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1
Q

What condition presents with hematuria, flank pain, abdominal mass that moves with inspiration?

A

Renal cell carcinoma

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2
Q

What general symtpoms can you have with renal cell carcinoma?

A

weight loss, fever, erythrocytosis

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3
Q

how do you diagnose a renal cell carcinoma?

A

CT scan

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4
Q

What condition is seen in female athletes and gives you symptoms of anterior knee pain, aching sensation, worsened by squatting or climbing stairs?

A

patellofemoral pain syndrome

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5
Q

What is the treatment for patellofemoral pain syndrome?

A

exercises to strengthen your thigh muscles

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6
Q

What people will you primarily see primary CNS lymphoma?

A

People with HIV

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7
Q

What virus is related to primary CNS lymphoma?

A

EBV virus

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8
Q

How do you treat bacterial conjunctivitis?

A

Macrolide (erythromycin)

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9
Q

How do you treat bacterial conjunctivitis in patient who wear contact lenses?

A

Fluoroquinolone

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10
Q

What complication can you see with bacterial conjunctivitis?

A

keratitis

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11
Q

What population do you usually see lumbar spinal stenosis and what symptoms?

A

Elderly population. Symptoms of lumbar pain on extension of the spine. Pain is better with sitting or bending forward

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12
Q

How would you diagnose lumbar spinal stenosis?

A

MRI

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13
Q

How do you diagnose a achilles tendon rupture?

A

MRI or calf squeeze test with absent plantar flexion on calf squeeze

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14
Q

What are the risk factors for osteoporosis?

A
  1. Caucasian female
  2. smoking
  3. family history
  4. prior steroid use
  5. postmenopausal
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15
Q

What is the best sign of a diagnosis of sarcoidosis?

A

bilar hilar lymph node enlargement

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16
Q

What disease is associated with erythema nodosum?

A

sarcoidosis

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17
Q

What does this T score mean? -1 and above

A

Normal

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18
Q

What does this T score mean? -2.5 or lower

A

osteoporosis

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19
Q

What does this T score mean? -1 to -2.5

A

osteopenia

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20
Q

If a confidence interval contains the null value 1, what does that mean?

A

Not statistically significant

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21
Q

When would you see lead time bias?

A

screening test where the screening test picked up the disease earlier than another test and made it appear like the patient survived longer

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22
Q

When would you see length time bias?

A

Rapidly progressive diseases less likely detected by screening test

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23
Q

What is saw palmetto used to treat?

A

BPH

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24
Q

What is the side effect of saw palmetto?

A

Bleeding

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25
Q

What is the definition of brain death?

A

The irreversible absence of brainstem and cerebral function

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26
Q

What is the treatment for PCP? (pneumocystis)

A

Steroids and TMP-SMX

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27
Q

What is the calculation of positive likelihood ratio?

A

sensitivity/ 1- specificity

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28
Q

What is the calculation of negative likelihood ratio?

A

1- sensitivity/ specificity

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29
Q

If you have typical symtpoms of GERD what is the next step?

A

Acid suppression

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30
Q

If you have GERD symptoms with history of NSAID use what is the next step?

A

discontinue NSAID or add acid suppression

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31
Q

If you have GERD symptoms with no evidence of GERD or NSAID use and no alarm symptoms and age less than 55 what is the next step?

A

PPI

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32
Q

f you have GERD symptoms with no evidence of GERD or NSAID use and no alarm symptoms and age older than 55 what is the next step?

A

H. pylori testing

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33
Q

What are the symptoms of polymyositis?

A

Proximal muscle weakness, difficulty climbing stairs, getting out of a car, combing hair, joint pain or sweliing

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34
Q

What labs are elevated in polymyositis?

A

elevated CK, CRP and transaminases

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35
Q

How do you confirm the diagnosis of polymyositis?

A

muscle biopsy

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36
Q

What disorder is seen in middle aged women with chronic widespread pain, tenderness at trigger points, with normal labs

A

Fibromyalgia

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37
Q

What disorder is seen in patients over 50 yrs with stiffness and pain in shoulders and hip girdles with elevated ESR, CRP?

A

Polymyalgia rheumatica

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38
Q

What is the treatment for polymyalgia rheumatica?

A

steroids

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39
Q

What disorder is associated with polymyalgia rheumatica?

A

Giant cell arteritis

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40
Q

What disease is seen in patient with a h/o asthma and cystic fibrosis and imaging shows recurrent fleeting infiltrates and bronchiectasis?

A

Allergic bronchopulmonary aspergillosis

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41
Q

How do you diagnosis allergic bronchopulmonary aspergillosis?

A

Eosinophilia and positive skin test

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42
Q

What is the treatment for allergic bronchopulmonary aspergillosis?

A

steroids first then itraconazole

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43
Q

What is the treatment for tourrette syndrome?

A

antipsychotics or alpha 2 agonists

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44
Q

What treats tourrettes tics?

A

risperidone

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45
Q

What is the diagnostic test for hirschsprung disease?

A

rectal suction biopsy

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46
Q

What syndrome is hirschsprung disease associated with?

A

down syndrome

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47
Q

What are the symptoms of hirschsprung disease?

A

Infant who has not passed meconium in the first 48rs, poor feeding, bilious vomiting, abdominal distension, expulsion of stool on rectal exam

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48
Q

What eye condition presents with pain, visual loss, constricted/irregular pupil and leukocytes seen in the anterior eye on slit lamp exam?

A

Anterior uveitis (Iritis)

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49
Q

What eye condition presents with severe photophobia and difficulty keeping the affected eye open?

A

Infectious keratitis

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50
Q

How do you treat kawasaki disease?

A

hydration and pain control

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51
Q

What is the treatment of paget disease?

A

bisphosphonates or calcitonin

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52
Q

What drugs affect lithium metabolism?

A
  1. Theophylline
  2. Potassium sparring diuretics
  3. Loop diuretics
  4. Calcium channel blockers
  5. Thiazide diuretics
  6. NSAIDS
  7. ACE inhibitors
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53
Q

What disorder causes painless blisters, increased fragility of the skin, facial hypertrichosis and hyperpigmentation?

A

Porphyria cutanea tarda

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54
Q

How do you diagnose porphyria cutanea tarda?

A

urinary uroporphyrins

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55
Q

What disease is porphyria cutanea tarda associated with?

A

Chronic hepatitis C

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56
Q

What is the treatment for porphria cutanea tarda?

A

phlebotomy or hydroxychloroquine

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57
Q

What is the treatment for scabies?

A

permethin

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58
Q

What disease causes RUQ pain, fever, and liver abscess?

A

Entamoeba histolytica

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59
Q

What is the treatment for entamoeba histolytica?

A

metronidazole

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60
Q

When do you do flexible endoscopy for coin ingestion?

A

If it has been greater than 24hrs, unknown ingestion time, or symptomatic

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61
Q

When does an abdominal aortic aneurysm need repair?

A

Symptomatic( Abdominal or back pain
size greater than 5.5 cm
grown more than 0.5cm over a 6month period

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62
Q

What is the initial evaluation for pulmonary hypertension?

A

Echocardiogram

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63
Q

What is the treatment for pulmonary hypertension?

A

Endothelin antagonist

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64
Q

What are some medications that can cause digoxin toxicity?

A
  1. verapmail
  2. quinidine
  3. Amiodarone
  4. Spironolactone
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65
Q

What examination findings are consistent with severe aortic stenosis?

A
  1. Single second heart sound
  2. Delayed and diminished carotid pulse
  3. Loud and late peaking systolic murmur
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66
Q

What are the complications of bicuspid aortic valve?

A
  1. Infective endocarditis
  2. severe regurgitation or stenosis
  3. Aortic root or ascending aortic dilation
  4. Dissection
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67
Q

What are some characteristics of ehlers danlos syndrome?

A

easy bruising, poor healing, velvety skin, MVP, abdominal or ingunial hernias, uterine prolapse, scoliosis, joint hypermobility, pectus excavatum

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68
Q

What are some characteristics of marfan syndrome?

A

Tall long and thin, MVP, pectus excavatum, joint hypermobility, scoliosis, lens detachment, spontaneous pnuemothorax, progressive aortic root dilation

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69
Q

What is the treatment for A.fib?

A

beta blockers, diltiazem, digoxin

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70
Q

What is the treatment for TCA overdose?

A

sodium bicarbonate infusions

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71
Q

What is the treatment for torsades de pointes?

A

Magnesium sulfate

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72
Q

What are the main risk factors for coronary artery disease?

A
  1. Atheresclerotic disease
  2. diabetes
  3. Chronic kidney disease
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73
Q

How do you manage PMS?

A
  1. SSRI

2. Oral contraceptive

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74
Q

What does PMS increase your risk for?

A

Depression

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75
Q

What is the management for aspiration pneumonia?

A

clindamycin

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76
Q

What renal condition gives you muddy brown casts?

A

Acute tubular necrosis

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77
Q

What are the side effects of amiodarone?

A

Photosensitivity, pulmonary toxicity, skin discoloration, bone marrow suppression, thyroid dysfunction, abnormal liver function

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78
Q

What are the absolute contraindications for combined hormonal contraceptions?

A

Migraine w/ aura, smoking + 35y/o, high blood pressure, diabetes, breast cancer, heart disease, h/o stroke, cirrohsis and liver cancer, surgery w/ prolonged immobilization

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79
Q

What things increase ovarian cancer risk?

A

early menarche, late age of menopause, genetic mutations

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80
Q

What things decrease your risk for ovarian cancer?

A

OCPs, breastfeeding, and multiparity

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81
Q

What is the treatment for acute dystonia?

A

diphenhydramine or benztropine

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82
Q

What are the characteristics of neurofibromatosis?

A
  1. Cafe-au-lait spots
  2. Neurofibromas
  3. Optic pathway gliomas
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83
Q

What is the most important risk factor of osteoporosis?

A

age

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84
Q

When should a IVC filter be placed?

A

If you have contraindication to anticoagulation, complications with anticoagulation or failure of anticoagulation

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85
Q

What is the management for acute asthma exacerbation?

A
  1. supplemental oxygen
  2. inhaled bronchodilator/ipatropium
  3. oral steroids
  4. Magnesium sulfate/terbutaline
  5. intubate
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86
Q

What is the most important predictor of survival/prognosis for patients with COPD?

A

FEV1 and age

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87
Q

What is the test of choice for diagnosing pneumothorax in acute settings?

A

bedside ultrasound

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88
Q

What is the treatment for oral candidiasis?

A

topical antifungal like nystatin suspension or clotrimazole troches

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89
Q

What lab is important to monitor in a patient who is receiving TPN?

A

phosphate levels (hypophospatemia)

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90
Q

If you have a patient who has COPD who is having a acute brinchitis exacerbation what is the management?

A

antibiotics

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91
Q

What is the treatment for a PE?

A

supplemental oxygen, heparin, warfarin

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92
Q

What signs should make you think of a PE?

A

sudden onset of SOB, tachycardia, hypoxia, in the setting of immobilization

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93
Q

How do you manage RSV?

A

supportive care

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94
Q

What is the complication of RSV?

A

recurrent wheezing

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95
Q

How are benign lung lesions described?

A
  1. homogenous
  2. central
  3. popcorn calcification
  4. concentric
  5. Laminated
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96
Q

How are malignant lung lesions described?

A
  1. eccentric
  2. peripheral
  3. spiculated
  4. irregular border
  5. ground glass appearance
  6. reticular, punctate
  7. size > 0.8cm
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97
Q

What are the false positive rates for lung cancer screening?

A

94-95%

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98
Q

What is the leading cause of death in parkinson disease?

A

aspiration pneumonia

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99
Q

Patient presents with SOB on exertion, fatigue, JVD, peripheral edema, and a right ventricular heave. What diagnosis are you thinking of?

A

pulmonary hypertension

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100
Q

What is the initial diagnostic test for pulmonary hypertension?

A

echocardiogram

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101
Q

How do you confirm pulmonary hypertension?

A

right heart catheterization

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102
Q

What is the strongest correlation with obstructive sleep apnea?

A

neck circumference

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103
Q

How do you diagnose obstructive sleep apnea?

A

polysomnography

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104
Q

How long can you delay repair of umbilical hernias in infants?

A

until age 5

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105
Q

Patient presents with dry gritty eyes, what is the diagnosis?

A

keratoconjunctivitis (dry eyes)

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106
Q

How do you treat keratoconjunctivitis?

A

artificial tears, methylcellulose eye drops

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107
Q

How do femoral hernias run?

A

inferior to the inguinal ligament and lie medial to the femoral nerve, artery and vein

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108
Q

How do you treat guillian barre syndrome?

A

IV immunoglobin or plasmapheresis

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109
Q

Describe symptoms of rheumatoid athritis?

A

pain and stiffness thats worse in the morning and improves throughout the day. symmetric joint involvement. commonly involve wrists and knees

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110
Q

How would you treat rheumatoid athritis?

A

acute: NSAIDS or steroids
chronic: methotrexate

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111
Q

What is sick sinus syndrome?

A

alternating episodes of tachycardia and bradycardia

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112
Q

How do you treat sick sinus syndrome?

A

pacemaker placement

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113
Q

What causes sick sinus syndrome?

A

SA node dysfunction

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114
Q

What are the main symptoms of parkinson disease?

A

resting tremor
bradykinesia
rigidity

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115
Q

If you see muddy brown casts what should you think of?

A

Acute tubular necrosis

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116
Q

If you see waxy casts what should you think of?

A

nephrotic syndrome

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117
Q

How do you reverse heparin?

A

protamine sulfate

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118
Q

How do you reverse warfarin?

A

vitamin K and FFP

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119
Q

How do you treat intussusception?

A

air or saline contrast enema

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120
Q

Patient presents with a bag of worm appearance in the scrotal area and a mass that increases with standing/valsalva and decreases with sitting. What is the diagnosis?

A

Varicocele

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121
Q

How do you diagnose a scrotal varicocele?

A

ultrasound

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122
Q

What are the complications of a scrotal varicocele?

A

testicular atrophy and subfertility

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123
Q

infant presents with noisey breathing and face turns blue during feeding. What is the diagnosis?

A

choanal atresia

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124
Q

How do you diagnosis choanal atresia?

A

nasogastric catheter or CT scan

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125
Q

How do you treat lead intoxication?

A

DMSA

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126
Q

At what level would you start to treat lead intoxication?

A

moderate levels (45-69)

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127
Q

Patient presents with pain in her hands that worsens with activity and is better with rest. What is the diagnosis?

A

osteoarthritis

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128
Q

What is the greatest risk factor for developing pancreatic cancer?

A

cigarette smoking

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129
Q

What is the treatment for acetaminophen overdose?

A

N-acetylcysteine

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130
Q

What is the treatment for prolactinoma?

A

dopamine agonist like cabergoline or bromocriptine

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131
Q

What is the most common cause of inherited thrombophilia?

A

Factor V leidin

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132
Q

What is the treatment for QRS prolongation?

A

sodium bicarbonate

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133
Q

How do you prophylactically treat migraine headaches?

A

beta blockers, TCA, anticonvulsants

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134
Q

Patient has symptoms of ulcerative colitis with an elevated alk phos what condition are you thinking of?

A

primary sclerosing cholangitis

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135
Q

How do you diagnose primary sclerosing cholangitis?

A

endoscopic cholangiogram

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136
Q

Patient presents with an acute respiratory infection, flank pain and gross hematuria. Whats the diagnosis?

A

IgA nephropathy

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137
Q

Patient presents with streptococcal throat/skin infection 10 days ago and onset of renal disease. RBC casts are seen with decreased complement levels. what is the diagnosis?

A

Acute post-streptococcal glomerulonephritis

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138
Q

Patient presents with dysuria, post void dribbling, dyspareunia, and anterior vaginal mass. What is the diagnosis?

A

urethral diverticulum

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139
Q

How do you treat polycystic kidney disease?

A

strict control of blood pressure with ACE inhibitors

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140
Q

How do you screen for polycystic kidney disorder?

A

with counseling and renal ultrasound

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141
Q

How do you treat acute cystitis in pregnancy?

A
  1. Nitrofurantoin
  2. amoxicillin
  3. cephalexin
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142
Q

What are the circumstances toddlers should undergo renal ultrasound for UTI?

A

If the child in under 2yrs of age with febrile UTI/recurrent UTIs

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143
Q

What is mixed cryoglobulinemia syndrome associated with?

A

chronic hepatitis C

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144
Q

What are the immune complexes associated with lupus nephritis?

A
  1. anti double stranded DNA

2. Complement

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145
Q

Patient presents with fever, chills, myalgia that eventually evolve into hypotension and shock with a fast decline. What diagnosis are you thinking of?

A

Toxic shock syndrome

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146
Q

What is the treatment for cocaine induced hypertension?

A

benzos and nitroglycerin

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147
Q

If you have a patient with cocaine intoxication with persistent chest pain, what is the management?

A

CCB

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148
Q

If you have a patient with cocaine intoxication with persistent HTN, what is the management?

A

phentolamine

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149
Q

When does breast cancer screening begin?

A

Age 40-50

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150
Q

Patient has painless blisters, increased fragility of the skin and facial hypertrichosis and hyperpigmentation. What is the diagnosis?

A

porphyria cutanea tarda

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151
Q

How do you diagnose porphyria cutanea tarda?

A

urinary uroporphyrins

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152
Q

What disease is porphria cutanea tarda associated with?

A

hepatitis C

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153
Q

What is the treatment for scabies?

A

permethrin and ivermectin

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154
Q

Patient presents woth RUQ pain, fever and liver abscess. What is the diagnosis?

A

Entamoeba histolytica

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155
Q

What is the treatment for entamoeba histolytica?

A

metronidazole

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156
Q

If a patient ingests a coin when would you do flexible endoscopy?

A

greater than 24hrs of ingestion/unknown time of ingestion/symptomatic

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157
Q

When do you need to repair an abdominal aortic aneurysm?

A

size greater than 5.5cm, symptomatic, grown more than 0.5cm over a 6 month period

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158
Q

Women has a palpable breast mass and is under the age of 30 what do you do?

A

Ultrasound

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159
Q

Women has a palpable breast mass and is over the age of 30 what do you do?

A

Mammogram

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160
Q

What is the problem in a patient who has stress incontinence?

A

urethral hypermobility or decreased urethral tone

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161
Q

What is the problem in a patient who has urge incontinence?

A

destrusor hyperactivity

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162
Q

What is the problem in a patient who has overflow incontinence?

A

impaired detrusor contractility or bladder outlet obstruction

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163
Q

What is the treatment for kawasaki disease?

A

aspirin or IVIG

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164
Q

What are the complications for kawasaki disease?

A

coronary artery aneurysms, MI

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165
Q

What are the antibodies for lupus?

A

anti-double stranded DNA and Anti-smith antibodies

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166
Q

What condition is anti-mitochondrial antibodies found in?

A

primary biliary cirrhosis

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167
Q

What condition is antiperoxidase antibodies found in?

A

hashimotos thyroiditis

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168
Q

What condition is anti-centromere antibodies found in?

A

scleroderma

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169
Q

Patient has an upper GI bleed and is hemodynamically unstable what is the workup?

A

EGD–>angiography–>colonoscopy–>capsule endoscopy

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170
Q

Patient has a lower GI bleed what is the workup?

A

colonoscopy–>EGD–>capsule endoscopy

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171
Q

what is a common complication of compartment syndrome?

A

acute renal failure

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172
Q

How do you diagnose compartment syndrome?

A

tissue pressures

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173
Q

What tissue pressure is diagnostic of compartment syndrome?

A

> 30mmHg

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174
Q

What is the most important factor in predicting complete functional recovery?

A

time to intervention

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175
Q

What is the treatment for compartment syndrome?

A

fasciotomy

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176
Q

What are the signs of cyanide toxicity?

A

flushing of the skin, cyanosis, HA, altered mental status, seizures, arrhythmias, abdominal pain, N/V

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177
Q

What is the treatment for cyanide toxicity?

A

sodium thiosulfate

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178
Q

What are the most common cardiac tumors?

A

atrial myoma

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179
Q

What is the most common complication of atrial myoma?

A

release of emboli into the systemic circulation

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180
Q

What is the most common cause of sudden death in steering wheel injuries?

A

Aortic injury

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181
Q

What are the symptoms of vasovagal syncope?

A

pallor, diaphoresis, nausea before or after event

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182
Q

What causes vasovagal syncope?

A

prolonged standing, stress, emotion or pain

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183
Q

What are common causes of secondary hypertension?

A

renal parenchymal disease in children and young adults and hyperaldosteronism and atherosclerotic renal artery stenosis in middle aged and older adults

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184
Q

What is the treatment for acute pericarditis?

A

NSIDS and colchicine

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185
Q

What is the management for peri-infarction pericarditis?

A

high dose aspirin

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186
Q

A patient is having a COPD exacerbation with tachycardia and EKG is obtained and shows p waves with 3 different morphologies. What is the diagnosis?

A

Multifocal atrial tachycardia

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187
Q

How do you diagnose multifocal atrial tachycardia?

A

EKG

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188
Q

What is a common cause of MAT?

A

electrolyte disturbances (hypokalemia, hypomagnesium)

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189
Q

How do you treat MAT?

A

treat the underlying illness

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190
Q

What are patients with down syndrome at increased risk of developing later in life?

A

acute leukemia

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191
Q

Infant presents with bilateral hydronephrosis, dilated and thickened bladder and oligohydramnios. What is the diagnosis?

A

posterior urethral valves

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192
Q

How do you diagnose posterior urethral valves?

A

voiding cystourethrogram

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193
Q

How do you treat posterior urethral valves?

A

place foley catheter to relieve obstruction and then cystoscopy for ablation

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194
Q

How do you definitively diagnose aspiration pneumonia in parkinson disease?

A

videofluoroscopic swallowing study

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195
Q

When would you need to taper a steroid?

A

If you have used it longer than 3 weeks

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196
Q

What is the treatment for SIADH?

A

water restriction

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197
Q

What is the treatment for hypocalcemia?

A

calcium gluconate

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198
Q

What is the treatment for hyperkalemia?

A

calcium gluconate

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199
Q

What are the symptoms of hypocalcemia?

A

paresthesia, muscle spasms/cramps, hyperreflexia, seizures, chvistek and trousseau sign

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200
Q

How do you manage a patient with infectious mononucleosis with impending airway obstruction?

A

steroids

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201
Q

If a patient has been vaccinated with rabies vaccine and gets a second bite, how do you manage?

A

booster rabies vaccine

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202
Q

What pathogen is found in human bites?

A

Eikenella corrodens

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203
Q

How do you treat human bites?

A

amoxicillin-clavulanate

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204
Q

What medicine do you use to prophylax against meningococcal meningitis?

A

rifampin

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205
Q

How is Giardiasis contracted?

A

contaminated food or water

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206
Q

What are the symptoms of giardiasis infection?

A

loose, foul smelling fatty stools with abdominal cramps weight loss and vitamin deficiencies

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207
Q

How do you treat giardiasis infection?

A

metronidazole

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208
Q

What is the first line treatment for cat scratch disease?

A

azithromycin

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209
Q

How is congenital toxoplasmosis contracted?

A

raw or undercook meat, unwasged fruits/vegetables or cat feces

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210
Q

What are the clinical features of a patient with congenital toxoplasmosis?

A

macrocephaly, diffuse microcalcifications, chorioretinitis, hearing impairment

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211
Q

What is the treatment for congenital toxoplasmosis?

A

pyrimethamine and sulfadiazine

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212
Q

What are the clinical features of congenital rubella infection?

A

hearing impairment congenital heart defects, eye abnormalities

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213
Q

How does disseminated gonococcal infection present?

A

systemic symptoms(fever malaise), tenosynivitis, dermatitis

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214
Q

What are the centor criteria for strep?

A
  1. Fever
  2. tonsillar exudates
  3. anterior cervical lymphadenopathy
  4. absence of a cough
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215
Q

How do you treat HIV associated thrombocytopenia?

A

antiretroviral medication

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216
Q

How do you screen for osteomyelitis?

A

probe to bone testing then MRI

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217
Q

What is chagas disease?

A

Protozoan infection contracted in mexico or south america that causes dilated cardiomyopathy and ventricular apical aneurysms

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218
Q

Patient has HIV with CD4 count <85 with lesions on the face, trunk, neck and upper thigh with central umbilication of small papules with central necrosis and covered with hemorrhagic crust. What is the diagnosis?

A

cutaneous cryptococcosis

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219
Q

What organism causes infection from tropical fish tank?

A

vibrio vilnificus

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220
Q

Which infection is seen in gardeners and landscapers that presents with skin papule with ulceration and proximal lesions along lymphatic chain

A

sporotrichosis

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221
Q

What diseases have low glucose in cerebrospinal fluid?

A

tuberculosis and viral

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222
Q

Patient presents with a rash consisting of small elevated erythematous area that progressed into a bigger rash that was itchy and painful and did not respond to steroid cream. The rash then started clearing from the center. What is the most likely diagnosis?

A

glucagonoma

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223
Q

What do you typically see in a patient with glucagonoma?

A

rare pancreatic tumor with associated diabetes and classic skin rash (necrolytic migratory erythema)

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224
Q

What is the initial diagnostic test for active TB?

A

acid fast bacilli sputum culture

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225
Q

can you use acid fast bacilli sputum test for confirmatory diagnosis of active TB?

A

No

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226
Q

If the sputum acid fast bacilli results are negative was is a confirmatory test?

A

mycobacterium culture or nucleic acid amplification

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227
Q

What is the standard caloric intake for enteral feedings for a patient with normal nutrition?

A

30kcal/kg/day and 1g/kg/day of protein

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228
Q

If you had a malnourished patient who needed enteral feedings what would you recommend for caloric intake?

A

15kcal/kg/day and 1g/kg/day of protein

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229
Q

What tendon is likely to be ruptured in a patient who is pivoting or landing?

A

patellar tendon

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230
Q

What are the symptoms of a patellar tendon rupture?

A

difficulty weight bearing, popping sentation, pain and swelling

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231
Q

Patient presents who cannot actively extend the knee or raise the knee against gravity. What have they injured?

A

patellar tendon tear

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232
Q

Patient presents with difficulty passing stool, bilious vomiting, abdominal distension, and a ground glass mass with the right side of the abdomen. What is the diagnosis?

A

meconium ileus

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233
Q

What condition is meconium ileus pathognomonic for?

A

cystic fibrosis

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234
Q

Patient presents with small rough erythematous keratotic papules and a history of heavy sunlight exposure. What is the diagnosis?

A

actinic keratosis

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235
Q

What is the treatment of actinic keratosis?

A

5-fluorouracil cream

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236
Q

What is the gold standard for the diagnosis of cystic fibrosis?

A

sweat chloride test

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237
Q

What is the treatment for narrow complex tachycardia?

A

adenosine or vagal maneuvers

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238
Q

For patient using statins and get rhabdomyolysis. When should they restart statins?

A

When the CK levels normalize

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239
Q

What are the 3 medications used for meningitis prophylaxsis?

A

rifampin, ceftriaxone, ciprofloxacin

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240
Q

Which prophylactic medication for meningitis can not be used in patients taking oral contraceptives?

A

rifampin

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241
Q

Patients who have immune thrombocytopenia and risk of bleeding, what is the management?

A

IVIG

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242
Q

What is the most common side effect of valproic acid?

A

thrombocytopenia

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243
Q

What does the kappa statistic measure?

A

reliability

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244
Q

If you have a patient with syphillis who has neurological symptoms(headache, blurry vision) what should be your next step?

A

Lumbar puncture with cerebrospinal fluid analysis

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245
Q

When would you give Benzathine pencillin G single dose for syphillis treatment?

A

primary, secondary or early latent syphillis

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246
Q

When would you give Benzathine penicillin G for 3 weeks for syphillis treatment?

A

late latent, unknown duration, or Gumma/CV syphillis

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247
Q

When would you give aqueous peniciilin for syphillis treatment?

A

neurosyphillis or congenital syphillis

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248
Q

What are the symptoms of primary syphillis?

A

chancre

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249
Q

What are the symptoms of secondary syphillis?

A

diffuse rash, condyloma lata

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250
Q

What are the symptoms of tertiary syphillis?

A

neurosyphillis or aortitis

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251
Q

What is jarisch herxheimer reaction?

A

seen in spirochete infection after treatment you get a acute febrile reaction. No treatment for this, self resolves

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252
Q

What are the features of hashimoto thyroiditis?

A

symptoms of hypothyroidisim, diffuse goiter

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253
Q

What does diagnostic testing show in hashimoto thyroiditis?

A

positive TPO antibodies and variable iodine uptake

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254
Q

What are the clinical features of painless thyroiditis?

A

mild brief hypothyroid phase, small nontender goiter, spontaneous recovery

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255
Q

What does the diagnostic testing show in painless thyroiditis?

A

positive TPO antibody and low iodine uptake

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256
Q

What are the clinical features of subacute thyroditis?

A

prominent fever and hyperthyroid symptoms, tender goiter

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257
Q

What does the diagnostic testing show in subacute thyroiditis?

A

elevated ESR and CRP with low iodine uptake

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258
Q

What is the treatment for subacute thyroiditis?

A

NSAIDS and beta blockers

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259
Q

What is st john wort used for?

A

antidepressant, antiinflammatory conditions, wound healing

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260
Q

What is the biggest side effect of st john wort?

A

drug interactions with drugs like OCPs, anticoagulants, antiretrovirals, immunosuppresants

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261
Q

What is the treatment for acute herpes zoster?

A

oral antivirals for 7 days if present <72hrs from onset of symptoms

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262
Q

What is the treatment for postherpetic neuralgia?

A

gabapentin

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263
Q

What is the treatment for infant botulism?

A

botulism immune globin

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264
Q

What is the pathogenesis of infant botulism?

A

toxin inhibits presynaptic acetylcholine release

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265
Q

What effects does amiodarone have one thyroid function?

A

It causes the inhibition of conversion of T4 to T3 causes increased T4 and decreased T3 with normal to borderline elevated TSH

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266
Q

Is the effects amiodarone has on thyroid longterm? how do you manage?

A

No its short term normally 3 months. Just repeat levels in few weeks

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267
Q

How are patients with acute hepatitis managed?

A

Normally with supportive care and outpatient follow-up

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268
Q

When should a patient with acute hepatitis B be hospitalized?

A

hemodynamically unstable, coagulation issues, high fevers, fulminate liver failure

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269
Q

What is the likelihood of progression to chronic hepatitis B in adults?

A

<5%

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270
Q

What is the likelihood of progression to chronic hepatitis B in infants?

A

> 90%

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271
Q

What is the likelihood of progression to chronic hepatitis B in kids age 1-5 y/o?

A

20-50%

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272
Q

What is the main reason for hypercalcemia in patients with sarcodosis?

A

overproduction of calcitriol

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273
Q

Power of a study is related to what type of error?

A

type 2 error

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274
Q

How do you treat H. pylori?

A

PPI, amoxicillin and clarithromycin

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275
Q

What is the treatment for lyme disease?

A

amoxicillin or doxycyclline

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276
Q

How do you treat gout in a patient with renal failure or recent renal transplant?

A

steroids

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277
Q

What is catatonia?

A

unresponsiveness, immobility, cataplexy where examiner is able to position your limbs in any position without resistance

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278
Q

What patients is catatonia seen in?

A

schizophrenia

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279
Q

What is the treatment for catatonia?

A

benzos

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280
Q

What is the empirical treatment for meningitis in infant population?

A

cefoxitin plus ampicillin

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281
Q

What is the empirical treatment for meningitis in children and adults?

A

ceftriaxone and vancomycin

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282
Q

What is the empirical treatment for meningitis in adults or alcoholics?

A

ceftriaxone, ampicillin and vancomycin

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283
Q

On blood culture you isolate gram negative bacilli what is the directed treatment?

A

ceftriaxone

284
Q

On blood culture you isolate gram positive cocci in clusters what is the directed treatment?

A

nafacillin

285
Q

On blood culture in a patient suspected of meningitis you isolate pseudomonas what is the directed treatment?

A

ceftazidime

286
Q

On blood culture in a patient suspected of meningitis you isolate H. influenza what is the directed treatment?

A

ceftriaxone

287
Q

What should a patient with a history of chemotherapy and new onset fever make you think of?

A

secondary infection from immunocompromised state

288
Q

What bug is commonly the culprit in febrile neutropenia?

A

Psuedomonas

289
Q

What are the most common pathogens for community acquired pneumonia?

A

strep pneumonia and H. influenza

290
Q

What is the treatment for community acquired pneumonia?

A

either fluoroquinolone or cephalosporin + macrolide

291
Q

How do you treat acute active tuberculosis?

A

2 months of 4 medications( INH, Rifampin, pyrazinamide, ethambutol and 4 months of 2 medications( INH and Rifampin).

292
Q

What is the side effect of ethambutol?

A

optic neuritis

293
Q

What is the side of effect of rifampin?

A

orange discoloration of fluids

294
Q

What is the side effect of pyrazinamide?

A

hyperuricemia

295
Q

What are the IV antibiotics of choice for acute bacterial prostatitis?

A

IV Ampicillin and gentamicin

296
Q

What are the oral antibiotics of choice for acute bacterial prostatitis?

A

ciprofloxacin or bactrim

297
Q

How do you differentiate a transudative pleural effusion from an exudative pleural effusion?

A 
Light criteria
1. Protein in PF/protein in Serum>0.5
2. LDH PF/LDH serum >0.6
3. LDH is 2/3 upper limits
if 1 of criteria met then you have a exudative pleural effusion
298
Q

What conditions causes a exudative pleural effusion?

A

Malignancy, infection, PE, GI disease, Rheumatoid disease

299
Q

What conditions causes a transudative pleural effusion?

A

nephrotic syndrome, cirrhosis, congestive heart failure, peritoneal dialysis

300
Q

What are the initial orders for a patient with sickle cell?

A

Pulse ox, CBC with diff, BMP, blood cultures, urinalysis with culture, EKG, chest x-ray, supplemental oxygen, type and screen, IV access

301
Q

What is the management for a patient with sickle cell disease?

A

IV D5 1/4 NSS, IV cuferoxime and azithromycin, nebulized albuterol, incentive spirometry, vitals Q4hrs, IV morphine, blood transfusion if oxygen levels do not improve

302
Q

What are vasopressors?

A

dopamine and phenylephrine

303
Q

What are the treatments for hyperkalemia?

A

Calcium gluconate, sodium bicarbonate, kayexalate, insulin and dextrose

304
Q

What is the diagnostic test for ulcerative colitis?

A

ESR, sigmoidoscopy or colonoscopy and rectal biopsy

305
Q

What is the management for ulcerative colitis?

A

5-ASA compounds, mesalamine, antidiarrheals and antispasmodics

306
Q

What is the diagnostic test for Irritable bowel syndrome?

A

CBC, BMP, ESR, FOBT, TSH, stool for ova/parasites/white cells/culture and 72 hr stool fat

307
Q

What is the management for IBS?

A

diet changes, lactose free diet, reasurrence antidiarrheal, antispasmodics, behavioral treatment, biofeedback

308
Q

What is the diagnostic workup for depression?

A

CBC, TSH, BMP, electrolytes, vitamin b12

309
Q

What is the management for depression?

A

SSRI, patient education, regular exercise, medication compliance

310
Q

A vaginal pH of >4.5 indicates what?

A

bacterial vaginosis or trichomonas

311
Q

A vaginal pH of < 4.5 indicates what?

A

yeast infection

312
Q

What are the diagnostic tests for vaginal yeast infection?

A

vaginal pH, wet mount, Gonorrhea culture, chlamydia culture, urinalysis, pap smear

313
Q

What is the treatment for alzheimers?

A

Donepezil, vitamin E, antipsychotic

314
Q

Patient with COPD exacerbation. What do you want to do right away?

A

pulse ox, cardiac monitor, oxygen, IV access, elevated head of bed

315
Q

Once patient is stable in a COPD exacerbation, what are your next steps?

A

cbc, bmp, ekg, PEFR, chest x-ray , ABG

316
Q

What is the therapy for COPD exacerbation?

A

inhaled bronchodilators, steroids, antibiotics, influenza vaccine, pneumococcal vaccine

317
Q

What are the emergency orders for a patient with hypertensive emergency?

A

IV access, oxygen, pulse ox, cardiac monitor, BP monitor

318
Q

After you get your emergency orders what is the next step in a patient with hypertensive emergency?

A

focused physical exam

319
Q

After your focused physical exam what orders do you want in a patient with hypertensive emergency?

A

CT scan, EKG, CBC, BMP, chest x-ray, UA, lipid profile

320
Q

When should you order IV hypertensive medication in a patient with hypertensive emergency?

A

after head CT scan to rule out stroke

321
Q

What is the first line treatment for hypertensive emergency?

A

nitroprusside

322
Q

What is the treatment for PID?

A

Cefoxitin plus doxycycline or gent clinda or ampicillin+sulbactam and doxycycline

323
Q

hemophilia A has a deficiency in what factor?

A

8

324
Q

hemophilia B has a deficiency in what factor?

A

9

325
Q

What should patient with hemophilia avoid?

A

aspirin and contact sports

326
Q

What are the stat orders for a patient presenting with chest pain?

A

IV access, oxygen, pulse ox, ekg, troponins, ckmb,, BP monitoring, cardiac monitoring, aspirin, nitroglycerin

327
Q

A barking cough is pathopneumonic for what disease?

A

viral croup

328
Q

What is the management for croup?

A

humidified oxygen, nebulized epinephrine, dexamethasone

329
Q

What is the steeple sign pathopneumonic for?

A

viral croup

330
Q

WHat is the treatment for viral pericarditis?

A

NSAIDs colchicine

331
Q

What is the treatment for post MI pericarditis?

A

high dose aspirin

332
Q

What is the treatment for cellulitis?

A

clindamycin, bactrim, doxycycline

333
Q

If you think a patient needs surgery what orders should you automatically put in?

A

pain medicine, antibiotics, antiemetics, fluids, NPO, the surgery, consult service

334
Q

What is the therapy for turners syndrome?

A

OCPs, growth hormone, calcium, vitamin D, psychiatry consult, ophthalmology consult, dietary

335
Q

What is the workup for turner syndrome?

A

karotype, cbc, bmp, fsh, lh, tsh, peliv US, renal US, lipid profile, fasting glucose

336
Q

What is post-exposure ppx treatment based on?

A

Exposure type and body fluids involved

337
Q

What kind of exposure type and body fluids increases your risk for HIV infection?

A

percutaneous needle sticks or mucous membrane exposure. Body fluids blood, semen, vaginal secretions. Possible risk fluids is CSF, synovial fluid, pleural fluid, pericardial fluid and amniotic fluid

338
Q

What vaccines do adults with HIV require?

A

Hepatitis B, HPV, Infulenza, Meningococcus, pneumococcus (PCV13, PCV23), TDAP

339
Q

When are live vaccines contraindicated in patient with HIV?

A

CD4 count <200

340
Q

What are the common diagnostic test for tuberculosis?

A
  1. Tuberculin skin test (only diagnosis latent)
  2. Interferon gamma ( only diagnosis latent)
  3. smear microscopy
  4. Sputum culture (Gold standard)
  5. Nucleic acid amplification
341
Q

What are signs of active TB infection?

A

upper lobe lung cavitation, hilar lymphadenopathy or pleural effusion

342
Q

What is the gold standard for microbial confirmation for TB?

A

mycobacterial culture along with nucleic acid amplification testing

343
Q

What is normal CSF findings?

A
  1. WBCs: 0-5
  2. Glucose: 40-70
  3. Protein: <40
344
Q

What is the CSF findings for bacterial infection?

A
  1. WBCs: >1000
  2. Glucose: <40
  3. Protein: >250
345
Q

What is the CSF findings for tuberculosis?

A
  1. WBCs: 5-1000
  2. Glucose: <10
  3. Protein: >250
346
Q

What is the CSF findings for viral infection?

A
  1. WBC: 100-1000
  2. Glucose: 40-70
  3. Protein: <100
347
Q

What is the CSF findings for guillian barre?

A
  1. WBCs: 0-5
  2. Glucose: 40-70
  3. Protein: 45-1000
348
Q

What is potts disease?

A

Active tuberculosis of the lungs and spine

349
Q

What is the follow-up for a health care worker who is exposed to a patient with TB?

A

Should receive screening test with tuberculin skin test or interferon gamma assay. If negative repeat in 8-10 weeks

350
Q

What should happen if there is a needle stick injury in a healthcare worker and the patient refuses testing or test results are unknown or test results are pending?

A

Treat with PEP ppx

351
Q

What happens with a serum sickness reaction?

A

antibiotics immune complex formation. symptoms include fever, skin rash, polyarthralgia

352
Q

What is the treatment for serum sickness reaction

A

supportive care

353
Q

What is a subphrenic abscess?

A

Seen in a patient with h/o abdominal surgery with a swinging fever, cough, shoulder tip pain and leukocytosis

354
Q

What is the diagnostic test for subphrenic abscess?

A

abdominal ultrasound

355
Q

What kind of patient would you see cutaneous cryptococcosis?

A

untreated HIV patient with CD$ count < 100

356
Q

What is the characteristic symptom of cutaneous cryptococcosis?

A

widespread skin papules with umbilication and central hemorrhage/necrosis that resemble molluscm

357
Q

How do you diagnosis cryptococcosis?

A

biopsy of the lesion

358
Q

What is the treatment for cutaneous cryptococcosis?

A

Amphotericn B and flucytosine for 2 wks then flucanazole for 1 year

359
Q

If a patient with cutaneous cryptococcosis develops signs of ICP what is the management?

A

serial lumbar punctures

360
Q

What is the diagnostic steps to a patient with osteomyelitis?

A
  1. Probe to bone testing
  2. Plain film x-ray
  3. MRI
361
Q

What is the most common culprit in patient with osteomyelitis?

A

Staph aureus, gram positive cocci

362
Q

What is the gold standard for guiding treatment in a patient with osteomyelitis?

A

bone biopsy with culture

363
Q

What is the most common side effect of isoniazid?

A

hepatotoxicity that is asymptomatic

364
Q

What is the side effect of pyrazinamide?

A

hyperuricemia

365
Q

What is the side effect of ethambutol?

A

ocular toxicity

366
Q

What are the symptoms of herangina?

A

Vesicles and ulcers on the posterior oropharynx with fever

367
Q

What virus causes herpangina?

A

coxsackie virus

368
Q

What are the symptoms of apthous stomatitis?

A

leads to recurrent ulcers on anterior oral mucosa with no fever or systemic symptoms

369
Q

What are the symptoms of Herpes gingivostomatitis?

A

Leada to visicles and ulcers on the anterior oral mucosa and around mouth with fever

370
Q

What are the symptoms for group A strep pharyngitis?

A

Tonsillar exudates, fever, anterior cervical lymphadenopathy and absence of cough

371
Q

What are the symptoms of infectious mono?

A

Tonsillar exudates, fever, diffuse cervical lymphadenopathy, +/- hepatosplenomegaly

372
Q

What are the signs of pulmonary aspergillosis?

A

cough, pleuritic chest pain, hemoptysis

373
Q

What are the risk factors for pulmonary aspergillosis?

A

Stem cell or organ transplant, prolonged neutropenia, chronic steroid use, immunocompromised

374
Q

What imaging test would you use to diagnose?

A

CT scan

375
Q

What are the imaging finding you would see with pulmonary aspergillosis?

A

nodules with ground glass opacitites (halo sign) with air fluid levels

376
Q

What is the treatment for aspergillosis?

A

Voriconazole

377
Q

What is erysipelas?

A

Infection that causes a facial rash that is red, elevated and painful

378
Q

What organism causes erysipelas?

A

Group A strep

379
Q

Who should get influenza vaccine?

A

Recommended for all ages > 6months

380
Q

What are the risk factors for congenital toxoplasmosis?

A

Exposure to raw or uncooked meats, unwashed fruits/vegetables, cat feces

381
Q

What are the clinical features of congenital toxoplasmosis?

A

macrocephaly, diffuse intracranial calcifications, jaundice and growth restriction

382
Q

How do you diagnosis congenital toxoplasmosis?

A

serology

383
Q

What is the treatment for congenital toxoplasmosis?

A

pyrimethamine, sulfadiazine, folate

384
Q

What is the most common cause of pneumonia in patients with HIV?

A

Strep pneumonia

385
Q

What is the treatment for lyme disease?

A

doxycycline

386
Q

How long does the tick need to be attached in order to transmit disease?

A

> 36hrs

387
Q

What are the symptoms of congenital rubella?

A

eye abnormalities, hearing abnormalities, heart abnormalities

388
Q

What is the pathopneumonic symptom for diptheria?

A

grey patches/pseudomembrane that bleeds with scraping

389
Q

What complication can develop for diptheria?

A

Myocarditis

390
Q

What is the treatment for diptheria?

A

erythromycin or penicillin G

391
Q

What are the symptoms of disseminated gonococcal infection?

A

Dermatitis, tenosynovitis, polyarthralgia

392
Q

If you have a patient with disseminated gonococcal infection what test should be run?

A

Chlamydia, gonorrhea, HIV

393
Q

What disease gives you a positive tourniquet test where you get petechia after sphygmomanometer?

A

dengue fever

394
Q

What is the complication you can see with dengue fever?

A

circulatory failure or shock

395
Q

What is the treatment for dengue fever?

A

Supportive care

396
Q

What organism causes infection if you cut your hand and place it in a fish tank?

A

Vibrio vulnificus

397
Q

What is the most common cause of pneumonia in preschool age children?

A

strep pneumonia

398
Q

What is the most common cause of pneumonia in patient with bilateral lung findings?

A

mycoplasma pnuemonia

399
Q

How do you treat pneumonia causes by mycobacteria?

A

azithromycin

400
Q

How do you treat pneumonia caused by strep pneumonia?

A

amoxicillin

401
Q

How do you diagnosis C.diff?

A

> 3 loose stools in a 24hr period plus a positive stool toxin

402
Q

How do you treat C. diff?

A

oral metronidazole for 14 days

403
Q

What population of people are at increased risk of C.diff?

A

People on gastric acid suppression, recent antibiotic exposure, recent hospitalization, advanced age

404
Q

What are the common causes of acute otitis media?

A
  1. Strep pneumonia
  2. Non typeable H. Influenza
  3. Moraxella catarrhalis
405
Q

What is the treatment for acute otitis media?

A

High dose amoxicillin

406
Q

If a patient get multiple ear infection within a month how would you treat the second infection?

A

Amoxicillin-clauvalenic acid

407
Q

What organism causes infection with concurrent otitis media and purulent conjunctivitis?

A

Nontypeable H. Flu

408
Q

What is the treatment for lactational mastitis?

A

dicloxacillin or cephalexin

409
Q

What organism most commonly causes lactational mastitis?

A

Staph aureus

410
Q

What is the mechanism of toxic shock syndrome?

A

widespread activation of T cells by exotoxins

411
Q

What organism causes toxic shock syndrome?

A

staph aureus

412
Q

What are the clinical symptoms of toxic shock syndrome?

A

hypotension, shock, GI, neuro, and muscular symptoms

413
Q

What is the treatment for toxic shock syndrome?

A

IV fluids and antibiotics

414
Q

Patient has white lesion on the oral mucosa that are removed with scraping and causes underlying hyperemia and bleeding. what is the diagnosis?

A

oral candidiasis seen in HIV

415
Q

Patient presents with a minor cut on the leg that leads to pain and swelling and erythema. Eventually the pain is out of proportion to injury. What is the diagnosis?

A

Necrotizing fasciitis

416
Q

What is the treatment for necrotizing fascitis?

A

surgical debridement and antibiotics

417
Q

What organism causes necrotizing fasciitis in healthy patients?

A

Group A strep

418
Q

What is the treatment for active TB?

A

INH, rifampin, ethambutol for 2 months followed by INH and rifampin for 7 months

419
Q

Women who are undergoing treatment for active TB, what should they be supplemented with?

A

pyridoxine

420
Q

Why are women being treated for active TB supplemented with pyridoxine?

A

Prevent neurotoxicitiy

421
Q

What drugs can you use for UTI treatment in pregnancy?

A
  1. Nitrofurantoin
  2. cephalexin
  3. amoxicillin- clauvanate
  4. fosfomycin
422
Q

What is the first line therapy for latent TB treatment?

A

INH for 9 months

423
Q

What is the alternative therapy for latent TB?

A

Rifampin for 4-6months

424
Q

What are the recommended vaccines for people age >65?

A
  1. Annual flu vaccine
  2. Td vaccine every 10 years
  3. PCV13 followed by PCV23 on 6-12 months
425
Q

Patient who have had BCG vaccine and is concerning for TB what screening test should they undergo?

A

Interferon gamma release assay

426
Q

What patient with syphillis gets benzathine penicillin G single shot for treatment?

A

Primary secondary and early latent syphillis

427
Q

What patient with syphillis gets benzathine penicillin G IM weekly for 3 weeks for treatment?

A

late latent, unknown or gummatous/CV syphillis

428
Q

What is the treatment for neurosyphillis?

A

Aqueous penicillin G IV q 4hrs for 10-14 days

429
Q

What is the treatment for congenital syphillis?

A

Aqueous penicillin G

430
Q

What are the symptoms of primary syphillis?

A

Chancre

431
Q

What are the symptoms of secondary syphillis?

A

diffuse rash, condylomata lata

432
Q

What are the symptoms of tertiary syphillis

A

neurosyphillis, aortitis

433
Q

What is the Jarisch Herxheimer reaction?

A

When a patient gets treated for syphillis infection and develops fever and generalized achiness due to release of spirochetes

434
Q

Is there anything to prevent Jarisch Herheimer reaction?

A

No

435
Q

How can you treat Jarisch Herxheimer reaction?

A

There is no treatment but could give tylenol for fever

436
Q

What 3 things should you avoid in a patient with HIV during labor?

A
  1. AROM
  2. Fetal scalp electrode placement
  3. Operative vaginal delivery
437
Q

What viral load needs to be present for patient with HIV to have vaginal delivery?

A

<1000 plus being on ART

438
Q

What viral load is present for a patient to have to have c-section with HIV?

A

viral load > 1000

439
Q

What is the management for the infant Post partum?

A

If vaginal delivery then zidovudine

If c-section them ART

440
Q

What are the contraindications to breast feeding?

A
  1. Active untreated TB infection
  2. HIV
  3. Active Varicella infection
  4. Galactosemia
  5. substance abuse
  6. Chemotherapy or radiation
  7. Herpetic breast lesion
441
Q

What medications can you take for chemoprophylaxsis for meningitis?

A
  1. Rifampin
  2. Ciprofloxacin
  3. Ceftriaxone
442
Q

When can you not use rifampin to ppx against meningitis exposure?

A

In a women taking oral contraception

443
Q

What syndrome commonly develops in patient with HIV who are receiving treatment?

A

dyslipidemia and insulin resistance

444
Q

If a patient had tuberculosis meningitis what treatment could reduce morbiditity and mortality?

A

steroids for 8 weeks

445
Q

When a patient develops a rash with mono after receiving amoxillin what is the treatment?

A

To observe and stop antibiotics

446
Q

What is the treatment for mono?

A

NSAIDs

447
Q

What patients are candidates for oseltamivir who has the flu?

A

Patient who present with symptoms less than 48hrs, require hospitalization, severe or progressive illness, underlying medical conditions

448
Q

What is the ppx treatment for PCP?

A

TMP-SMX

449
Q

What is the most common bug found in human bites?

A

Eikenella corrodens

450
Q

What is the treatment for a human bite?

A

Amoxicillin-Clavulanate

451
Q

What is the prognosis for patients treated with lyme disease?

A

favorable and most patients completely recover

452
Q

What is the treatment for cat scratch disease?

A

azithromycin

453
Q

What are the principle pathogens that cause disease in patient with cystic fibrosis?

A

Staph aureus and pseudomonas

454
Q

What bug is more likely in a patient with cystic fibrosis and older in age?

A

psuedomonas

455
Q

What drugs can you use to treat a pseudomonas infection?

A

cefipime, ceftazidime, pipercillin-tazobactam, meropenam, aztreonam, amikacin

456
Q

What is a complication of C.diff?

A

toxic megacolon

457
Q

What is the treatment for severe C. diff?

A

vancomycin

458
Q

What are the signs of severe C. diff

A

WBC count > 20,000
Cr > 1.5x baseline
lactate > 2.2

459
Q

Patient presents with rapid jerking movements of the face and feet, tongue fasciculation, facial grimacing, pronator sign positive and petallar reflex is delayed, what diagnosis are you thinking of?

A

Sydenham chorea

460
Q

What disease is sydenham chorea commonly seen in?

A

Acute rheumatic fever

461
Q

What are the major criteria in acute rheumatic fever?

A

JONES

  1. Joints (migratory arthritis)
  2. heart (carditis)
  3. Nodules (subcutaneous)
  4. Erythema marginatum
  5. sydenham chorea
462
Q

What is the treatment for acute rheumatic fever?

A

Penicillin

463
Q

How long should a patient with acute rheumatic fever be treated?

A

Until adulthood

464
Q

What is the treatment for strep pharyngitis?

A

Penicilin or amoxicillin for 10 days

465
Q

What can happen if you dont treat a strep throat infection?

A

Can develop acute rheumatic fever

466
Q

When is a person with active TB considered noninfectious?

A

After 3 consecutive acid fast bacilli smear negative results

467
Q

When is a person with latent TB considered noninfectious?

A

People with latent TB are never infectious

468
Q

What is the treatment for latent TB?

A

isoniazide for 6-9 months or rifampin for 4 months

469
Q

What people with latent TB should receive treatment?

A

HCP, inmates, immunosupressive patients

470
Q

What bug causes epiglottis?

A

H. influenza

471
Q

What are the symptoms of epiglottis?

A

Dysphagia, drooling, high fever, tripod position (leaning forward with neck extended

472
Q

What would you see on x-ray in a patient with epiglottis?

A

Thumb print sign

473
Q

What is the management for epiglottis?

A

endotracheal intubation and antibiotics

474
Q

Patient has loose fatty foul smelling stools, weight loss, and stool culture positive for multiple cyst, what is the diagnosis?

A

Giardiasis

475
Q

What is the treatment for Giardiasis?

A

metroniadozole

476
Q

What is the treatment for CAP in the outpatient setting?

A

macrolide or doxycycline (healthy)

fluoroquinolone or macrolide + beta lactam (comorbidities)

477
Q

What is the treatment for CAP in the inpatient non ICU setting?

A

fluoroquinolone or macrolide + beta lactam

478
Q

What is the treatment for CAP in the inpatient ICU setting?

A

fluoroquinolone + beta lactam

479
Q

Should live vaccines be delayed in children who live with pregnant women?

A

No

480
Q

What is the treatment for BV?

A

Metronidazole or clindamycin

481
Q

What is the gold standard of treatment for a skin abscess?

A

incision and drainage

482
Q

When would you give antibiotics to a person with a skin abscess?

A

If there are systemic symptoms, evidence of cellulitis, abscess greater than 2cm

483
Q

What is the most common bug in a patient with an skin abscess?

A

Staph aureus

484
Q

What is the most common bug in a patient with skin cellulitis?

A

Strep pyogenes

485
Q

What are the rules for tetanus ppx in patient with bite wounds?

A
  1. If you have a clean wound with a person who has been immunized in the last 10 yrs nothing has to be done
  2. If you have a dirty/severe wound in a person who has been immunized in the last 5yrs you do nothing
  3. If you have a clean wound with an unimmunized person then you give the vaccine
  4. If you have a dirty wound in a person who has not been immunized you give vaccine and immunoglobin
486
Q

What is centor criteria?

A

Used in cases of pharyngitis to determine likelihood of bacterial involvement. Scores of 3 or more indicated need for rapid strep test and treatment. Criteria include absence of cough, tonsillar exudates, fever, anterior cervical lymphadenopathy

487
Q

What patients do you typically see rhinocerebral mucormycosis in?

A

Patients with DKA

488
Q

What is the treatment for rhinocerebral mucormycosis?

A

Surgical debridement and amphotercin B

489
Q

Neonates with a sepsis picture, what antibiotics should be given during the workup?

A

Amp/gent or cefotaxime

490
Q

In a new patient being treated for HIV where should their viral load be after 1 month of treatment?

A

<5,000

491
Q

In a new patient being treated for HIV where should their viral load be after 2-4 months of treatment?

A

<500

492
Q

In a new patient being treated for HIV where should their viral load be after 4-6 months of treatment?

A

<50

493
Q

What is the most common complication of cat scratch disease?

A

suppuration of lymph nodes

494
Q

What is the treatment for chronic bacterial prostatitis?

A

6 weeks of ciprofloxacin or TMX-SMX

495
Q

Patient who immigrated from africa presents with terminal hematuria, dysuria, peripheral eosinophilia and increased frequency, what is the diagnosis?

A

Helminth infection

496
Q

How doe you diagnose a helminth infection?

A

urine sediment

497
Q

What is the treatment for a helminth infection

A

albendazole

498
Q

Do patients who have undergone treatment for latent tuberculosis need to have repeat testing or treatment?

A

No

499
Q

When would you need rabies vaccine and immunoglobin?

A

If you get bit by an animal with rabies and have never been vaccinated

500
Q

If you were previously vaccinated for rabies and got bit by an animal with rabies what is the management?

A

2 doses of rabies vaccine

501
Q

What lab do you follow to see there is improvement in a patient with osteomyeleitis?

A

ESR

502
Q

What is otitis externa commonly associated with?

A

Swimming

503
Q

What is the best initial test for malignant otitis externa?

A

CT or MRI

504
Q

What is the most accurate test for malignant otitis externa?

A

biopsy

505
Q

What is the treatment for malignant otitis externa?

A

surgical debridement and antibiotics against pseudomonas

506
Q

What the mechanism of otitis media?

A

Swelling of the eustachian tube

507
Q

What group of bugs cause sinusitis if its bacterial?

A

Strep pneumo, H. influenza, moraxella catarrhalis

508
Q

What is the best initial test for sinusitis?

A

x-ray

509
Q

What is the most accurate test for sinusitis?

A

sinus aspirate for culture

510
Q

What is the diagnostic test for influenza?

A

viral rapid antigen test of nasopharyngeal swab

511
Q

Is the influenza vaccine a live virus or inactivated virus?

A

There are two kinds. The injectable form is inactivated and indicated for patient with medical conditions and over 50yrs of age. The inhaled form is live and can only be given to people who are healthy and under 50yrs

512
Q

Patient has a skin infection that causes weeping, crusting and oozing of the skin, what is the likely diagnosis?

A

Impetigo

513
Q

What bugs cause impetigo?

A

Strep pyogenes or staph aureus

514
Q

What is the treatment for simple impetigo?

A

Topical mupirocin

515
Q

What is the treatment for severe impetigo?

A

oral dicloxacillin or cephalexin

516
Q

Patient presents with a very bright red and hot appearing facial rash, what is the diagnosis?

A

Erysipelas

517
Q

What is the best initial test for fungal infections of the skin and nails?

A

KOH preparation

518
Q

What is the treatment for impetigo?

A

Topical antibiotic like mupirocin

519
Q

What is the treatment for tinea vesicolor?

A

Topical antifungals

520
Q

What is actinic keratosis?

A

premalignant condition caused by excessive sunlight

521
Q

What does actinic keratosis increase your risk of?

A

squamous cell carcinoma

522
Q

How does porphyria cutanea tarda arise?

A

deficiency of the uroporphyrinogen decarboxylase enzyme involved in the heme synthesis pathway

523
Q

What is the treatment for porphyria cutanea tarda?

A

phlebotomy or hydroxychlorquine

524
Q

What is seborrheic dermatitis?

A

erythematous pruritic plaques with greasy scales (Flaky and itchy scalp)

525
Q

What is the treatment for seborrheic dermatitis?

A

topical antifungal (selenium shampoo, ketaconazole)

526
Q

What is the longterm prognosis of seborrheic dermatitis?

A

Its a chronic relapsing condition where weekly retreatment could be needed to prevent recurrence

527
Q

What is rosacea?

A

Characterized by redness in the central face with flushing telangiectasias and pustules

528
Q

What is the treatment for rosacea?

A

topical metronidazole

529
Q

What is the most frequent complication from rosacea?

A

Ocular abnormalities, recurrent chalazion

530
Q

What is seborrheic keratosis?

A

Benign epidermal tumor due to proliferation of immature keratinocytes that cause round pigments well demarcated lesion with stuck on appearance

531
Q

What is the treatment for herpes zoster?

A

valacyclovir

532
Q

What is postherpetic neuralgia?

A

Persistent pain in patient with herpes zoster after 4 months

533
Q

What is the treatment for postherpetic neuralgia?

A

gabapentin or TCA

534
Q

What is the treatment for wrinkles?

A

tretinoin

535
Q

What is alopecia areata?

A

discrete, smooth and circular areas of hair loss over the scalp

536
Q

What other conditions are alopecia areata associated with?

A

Vitiligo, thyroid disease, pernicious anemia

537
Q

What is the treatment for alopecia areata?

A

intralesional steroids

538
Q

What are some ways to prevent sun damage?

A

sun protective behaviors, sunscreens and adequate hydration

539
Q

What is the treatment for plantar warts?

A

Salicyclic acid

540
Q

What causes plantar warts?

A

HPV

541
Q

What is the management for melasma?

A

avoiding sun exposure and broad spectrum sunscreen

542
Q

Seborrheic dermatitis is seen commonly in what kind of patients?

A

HIV and parkinson disease

543
Q

What is the prognosis of chronic uticaria?

A

Self resolves in 2-5 years

544
Q

What is the first line therapy for psoriasis?

A

topical steroids

545
Q

What are the surgical options for squamous cell skin cancer?

A
  1. Surgical excision
  2. cryotherapy
  3. radiation therapy
  4. electrosurgery
546
Q

What is the best initial test for PID?

A

Pregnancy test, gonorrhea and chlamydia

547
Q

What is the most accurate test for PID?

A

laparoscopy

548
Q

What is the outpatient treatment for PID?

A

Ceftriaxone and doxycycline

549
Q

What is the inpatient treatment for PID?

A

cefoxitin and doxycycline

550
Q

What is the alternative treatment for PID if patient is allergic to PCN?

A

Gentamicin and clindamycin

551
Q

What disease presents with a painful and tender testicle that sits an a normal position in the scrotum?

A

epididymo- orchitis

552
Q

What is the treatment for epididymo-orchitis?

A

ceftriaxone and doxycycline

553
Q

What is the most accurate test in primary syphillis?

A

Dark field microscopy

554
Q

Whats the diagnosis for a rare beefy red genital lesion that ulcerates?

A

granuloma inguinale

555
Q

What is the treatment for uncomplicated cystitis?

A

TMP-SMX for 3 days

556
Q

What is the treatment for complicated cystitis?

A

TMP-SMX for 7 days

557
Q

What is the treatment for outpatient pyelonephritis?

A

Ciproflaxacin

558
Q

You have a patient with diagnosed pyelonephritis that is on treatment but is not getting better, what diagnosis should you be considering?

A

perinephric abscess

559
Q

What is the best initial test for prostatitis?

A

urinalysis

560
Q

What is the most accurate test for prostatitis?

A

Urine WBCs after Prostate massage

561
Q

What is the treatment for prostatitis?

A

TMP-SMX or ciprofloxacin for 2-6 weeks

562
Q

Patient has fever with new heart murmur or change in murmur, what diagnosis are you thinking of?

A

Endocarditis

563
Q

Roth spots, janeway lesion, osler noder and splinter hemorrhages are seen in what disease?

A

Endocarditis

564
Q

What is the best initial test in a patient with endocarditis?

A

blood cultures

565
Q

What is the 2nd best test in a patient with endocarditis?

A

echo

566
Q

What is the treatment for endocarditis?

A

Vancomycin and gentamicin

567
Q

What is the treatment for endocarditis ppx?

A

Amoxicillin

568
Q

What are the side effects of the protease inhibitors used in HIV treatment?

A

Hyperlipidemia and hyperglycemia

569
Q

What is the treatment of CMV in HIV?

A

ganciclovir

570
Q

CMV is seen with what CD4 level?

A

<50

571
Q

cryptococcus is seen with what CD4 level?

A

<50

572
Q

Whats the initial test for cryptococcus diagnosis?

A

India ink stain

573
Q

Whats the most accurate test for cryptococcus?

A

cryptococcal antigen test

574
Q

CD4 count < 50 with blurry vision what are you thinking of?

A

CMV

575
Q

CD4 count <50 with fever and headache what are you thinking of?

A

cryptococcus

576
Q

CD4 count < 50 with focal neurological abnormalities, what are you thinking of?

A

Progressive multifocal leukoencephalopathy

577
Q

Patient is a rabbit hunter and presents with an ulcer on his hand, lymphadenopathy and conjunctivitis. What is the diagnosis

A

tularemia

578
Q

How do you diagnose tularemia?

A

Serology

579
Q

What is the treatment for tularemia?

A

streptomycin or gentamicin

580
Q

Patient has eaten some pork chops and CT scan shows thin walled cysts that are calcified, what is the diagnosis?

A

cysticercosis

581
Q

What is the treatment for cysticercosis?

A

albendazole

582
Q

What are the complications of lyme disease?

A

Joints involvement, AV nodal block, Bells palsy

583
Q

If a patient has lyme disease with cardiac or CNS involvement what is the treatment?

A

Ceftriaxone

584
Q

Patient presents with palatal ulcers and splenomegaly with a history of being in bat caves, what is the diagnosis?

A

Histoplasmosis

585
Q

broad budding yeast is characteristic of what?

A

blastomycosis

586
Q

How do you diagnosis angioedema?

A

Finding low levels of C2 and C4 of the complement pathway

587
Q

Why does ACE inhibitors cause angioedema?

A

C1 esterase defiency

588
Q

What is the treatment for angioedema?

A

FFP if acute, androgens if chronic

589
Q

What is the treatment for allergic rhinitis?

A

intranasal steroids

590
Q

If a patient has to undergo desensitization for allergies or PCN treatment, what medication would you want to make sure the patient is not taking?

A

Beta blockers

591
Q

Patient presents with recurrent sinopulmonary infections along with GI disturbances of diarrhea and malabsorption, what is the diagnosis?

A

Common Variable Immunodeficiency (CVID)

592
Q

What is the issue in CVID?

A

Low levels of IgG

593
Q

How do you treat CVID?

A

Infusion of immunoglobins

594
Q

What is the most common primary immunodeficiency?

A

IgA deficiency

595
Q

What are the characteristics caused by IgE syndrome?

A

Recurrent skin infections cause by staph aureus

596
Q

Patient presents with painful bullae that are very thin and fragile. Nikolskys sign is positive. Skin sloughs off with light pressure What is the diagnosis?

A

Pemphigus vulgaris

597
Q

What is the treatment for pemphigus vulgaris?

A

Steroids

598
Q

biopsy with immunoflorescent antibodies are positive and patient has thick walled bullae on skin, what disease is this associated with?

A

bullous pemphigoid

599
Q

Which pemphigus disorder has oral lesions associated with it?

A

pemphigus vulgaris

600
Q

What is the treatment for uticaria?

A

H1 antihistamines

601
Q

What is erythema multiforme?

A

Its a rash that is medication induced that presents with target like lesions on the palms and soles

602
Q

Painful, red, tender nodules on the anterior surface of the lower extremities is what diagnosis?

A

Erythema nodosum

603
Q

If yiu have a fungal hair or nail infection what is the treatment?

A

Terbinafine or itraconazole

604
Q

What is the side effect of terbinafine?

A

Hepatotoxicity

605
Q

What are the side effects or oral ketoconazole?

A

Hepatotoxicity and gynecomastia

606
Q

What is the best initial test for herpes?

A

Tzanck smear

607
Q

What is the most accurate test for herpes?

A

viral culture

608
Q

What is the management for non-immune adults that are exposed to chicken pox?

A

Should be given varicella immunoglobulin within 96hrs of exposure

609
Q

What is imiquimod?

A

A drug used for the reomval of warts in HPV

610
Q

If you have symptoms of primary syphillis what tests should you order?

A

Darkfiel microscopy

611
Q

If you have symptoms of secondary syphillis what tests should you order?

A

VDRL, RPR

612
Q

what is the treatment for lice and crabs?

A

permethrin cream

613
Q

What is the treatment for anthrax?

A

Ciprofloxacin

614
Q

what is the characteristic appearance of basal cell carcinoma?

A

pearly appearance

615
Q

How do you diagnose basal cell carcinoma?

A

shave or punch biopsy

616
Q

red itchy patches on the flexor surfaces are indicative of was disease?

A

atpic dermatitis

617
Q

What is the lab abnormality in atopic dermatitis?

A

Elevated IgE

618
Q

pruritic salmon colored erythematous patch is indicative of what disease?

A

pityriasis rosacea

619
Q

What is the flow for acne treatment for mild to severe cases?

A

topical antibiotic–>topical retinoid–>benzoyl peroxide + retinoids–>oral antibiotics + isotretinoin

620
Q

What HbA1C diagnosis diabetes?

A

HbA1C >6.5

621
Q

What are the criteria for diabetes diagnosis?

A
  1. Two abnormal fasting glucose >126
  2. Random glucose >200 with symptoms
  3. Abnormal glucose tolerance test
  4. HbA1C >6.5%
622
Q

What is the best initial therapy for diabetes?

A

Diet, exercise, weight loss

623
Q

What is the best initial medical therapy for type 2 diabetes?

A

Metformin

624
Q

What is a side effect of sulfonylureas?

A

weight gain, hypoglycemia, SIADH

625
Q

How does metformin work and what are the advantages of using metformin?

A

Blocks gluconeogensis and it does not cause weight gain and does not cause hypoglycemia

626
Q

What is the mechanism of action of sulfonylureas?

A

Increases insulin release from beta cells

627
Q

What are examples of sulfonylureas?

A

gylburide, glipizide

628
Q

What are the DPP-IV inhibitors?

A

saxagliptin, linagliptin, sitagliptin

629
Q

How do the DPP-IV inhibitors work?

A

They increase insulin release and block glucagon

630
Q

What are the thiazolidinediones?

A

rosiglitazone and pioglitazone

631
Q

How doe thiazolidinediones work?

A

Increases peripheral insulin sensitivity

632
Q

What are the alpha glucosidase inhibitors?

A

acarbose and miglitol

633
Q

How do alpha glucosidase inhibitors work?

A

Blocks the absorption of glucose at the intestinal lining

634
Q

What are the side effects of thiazolidinediones?

A

Worsens congestive heart failure

635
Q

What are the side effects of alpha glucosidase inhibitors?

A

diarrhea, abdominal bloating

636
Q

What are the long acting insulins?

A

Detemir, NPH, glargine

637
Q

What are the best initial tests for DKA?

A

serum bicarbonate, beta hydroxybutyrate

638
Q

What are the lab findings in DKA?

A

Metabolic acidosis, respiratory alkalosis

  1. Low serum bicarboate
  2. High glucose
  3. Elevated potassium
  4. elevated anion gap
639
Q

High glucose plus low bicarboate =???

A

DKA

640
Q

What is the management for DKA?

A

Fluids and insulin

641
Q

What are the complications of diabetes thats needed to be checked in the office setting?

A
  1. HTN ( Goal BP 130/80)
  2. Lipid management ( <100)
  3. retinopathy
  4. Nephropathy (looking for albumin)
  5. Neuropathy
  6. Gastroparesis
642
Q

What blood pressure medication is best for patient with diabetes?

A

ACE inhibitors

643
Q

What is the most common cause of hypothyroidism?

A

Hashimoto thyroiditis?

644
Q

What is the best initial test for hypothyroidism?

A

T4 and TSH

645
Q

What thyroid disorders cause an elevated RAIU?

A

graves disease and pituitary adenomas

646
Q

What is the treatment of hyperthyroidism?

A

PTU or methimazole then radioactive iodine to ablate the gland

647
Q

What is the treatment for subacute thyroidits?

A

aspirin

648
Q

What is the only cause of hyperthyroidism with an elevated TSH?

A

Pituitary adenoma

649
Q

How does PTU work?

A

Blocks the conversion of T4 to T3

650
Q

What is the treatment for thyroid storm?

A
  1. Iodine
  2. PTU or methimazole
  3. Dexamethasone
  4. Propanolol
651
Q

What is the managment for solitary thyroid nodule?

A

FIne needle aspiration

652
Q

How do thiazide diuretics cause hypercalcemia?

A

tubular reabsorption of calcium

653
Q

Is high calcium inhibitory or hyper excitable?

A

inhibitory

654
Q

What are the symptoms of hypercalcemia?

A

Kidney stones, osteoporosis, abdominal pain/constipation, confusion

655
Q

What is the best inital test for cushing syndrome?

A

1mg dexamethasone test followed by 24hr urine cortisol

656
Q

In terms of cushing syndrome diagnosis, if you have a low ACTH what should that tell you?

A

Cushing cause is from the adrenals

657
Q

In terms of cushing syndrome diagnosis, if you have a high ACTH what should that tell you?

A

Pituitary or ectopic production

658
Q

If you have a patient with cushing symptoms with elevated ACTH what is your next test?

A

High dose dexamethasone test

659
Q

A thin patient with hyperpigmented skin and the symptoms of weight loss, fatigue, anorexia, hypotension?

A

Addison disease

660
Q

What are the laboratory abnormalities for addison disease?

A

Hyponatremia, hyperkalemia, metabolic acidosis

661
Q

What are the most accurate test for diagnosing addison disease?

A

cosyntropin stimulation test and CT scan

662
Q

What is the management for addison disease?

A

hydrocortisone–>prednisone–>fludrocortisone

663
Q

What are the features of hyperaldosteronism?

A

Hypertension, hypokalemia, metabolic alkalosis, low renin

664
Q

If hyperaldosteronism is due to hyperplasia what is the treatment?

A

spironolactone

665
Q

If hyperaldosteronism is due to adenoma what is the treatment?

A

surgical excision

666
Q

What is the best initial test for pheochromocytoma?

A

Elevated urinary and plasma catecholamines and plasma free VMA and metanephrine levels

667
Q

What is the most accurate test for pheochromocytoma?

A

CT or MRI

668
Q

Episodic HTN is a clue for what?

A

Pheochromocytoma

669
Q

What is the treatment for pheochromocytoma?

A

First phenoxybenzamine then propanolol

670
Q

What is phenoxybenzamine?

A

Drug used to treat HTN in pheochromocytoma by blocking alpha receptors

671
Q

What are the symptoms of 11 hydroxylase deficiency?

A

Hirsuitism, virilization and hypertension

672
Q

What are the symptoms of 17 hydroxylase deficiency?

A

Hypertension, low androgens

673
Q

What are the symptoms of 21 hydroxylase deficiency?

A

Hypotension, virilization and hirsuitism

674
Q

How do you diagnose 21 hydroxylase deficiency?

A

17 hydroxyprogesterone level

675
Q

What is the most accurate test for a prolactinoma?

A

MRI

676
Q

What are some other causes of hyperprolactinemia besides a prolactinoma?

A
  1. Prenancy
  2. Drugs
  3. hypothyroidism
  4. stress
  5. Nipple stimulation
677
Q

What is the best initial therapy for prolactinoma?

A

bromocriptine and cabergoline

678
Q

What are symptoms of prolactinoma in men?

A

gynecomastia, impotence, decrease libido, headaches, visual disturbances

679
Q

What are the symptoms of prolactinoma in women?

A

ammenorrhea and galactorrhea

680
Q

What is the best initial test for acromegaly?

A

Insulin like growth factor

681
Q

What is the most accurate test for acromegaly?

A

Suppression of GH by glucose and MRI

682
Q

What are the causes of primary amenorrhea?

A

Turner syndrome and testicular feminization

683
Q

What are the causes of secondary amenorrhea?

A

Pregnancy, exercise, extreme weight loss, hyperprolactinemia, PCOS

684
Q

What are the features of klinefelter syndrome?

A

XXY karotype, tall thin male. No testosterone production, high FSH and LH levels

685
Q

Anosmia and hypogonadism is characteristic of what diagnosis?

A

Kallman syndrome

686
Q

What are the lab abnormalities in Kallman syndrome?

A

Low GnRH, FSH and LH

687
Q

What are the features of androgen insentivity syndrome?

A

Low testosterone, phenotypical female with genotypical male. Breast development, absent pubic, axillary hair, cryptorchid testes

688
Q

How do thiazide diuretics work with calcium?

A

Reabsorbs calcium in the kidney and decrease calcium in the urine

689
Q

What is the treatment for hypoparathyroidism?

A

Vitamin D, calicum, thiazide diuretic

690
Q

How does insulin work with potassium?

A

Insulin promotes potassium entry into the cells

691
Q

What is nelson syndrome?

A

Occurs when a patient with cushing disease has bilateral adrenalectomy and develops pituitary enlargement and hyperpigmentation

692
Q

What are the complications of hyperthyroidism?

A

osteoporosis, arrhythmia, cardiomyopathy

693
Q

How do you treat medullary thyroid cancer?

A

Thyroidectomy

694
Q

What age should women be screened for breast cancer?

A

age 50

695
Q

What age should men be screened for prostate cancer?

A

No recommended screening

696
Q

What age should patients be screened for osteoporosis?

A

Age 65

697
Q

What age should men be screened for abdominal aortic aneurysms?

A

Age 65

698
Q

What age should patients be screened for colon cancer?

A

age 50

699
Q

If you have lynch syndrome what age should colon cancer screening be performed?

A

age 25 and be done every 1-2yrs

700
Q

What age does pap smear screening start?

A

age 21

701
Q

What hage does hyperlipidemia screening start?

A

Men age 35

women age 45

702
Q

What age should people be vaccinated with meningiococcal vaccine?

A

age 11

703
Q

What age should people be vaccinated with pneumococcal vaccine?

A

age 65

704
Q

What age should people be vaccinated with varicella vaccine?

A

age 60

705
Q

What age should you start offering HPV vaccine and what age is it stopped?

A

age 13-26

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