causes galactose accumulation after lactose or galactose ingestion Sx: Jaundice and hepatomegaly. Vomiting, poor feeding/failure to thrive, cataracts, increased risk for E. coli sepsis. Possibly seizures due to low glucose Labs: increased bilirubin, AST, ALT. Decreased glucose. + urine reducing substances.

Answer 572

risk for neonatal kernicterus

Answer 573

>5 years post transplant Chronic lymphocytic inflammation of the small airway submucosa which eventually leads to ingrowth of fibromyxoid tissue into the airway lumen. Some small airways become obstructed trapping air distally causing obstructive pattern.

Answer 574

Chiari I malformation Inferior displacement of cerebellar tonsils Syringomyelia is commonly associated with this Chiari II malformation Herniation of the cerebellar tonsils and vermis as well as inferior displacement of medulla Associated with myelomeningocele

Answer 575

Brachial plexus injury Significant pain with passive or active motion of the arm Most occur during high impact trauma Pain and muscles weakness C5-6/cervical radiculopathy nerve root radiculopathy Weakness in myotome Sensory loss in a dermatome

Answer 576

First line pharmacotherapy for alcohol use disorder - Naltrexone (long acting opioid receptor antagonist) - it can be initiated in opioid free patients w/out significant liver dx - Acamprosate is option for those using opioids - Disulfiram and gabapentin First line therapies for smoking cessation - Bupropion - Varenicline

Answer 577

If pregnant → U/S +/- MRI Not pregnant → Abdominopelvic CT scan

Answer 578

Acute stress disorder: sx must last >= 3 days and <= 1 month following trauma exposure PTSD: sx persist for >1 month

Answer 579

Greatest risk of causing seizures in 2nd generation antipsychotics Neutropenia/agranulocytosis Seizures Myocarditis

Answer 580

active untreated tuberculosis varicella infection herpetic breast lesions current chemotherapy active substance use (eg, cocaine, phencyclidine).

Answer 581

1. Caused by water exposure, trauma, foreign material, dermatologic conditions 2. Pseudomonas or staph aureus 3. Topic antibiotic (e.g. floroquinolone) +/- topical glucocorticoid

Answer 582

Viral esophagitis - common in patients with HIV (especially CD4 <100) Viruses involved include HSV (circular or ovoid vesicular and ulcerated lesions) and CMV (large, linear distal esophageal ulcers)

Answer 583

Tx includes: 1. Antidopaminergic drugs (VMAT 2 inhibitors work as dopamine depleters) 2. Alpha 2 adrenergic receptor agonists (guanfacine, clonidine - can be considered in patients with comorbid ADHD or behavioral sx)

Answer 584

1. abduction and external rotation (like rotator cuff tear) 2. - 3. impingement tests like Neer (point thumb down and move arm in flexion) and Hawkins (have forearm in front of chest w/palm facing down. Then move hand downward while stabilizing elbow) - both are positive if there is pain with these movements. Indicate impingement

Answer 585

1. rifampin 2. ceftriaxone 3. ciprofloxacin (adults only) *ppx should be given to asymptomatic close contacts regardless of vax status

Answer 586

1. strep pneumoniae - the other two are rare in vaccinated patients

Answer 587

1. Bacterial vaginosis (gardnerella vaginalis, coccobacilli) --> if asymptomatic then do not require tx. Tx is avoided bc it may resolve spontaneously and tx can lead to sx vaginal candidiasis. 2. Trichomonas vaginalis 3. Candida albicans

Answer 588

disseminated gonococcal infection

Answer 589

1. staph aureus 2. strep pyogenes

Answer 590

A. TSH and prolactin. Cause of amenorrhea can be hypothyroidism, prolactinoma. Or if levels are normal then functional hypothalamic amenorrhea. B. imperforate hymen C. Karyotype to determine if Turner syndrome (45, XO) and if not then likely primary ovarian insufficiency (common in women with FMR1 gene mutation)

Answer 591

1. parkinsonism 2. Fluctuating cognition 3. visual hallucinations 4. rapid eye movement sleep behavior disorder.

Answer 592

Clinical features of Alzheimer disease Early findings 1.Anterograde memory loss (ie, immediate recall affected, distant memories preserved) 2.Visuospatial deficits (eg, lost in own neighborhood) 3.Language difficulties (eg, difficulty finding words) 4.Cognitive impairment with progressive decline Late findings 1. Neuropsychiatric (eg, hallucinations, wandering) 2. Dyspraxia (eg, difficulty performing learned motor tasks) 3. Lack of insight regarding deficits 4. Noncognitive neurologic deficits (eg, pyramidal & extrapyramidal motor, myoclonus, seizures) 5. Urinary incontinence

Answer 593

1. antithrombotic meds 2. Bleeding within the spinal canal results in progressive motor and sensory dysfunction in the distribution of the affected nerve root. --bowel and bladder dysfunction - localized back pain and point tenderness - bleeding source is typically venous which is why sx are usually slowly progressive 3. urgent MRI of spine --surgical emergency and requires urgent decompression (e.g. laminectomy)

Answer 594

1. neurodegenerative disease. UMN and LMN are affected. Degeneration of cells in the anterior horn of the spinal cord. 2. Asymmetric weakness with upper and lower motor neuron signs. -

Answer 595

Initial management of ischemic stroke 1. If <4.5 hr give thrombolysis --> CTA of head and neck 2. If >= 4.5-24 hours not eligible for thrombolysis --> CTA of head and neck 3. If >= 24 hr not eligible for thrombolysis --> standard postischemic stroke management (e.g. antiplatelet therapy, investigate for embolic source) -->For 1-3, the ones that go on to get CTA of head and neck a. if large vessel occlusion is noted --> mechanical thrombectomy b. if large vessel occlusion is absent --> standard postischemic stroke management (e.g. antiplatelet therapy, investigate for embolic source)

Answer 596

1. thelarche (breast development) 2. around 10 but as early as 8 years old --breast buds - enlargement of areola, elevation of the papilla, and growth of a small mound of breast tissue. Firm, retroareolar mass that may be slightly tender. It is normal for breast bud to be unilateral in early stages.

Answer 597

1. fat necrosis 2. lipoma

Answer 598

Hypoxic conditions like CO poisoning

Answer 599

CHOLINERGIC toxicity 1. atropine (reverses muscarinic sx) --> pralidoxime reverses nicotinic and muscuarinic sx (administer after atropine)

Answer 600

1. Inhibition of Na/Cl cotransporter in distal convoluted tubule 2. compensatory rise in renin & aldosterone leads to K release 3. Increased Ca reabsorption in distal tubule 4. Decreased insulin secretion and increased insulin resistance 5. same as above 6. Increased uremia reabsorption in proximal tubule

Answer 601

--> clozapine

Answer 602

1. Patients can develop fever, hypotension, flank pain, hemoglobinuria, and disseminated intravascular coagulation within minutes to hours of transfusion. 2. Diagnosis is with a positive direct Coombs test.

Answer 603

1. immediately after birth, in premature babies 2. surfactant deficiency causing increases alveolar surface tension and diffuse atelectasis 3. ground glass opacities, air bronchograms, decreased lung volumes

Answer 604

1. bronchiolar obstruction and inflammation due to particulate matter (ie. meconium) 2. hyperinflated lungs and streaky, linear densities

Answer 605

- fluid in interlobar fissures - severe hypoxia requiring invasive respiratory suppor

Answer 606

1. Acute stress disorder -- exposure to life threatening traumatic event. Reexperiencing events (intrusive memories, flashbacks), avoidance, negative mood, dissociation, and hyperarousal lasting 3 days - 1 month 2. mood and behavioral symptom onset within 3 months of identifiable stressor. Marked distress and/or functional impairment.

Answer 607

1. insulin resistance 2. pregnancy 3. crohn disease

Answer 608

celiac disease

Answer 609

1. HIV infection

Answer 610

1. HIV infection 2. Parkinson disease

Answer 611

GI malignancy

Answer 612

1. inflammatory bowel disease

Answer 613

1. pathogen invasion of lymphatics in deep dermis 2. strep pyogenes & MSSA 3. tender, erythematous streaks proximal to wound, regional tender LAD, systemic sx 4. cephalexin

Answer 614

1. systemic inflammation leading to infiltration of lymphocytes and macrophages into cardiac tissue and vasculature leading complications like a. coronary artery aneurysm b. ventricular dysfunction c. pericardial effusion

Answer 615

1a. cefazolin 1b: vancomycin, clindamycin --> skin flora are typical contaminants 2a. skin flora (strep, staph, coagulase neg staph), gram neg bacilli, enterococci, endogenous flora of the viscus

Answer 616

1. Immunosuppression following solid-organ or stem cell transplantation → suppressed cytotoxic T-cell immunosurveillance → unchecked viral replication → immortalized lymphocytes or plasma cells (EBV is an oncogenic virus bc it makes proteins that lead to B cell proliferation and B cell immortalization) Epstein-Barr virus causes >95% of cases, but other human herpesviruses (eg, HHV8) can also trigger the disease 2. fever, LAD, hepatosplenomegaly, leukopenia, masses in nonlymphatic tissue 3. high viral titers, bx evidence of lymphoid or plasma cell proliferation

Answer 617

1. gram positive rods 2. gram positive rods 3. gram positive coccus that organizes into pairs and chains 4. gram positive rod 5. gram positive cocci in clusters 6. gram positive coccus that organizes into pairs and chains

Answer 618

1. lymphohematogenous 2. LN, liver, spleen, bones and marrow, and CNS 3. interferon based testing

Answer 619

1. IV fluids 2. Packed RBC transfusion to help restore circulatory volume and correct the anemia (administer cautiously, half of normal volume) 3. If recurrence rate of splenic sequestration is high then this may warrant splenectomy but this is not done in acute setting

Answer 620

1. administer activated charcoal then do #2 2. check acetaminophen level >=4 hr post ingesttion --consider empiric NAC for a. any evidence of liver injury b. >= 8 hrs since ingestion or level not avail c. >=8 hrs post ingestion *once acetaminophen level available the nplot on Rumack-Matthew nomogram and administer NAC if level is above tx line

Answer 621

Atopic keratoconjunctivitis

Answer 622

1. viral - also with viral prodrome, can have itchiness, can have mild crusting --> none 2. bacterial --> gentamicin 3. allergic --> olopatadine (mast cell stabilizer), hydrocortisone

Answer 623

1. GABA producing neurons (inhibitory) 2. Dopamine producing

Answer 624

Alport syndrome 1. genetic testing --renal biopsy: longitudinal splitting of GBM

Answer 625

IgA nephropathy Dx -Typically clinical but can be confirmed with kidney biopsy -Urinalysis: positive protein, RBCs, RBC casts Serum -Normal C3 and C4 -Increased creatinine

Answer 626

poststreptococcal glomerulonephritis *symptoms usually develop 1-3 weeks after streptococcal pharyngitis or impetigo, and the C3 level is decreased (not seen in this patient).

Answer 627

Goodpasture syndrome.

Answer 628

1. 3 ft 2. 5 ft 3. CSF rhinorrhea - manage with head CT w/out contrast

Answer 629

serum free thyroxine (FT4)

Answer 630

1. delayed wound healing 2. impaired lipid metabolism 3. insulin resistance 4. osteoporosis 5. weight gain 6. HTN 7. adrenal suppression --exerts anti-inflammatory properties by inhibiting the production and function of T lymphocytes

Answer 631

1. drug induced neutropenia other drugs that do this: TMP-SMX, antithyroid drugs (methimazole), clozapine

Answer 632

1. BB 2. RAAS inhibitor (ACEi/ARB) 3. Diuretic

Answer 633

1. shortened PR interval with delta wave (slurred upstroke of the QRS complex)

Answer 634

LR = true positive/false positive

Answer 635

ACEi - inhibit function of angiotensin II which is constricting the efferent arterioles to increase GFR and filtration pressure, especially when renal perfusion is low 1. Unilateral + ACEi: one kidney is getting underperfused so will activate RAAS system but ACEi will prevent this. This decreases GFR in singular stenosed kidney but other healthy kidney will compensate and increase its filtration. 2. Bilateral + ACEi: both kidneys are underperfused so RAAS system activates. ACEi prevents this and so both kidneys experience decreased GFR and thus acute kidney injury

Answer 636

1. JAK2 mutation 2. increased production of erythrocytes (but also eosinophils and platelets) 3. leukocytosis, thrombocytosis, increased erythrocyte mass and hematocrit (which causes hyperviscosity syndrome) 4. Pruritus, burning pain in digits w/red-blue discoloration, splenomegaly, congestion of vessels seen as plethora 5. tx with therapeutic phlebotomy

Answer 637

IV administration of 3% saline Safe rate of correction rate < 12 mEq/L in 24 hrs or < 19 mEq/L in 48 hrs --when serum Na is <120 then correction should not exceed 8 mEq/L in 24 hrs

Answer 638

1. pityriasis rosea 2. observation, resolve in 6-8 weeks without treatment *lesions are longitudinal axis and lined up with the relaxed skin tension lines on the trunk

Answer 639

1. squamous cell carcinoma --incidence is greatest between 55-85 --presents with a vulvar nodule, papule, or plaque. Rare occasions can be seen as verrucous carcinoma with a large cauliflower like growth

Answer 640

- emergent endotracheal intubation. Should be done in operating room under direct visualization with a laryngoscope

Answer 641

Hyper-IgM syndrome

Answer 642

1. Neutrophil counts of less than 100/mm3 (neutropenia is absolute neutrophil count of less than 1500/mm3) tx: withdrawal of implicated medication, tx of any underlying infection and administration of granulocyte colony stimulating factor

Answer 643

strep pneumoniae (gram positive lancet shaped coccus) --> In infants --> bulging of anterior fontanelle, petechiae may be present, leukocytosis, etc

Answer 644

1. Determine whether she has been infected through measurement of serum specific IgG and IgM concentrations

Answer 645

1. carotid artery dissection 2. CT or MR angiography 3. antiplatelet agents, alteplase, mechanical thrombectomy, and/or endovascular stenting

Answer 646

aortic insufficiency (aortic valve regurgitation) --> on left side indicates valve dx, on right indicates root disease Aortic Stenosis Mitral stenosis Mitral regurgitation Mitral valve prolapse Atrial septal defect

Answer 647

1. uncoordinated swallowing mechanism which results in muscle spasms of the cricopharyngeus 2. asymptomatic or initially dysphagia. Halitosis, regurgitation of UNDIGESTED food or pills. Appearance of neck mass 3. barium swallow

Answer 648

1. 50 2. 50 3. 200 4. 100

Answer 649

1. ends of bone 2. line indicated growth plate and in between 1 and 3 3. neck portion 4. middle of bone

Answer 650

1. ulnar 2. brachial artery, median nerve 3. radial *brachial artery bifurcates into the radial and ulnar arteries just distal to elbow joint

Answer 651

1. thoracentesis works as more of a diagnostic and small volume 2. able to get rid of large volume and can be left in place to trend and monitor ongoing bleeding

Answer 652

1. bacterial prostatitis (chronic does not show fever) 2. two glass test - urine sample is collected before and after prostatic massage to localize the infection to the prostate

Answer 653

Bacterial tracheitis

Answer 654

a temporary measure to prevent progression of kidney failure prior to definitive management of the vesicuoureteral reflux or ureteral obstruction

Answer 655

1. d-dimer is when there is low suspicion for DVT or PE 2. when there is high risk (according to wells score) that PE has occured

Answer 656

1. preload dependent 2. IV crystalloids (e.g. saline) --also get antiplatelet agents (aspirin, clopidogrel), anticoagulants (e.g. heparin), pain meds, coronary revascularization

Answer 657

Degenerative disc disease --the nutrient gradient from the cartilaginous endplates decreases with aging along wit ha declining water content of nucleus pulposus resulting in loss of disc height x-ray series of lumbar spine to evaluate degenerative changes --often tx with NSAIDs, hot or cold compress, weight loss, activity modification, PT

Answer 658

1. Staph aureus, GAS, strep pneumo, H influenzae 2. Vancomycin (effective against MRSA and MSSA)

Answer 659

1. vaccination against the SHiN organisms 2. prophylaxis with penicillin or amoxicillin daily

Answer 660

Gastric carcinoma

Answer 661

- Multiple myeloma

Answer 662

1. Efficacy - ability of tx to produce a desired effect in an ideal patient under ideal circumstances (phase 2 trials) 2. Effectiveness - ability of the tx to produce a desired effect in a general pt population and in real world settings - taking into consideration conditions/challenges of actual clinical practice (phase 3)

Answer 663

HMG-CoA is enzyme responsible for cholesterol synthesis --LOW thyroid hormone causes decrease in activity of this enzyme. The body compensates for decreased cholesterol synthesis by increasing absorption from the GI tract. -Hypothyroidism also decreases production of LDL receptors in the liver further increasing serum cholesterol concn.

Answer 664

1. bronchiectasis 2. CT scan of the chest Conditions associated: chronic bronchial obstruction, tobacco use, cystic fibrosis, primary immunodeficiency disorders, Kartagener syndrome, and allergic bronchopulmonary aspergillosis

Answer 665

high dose corticosteroid such as prednisone should occur immediately after dx to preserve vision sx: headaches, hx of preceding transient vision loss, jaw claudication, tenderness of the scalp, and pale optic disc this is autoimmune inflammatory vasculitis of medium and large vessels *tx does not compromise biopsy results needed for dx as long as bx is done within 1-2 weeks

Answer 666

ABI = SBP in ankle/SBP in brachial artery <= 0.9 : diagnostic of PAD 0.91 - 1.13: Normal > 1.3 : suggests calcified and incompressible vessels Tx: Step 1A: risk factor management → smoking cessation, BP and DM control, Antiplatelet (aspirin) and statin therapy Patients diagnosed with PAD should undergo aggressive management of cardiovascular risk factors to reduce risk of MI and stroke Step 1B: Initial treatment is supervised exercise program Step 2: Pharmacological → cilostazol Step 3: Percutaneous or surgical revascularization

Answer 667

Arteriography of extremity with contrast MR angio of extremity

Answer 668

diffuse, BILATERAL changes (lumps, cysts, dense, irregular, and bumpy consistency) --may change with hormone chnages

Answer 669

1. weeks to months after cessation of breastfeeding and is due to blockage with resulting milk accumulation 2. soft, mobile, non tender mass in the subareolar region 3. U/S and needle aspiration

Answer 670

Biliary leakage - lab studies show elevated LFTs, bilirubin, normal appearing bile ducts

Answer 671

SSRI _ CBT

Answer 672

Candida (budding yeast forms is blastoconidia) *this is on KOH prep or fungal culture of skin Dermatophytes (ex: tinea cruris)

Answer 673

ROSACEA 1. erythematotelangiectasisa: erythema and facial flushing, telangiectasias, roughness or scaling, and burning 2. Papulopustular : papules and pustules resembling acne 3. phymatous: chronic, irregular thickening of the skin, usually involving the nose 4. Ocular rosacea: involvement of the cornea, conjunctiva, and lids w/burning or foreign body sensations

Answer 674

1. elevated aminotransferases 2. hepatic encephalopathy 3. prolonged prothrombin time in pt w/out underlying liver disease

Answer 675

1. Decerebrate (contains multiple E's - for extension): lesion in brain is in red nucleus where neurons are that allow for flexion. Since these are not working then extension occurs. 2. Decorticate (includes word core-involves arm movement toward body, less severe) - lesion in cerebral cortex where neurons that inhibit red nucleus are located. When these are not working well then flexors predomiante.

Answer 676

1. above pons (2 in midbrain), pons, and in medulla 2. -- 3. Motor pathways/corticospinal tract (opposite motor weakness) -medial lemniscus (posterior column - opposite deficits) -medial longitudinal fasciculus (unable to coordinate lateral eye movements - same side of lesion look left, right stays straight) -medial CN 4. Spinocerebellar pathway (same ataxia in arm, leg) -spinothalamic (opposite pain/temp deficit) -sensory portion of CN 5 (same face sensation) -sympathetic pathway (same Horner)

Answer 677

analgesic medication with serotonergic activity

Answer 678

Preoperative physical therapy

Answer 679

Entamoeba histolytica - Liver abscess cause RUQ pain, fever tx: metronidazole + intraluminal antibiotic

Answer 680

1. Asthma 2. Bronchiectasis 3. Positive Aspergillus skin test and/or IgE (elevated serum IgE, Eosinophilia) *ABPA is a hypersensitivity to inhaled aspergillus fumigatus and typically presents in pts with underlying asthma or CF. --> can have recurrent infiltrates, fever, cough productive of brown sputum, and hemoptysis tx: oral corticosteroids for several months + itraconazole

Answer 681

1. fatigue, arthropathy, and hypogonadism (can cause ED, loss of libido) 2. dx can be confirmed by genetic analysis of HFE mutations

Answer 682

Form multidisciplinary team Define process to be studied Construct flowchart of process Analyze error risks at each step Identify potential corrective actions Implement plan

Answer 683

1. Lambert-eaton syndrome 2. small cell lung cancer 3. CT of the chest to evaluate for lung mass

Answer 684

Polymyalgia rheumatica

Answer 685

Anal cancer - dx requires bx of the lesion - may be falsely attributed to hemorrhoids if the tumor is located above the anal sphincter, hiding it from view

Answer 686

1. Anal fissures 2. chancroid (H. ducreyi) 3. Anal fistulas 4. Gonococcal proctitis 5. Lymphogranuloma venereum (caused by chlamydia trachomatis)

Answer 687

1. Strep pneumo 2. - 3. IV antibiotics, drainage of purulent material. ---Imaging is not required for dx but is indicated if meningitis, FND are suspected, if no response to tx. Imaging is CT scan of temporal bones or MRI w/contrast

Answer 688

anitphospholipid syndrome (associated w/ prolonged PTT but NOT PT

Answer 689

Cervical cancer (lower uterine segment mass can cause obstruction on ureters, blood vessels, lymphatics ) dx: cervical bx on colposcopy AIDS defining illness

Answer 690

Soft tissue calcification in the basal ganglia - which can lead to extrapyramidal manifestations (e.g. movement disorders) calcium phosphorus product (calcium level X phosphorus levels = ??)

Answer 691

1. acute onset (lack of prodrome) 2. identifiable precipitant 3. older age at onset 4. Presence of predominantly positive (as opposed to negative) psychotic symptoms 5. No family history 6. short duration of active symptoms 7. female sex

Answer 692

1. Chemotherapy induced cardiotoxicity --> cardiomyocyte replacement by fibrous tissue. Myocyte necrosis and destruction. This is type I 2. Myocardial stunning/hibernation without myocyte destruction. Loss of myocardial contractility/stunning. Type II. 3. thickening and fibrosis of the pericardium

Answer 693

Nail melanomas that first were longitudinal melanonchia

Answer 694

Dialectical behavior therapy - psychotherapy

Answer 695

1. Chalazion - Occur more commonly in patients with rosacea or eyelid margin blepharitis. 2. Hordeolum

Answer 696

Osteoclastoma (giant cell tumor of bone)

Answer 697

1. incisional hematoma - collection of blood at incision site often due to inadequate surgical hemostasis --> tx by opening incision, evacuating clot, obtaining hemostasis, and reclosing incision

Answer 698

1. congenital heart disease 2. neural tube defects 3. small left colon syndrome 4. spontaneous abortion 1. fetal hyperglycemia 2. Hyperinsulinemia

Answer 699

1. Increased metabolic demand causes hypoxia so baby can develop polycythemia 2. organomegaly 3. neonatal hypoglycemia 4. macrosomia can lead to shoulder dystocia (brachial plexopathy, clavicle fracture, perinatal asphyxia) 5. increased glycogen synthesis, glycogen deposition in interventricular septum can lead to hypertrophic cardiomyopathy

Answer 700

1. drug - most commonly allopurinol and antiepileptics (e.g. phenytoin, carbamazepine) 2. reaction (rash) - morbiliform eruption that starts on the face or upper trunk and becomes diffuse and confluent, facial edema 3. eosinophilia 4. systemic symptoms: fever, malaise, diffuse LAD *tx is stopping drug

Answer 701

Severe hyperglycemia and a hyperosmolar hyperglycemic state. Excess of osmotically active substance (e.g. glucose) in the bloodstream draws intracellular water out and dilutes extracellular fluid. - serum osmolality is elevated bc of elevated serum glucose

Answer 702

Squamous cell carcinoma - Leukoplakia or erythroplakia are precancerous plaques that progress to ulceration and deeper tissue invasion

Answer 703

1. septic arthritis 2. hematogenous spread of bacteria into joint space - will want to maintain hip externally rotated. dx and tx: blood cultures, arthrocentesis (purulent synovial fluid >50,000 leukocytes), prompt surgical drainage, IV antibiotics

Answer 704

1. Microscopic colitis stool studies should be done to exclude other common causes of diarrhea

Answer 705

1. Myelodysplastic syndrome - clonal neoplasm of hematopoietic progenitor cell that results in cytopenias and blood cell line dysplasias --CBC shows normocytic or macrocytic anemia w/insufficient reticulocytes - Leukopenia with immature neutrophil cells - thrombocytopenia

Answer 706

1. legionella pneumonia 2. sputum gram stain: PMNs, few/no organisms -- urine legionella antigen 3. respiratory fluoroquinolone or newer macrolide

Answer 707

1. pregnancy test (2 negative pregnancy tests are required before starting + monthly pregnancy testing during tx) 2. liver function test 3. lipid panel adverse effects are 1. teratogen 2. pseudomotor cerebri 3. hypertriglycerides 4. dry skin or mucous membranes 5. acne fulminans (initial worsening of acne) 6. elevated LFTs

Answer 708

1. waldenstrom macroglobulinemia 2. rare B cell malignancy characterized by excessive production of IgM. 3. dx with serum protein electrophoresis (M-spike) and bone marrow biopsy 4. tx: plasma exchange

Answer 709

1. IgG, IgA, light chains - also has rouleaux formation and >10% clonal plasma cells

Answer 710

Massive PE can lead to a sudden occlusion of >50% of the pulmonary arterial circulation, causing a rapid increase in pulmonary vascular resistance and right ventricular (RV) pressure load. This can result in acute RV dysfunction and sudden loss of cardiac output. ---Depending on the degree of compensation for these cardiovascular changes, patients can present with sudden cardiac death, syncope, or presyncope. ---Acute PE can also cause syncope due to cardiac arrhythmia induced by RV strain and ischemia, or due to a vasovagal response to PE.

Answer 711

1. acute post infectious cerebellar ataxia which often follows viral illness -1-3 weeks after infection and generally resolves spontaneously - ataxia, symmetric involvement of the extremities, staggering gait, intention tremor, and nystagmus. - Sensation and deep tendon reflexes are preserved

Answer 712

1. trichloroacetic acid -warts tend to increase in size and number during pregnancy due to physiologic, pregnancy associated immunosuppresion - Other first line tx include imiquimoid, pdophyllotoxin but this IS NOT FOR PREGNANT PTS bc of teratogenicity ---> excisional bx is typically avoided due to increased anesthetic and surgical risks in pregnant pts but can be done in nonpregnant **c section does not reduce risk of vertical transmission of HPV so it is only done if there is large condylomata blocking introitus

Answer 713

azithromycin and ceftriaxone amoxicillin or doxycylcine