step 3 Flashcards
(705 cards)
1
Q
What condition presents with hematuria, flank pain, abdominal mass that moves with inspiration?
A
Renal cell carcinoma
2
Q
What general symtpoms can you have with renal cell carcinoma?
A
weight loss, fever, erythrocytosis
3
Q
how do you diagnose a renal cell carcinoma?
A
CT scan
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
5
Q
What is the treatment for patellofemoral pain syndrome?
A
exercises to strengthen your thigh muscles
6
Q
What people will you primarily see primary CNS lymphoma?
A
People with HIV
7
Q
What virus is related to primary CNS lymphoma?
A
EBV virus
8
Q
How do you treat bacterial conjunctivitis?
A
Macrolide (erythromycin)
9
Q
How do you treat bacterial conjunctivitis in patient who wear contact lenses?
A
Fluoroquinolone
10
Q
What complication can you see with bacterial conjunctivitis?
A
keratitis
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
12
Q
How would you diagnose lumbar spinal stenosis?
A
MRI
13
Q
How do you diagnose a achilles tendon rupture?
A
MRI or calf squeeze test with absent plantar flexion on calf squeeze
14
Q
What are the risk factors for osteoporosis?
A
- Caucasian female
- smoking
- family history
- prior steroid use
- postmenopausal
15
Q
What is the best sign of a diagnosis of sarcoidosis?
A
bilar hilar lymph node enlargement
16
Q
What disease is associated with erythema nodosum?
A
sarcoidosis
17
Q
What does this T score mean? -1 and above
A
Normal
18
Q
What does this T score mean? -2.5 or lower
A
osteoporosis
19
Q
What does this T score mean? -1 to -2.5
A
osteopenia
20
Q
If a confidence interval contains the null value 1, what does that mean?
A
Not statistically significant
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
22
Q
When would you see length time bias?
A
Rapidly progressive diseases less likely detected by screening test
23
Q
What is saw palmetto used to treat?
A
BPH
24
Q
What is the side effect of saw palmetto?
A
Bleeding
25
What is the definition of brain death?
The irreversible absence of brainstem and cerebral function
26
What is the treatment for PCP? (pneumocystis)
Steroids and TMP-SMX
27
What is the calculation of positive likelihood ratio?
sensitivity/ 1- specificity
28
What is the calculation of negative likelihood ratio?
1- sensitivity/ specificity
29
If you have typical symtpoms of GERD what is the next step?
Acid suppression
30
If you have GERD symptoms with history of NSAID use what is the next step?
discontinue NSAID or add acid suppression
31
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?
PPI
32
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?
H. pylori testing
33
What are the symptoms of polymyositis?
Proximal muscle weakness, difficulty climbing stairs, getting out of a car, combing hair, joint pain or sweliing
34
What labs are elevated in polymyositis?
elevated CK, CRP and transaminases
35
How do you confirm the diagnosis of polymyositis?
muscle biopsy
36
What disorder is seen in middle aged women with chronic widespread pain, tenderness at trigger points, with normal labs
Fibromyalgia
37
What disorder is seen in patients over 50 yrs with stiffness and pain in shoulders and hip girdles with elevated ESR, CRP?
Polymyalgia rheumatica
38
What is the treatment for polymyalgia rheumatica?
steroids
39
What disorder is associated with polymyalgia rheumatica?
Giant cell arteritis
40
What disease is seen in patient with a h/o asthma and cystic fibrosis and imaging shows recurrent fleeting infiltrates and bronchiectasis?
Allergic bronchopulmonary aspergillosis
41
How do you diagnosis allergic bronchopulmonary aspergillosis?
Eosinophilia and positive skin test
42
What is the treatment for allergic bronchopulmonary aspergillosis?
steroids first then itraconazole
43
What is the treatment for tourrette syndrome?
antipsychotics or alpha 2 agonists
44
What treats tourrettes tics?
risperidone
45
What is the diagnostic test for hirschsprung disease?
rectal suction biopsy
46
What syndrome is hirschsprung disease associated with?
down syndrome
47
What are the symptoms of hirschsprung disease?
Infant who has not passed meconium in the first 48rs, poor feeding, bilious vomiting, abdominal distension, expulsion of stool on rectal exam
48
What eye condition presents with pain, visual loss, constricted/irregular pupil and leukocytes seen in the anterior eye on slit lamp exam?
Anterior uveitis (Iritis)
49
What eye condition presents with severe photophobia and difficulty keeping the affected eye open?
Infectious keratitis
50
How do you treat kawasaki disease?
hydration and pain control
51
What is the treatment of paget disease?
bisphosphonates or calcitonin
52
What drugs affect lithium metabolism?
1. Theophylline
2. Potassium sparring diuretics
3. Loop diuretics
4. Calcium channel blockers
5. Thiazide diuretics
6. NSAIDS
7. ACE inhibitors
53
What disorder causes painless blisters, increased fragility of the skin, facial hypertrichosis and hyperpigmentation?
Porphyria cutanea tarda
54
How do you diagnose porphyria cutanea tarda?
urinary uroporphyrins
55
What disease is porphyria cutanea tarda associated with?
Chronic hepatitis C
56
What is the treatment for porphria cutanea tarda?
phlebotomy or hydroxychloroquine
57
What is the treatment for scabies?
permethin
58
What disease causes RUQ pain, fever, and liver abscess?
Entamoeba histolytica
59
What is the treatment for entamoeba histolytica?
metronidazole
60
When do you do flexible endoscopy for coin ingestion?
If it has been greater than 24hrs, unknown ingestion time, or symptomatic
61
When does an abdominal aortic aneurysm need repair?
Symptomatic( Abdominal or back pain
size greater than 5.5 cm
grown more than 0.5cm over a 6month period
62
What is the initial evaluation for pulmonary hypertension?
Echocardiogram
63
What is the treatment for pulmonary hypertension?
Endothelin antagonist
64
What are some medications that can cause digoxin toxicity?
1. verapmail
2. quinidine
3. Amiodarone
4. Spironolactone
65
What examination findings are consistent with severe aortic stenosis?
1. Single second heart sound
2. Delayed and diminished carotid pulse
3. Loud and late peaking systolic murmur
66
What are the complications of bicuspid aortic valve?
1. Infective endocarditis
2. severe regurgitation or stenosis
3. Aortic root or ascending aortic dilation
4. Dissection
67
What are some characteristics of ehlers danlos syndrome?
easy bruising, poor healing, velvety skin, MVP, abdominal or ingunial hernias, uterine prolapse, scoliosis, joint hypermobility, pectus excavatum
68
What are some characteristics of marfan syndrome?
Tall long and thin, MVP, pectus excavatum, joint hypermobility, scoliosis, lens detachment, spontaneous pnuemothorax, progressive aortic root dilation
69
What is the treatment for A.fib?
beta blockers, diltiazem, digoxin
70
What is the treatment for TCA overdose?
sodium bicarbonate infusions
71
What is the treatment for torsades de pointes?
Magnesium sulfate
72
What are the main risk factors for coronary artery disease?
1. Atheresclerotic disease
2. diabetes
3. Chronic kidney disease
73
How do you manage PMS?
1. SSRI
| 2. Oral contraceptive
74
What does PMS increase your risk for?
Depression
75
What is the management for aspiration pneumonia?
clindamycin
76
What renal condition gives you muddy brown casts?
Acute tubular necrosis
77
What are the side effects of amiodarone?
Photosensitivity, pulmonary toxicity, skin discoloration, bone marrow suppression, thyroid dysfunction, abnormal liver function
78
What are the absolute contraindications for combined hormonal contraceptions?
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
79
What things increase ovarian cancer risk?
early menarche, late age of menopause, genetic mutations
80
What things decrease your risk for ovarian cancer?
OCPs, breastfeeding, and multiparity
81
What is the treatment for acute dystonia?
diphenhydramine or benztropine
82
What are the characteristics of neurofibromatosis?
1. Cafe-au-lait spots
2. Neurofibromas
3. Optic pathway gliomas
83
What is the most important risk factor of osteoporosis?
age
84
When should a IVC filter be placed?
If you have contraindication to anticoagulation, complications with anticoagulation or failure of anticoagulation
85
What is the management for acute asthma exacerbation?
1. supplemental oxygen
2. inhaled bronchodilator/ipatropium
3. oral steroids
4. Magnesium sulfate/terbutaline
5. intubate
86
What is the most important predictor of survival/prognosis for patients with COPD?
FEV1 and age
87
What is the test of choice for diagnosing pneumothorax in acute settings?
bedside ultrasound
88
What is the treatment for oral candidiasis?
topical antifungal like nystatin suspension or clotrimazole troches
89
What lab is important to monitor in a patient who is receiving TPN?
phosphate levels (hypophospatemia)
90
If you have a patient who has COPD who is having a acute brinchitis exacerbation what is the management?
antibiotics
91
What is the treatment for a PE?
supplemental oxygen, heparin, warfarin
92
What signs should make you think of a PE?
sudden onset of SOB, tachycardia, hypoxia, in the setting of immobilization
93
How do you manage RSV?
supportive care
94
What is the complication of RSV?
recurrent wheezing
95
How are benign lung lesions described?
1. homogenous
2. central
3. popcorn calcification
4. concentric
5. Laminated
96
How are malignant lung lesions described?
1. eccentric
2. peripheral
3. spiculated
4. irregular border
5. ground glass appearance
6. reticular, punctate
7. size > 0.8cm
97
What are the false positive rates for lung cancer screening?
94-95%
98
What is the leading cause of death in parkinson disease?
aspiration pneumonia
99
Patient presents with SOB on exertion, fatigue, JVD, peripheral edema, and a right ventricular heave. What diagnosis are you thinking of?
pulmonary hypertension
100
What is the initial diagnostic test for pulmonary hypertension?
echocardiogram
101
How do you confirm pulmonary hypertension?
right heart catheterization
102
What is the strongest correlation with obstructive sleep apnea?
neck circumference
103
How do you diagnose obstructive sleep apnea?
polysomnography
104
How long can you delay repair of umbilical hernias in infants?
until age 5
105
Patient presents with dry gritty eyes, what is the diagnosis?
keratoconjunctivitis (dry eyes)
106
How do you treat keratoconjunctivitis?
artificial tears, methylcellulose eye drops
107
How do femoral hernias run?
inferior to the inguinal ligament and lie medial to the femoral nerve, artery and vein
108
How do you treat guillian barre syndrome?
IV immunoglobin or plasmapheresis
109
Describe symptoms of rheumatoid athritis?
pain and stiffness thats worse in the morning and improves throughout the day. symmetric joint involvement. commonly involve wrists and knees
110
How would you treat rheumatoid athritis?
acute: NSAIDS or steroids
chronic: methotrexate
111
What is sick sinus syndrome?
alternating episodes of tachycardia and bradycardia
112
How do you treat sick sinus syndrome?
pacemaker placement
113
What causes sick sinus syndrome?
SA node dysfunction
114
What are the main symptoms of parkinson disease?
resting tremor
bradykinesia
rigidity
115
If you see muddy brown casts what should you think of?
Acute tubular necrosis
116
If you see waxy casts what should you think of?
nephrotic syndrome
117
How do you reverse heparin?
protamine sulfate
118
How do you reverse warfarin?
vitamin K and FFP
119
How do you treat intussusception?
air or saline contrast enema
120
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?
Varicocele
121
How do you diagnose a scrotal varicocele?
ultrasound
122
What are the complications of a scrotal varicocele?
testicular atrophy and subfertility
123
infant presents with noisey breathing and face turns blue during feeding. What is the diagnosis?
choanal atresia
124
How do you diagnosis choanal atresia?
nasogastric catheter or CT scan
125
How do you treat lead intoxication?
DMSA
126
At what level would you start to treat lead intoxication?
moderate levels (45-69)
127
Patient presents with pain in her hands that worsens with activity and is better with rest. What is the diagnosis?
osteoarthritis
128
What is the greatest risk factor for developing pancreatic cancer?
cigarette smoking
129
What is the treatment for acetaminophen overdose?
N-acetylcysteine
130
What is the treatment for prolactinoma?
dopamine agonist like cabergoline or bromocriptine
131
What is the most common cause of inherited thrombophilia?
Factor V leidin
132
What is the treatment for QRS prolongation?
sodium bicarbonate
133
How do you prophylactically treat migraine headaches?
beta blockers, TCA, anticonvulsants
134
Patient has symptoms of ulcerative colitis with an elevated alk phos what condition are you thinking of?
primary sclerosing cholangitis
135
How do you diagnose primary sclerosing cholangitis?
endoscopic cholangiogram
136
Patient presents with an acute respiratory infection, flank pain and gross hematuria. Whats the diagnosis?
IgA nephropathy
137
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?
Acute post-streptococcal glomerulonephritis
138
Patient presents with dysuria, post void dribbling, dyspareunia, and anterior vaginal mass. What is the diagnosis?
urethral diverticulum
139
How do you treat polycystic kidney disease?
strict control of blood pressure with ACE inhibitors
140
How do you screen for polycystic kidney disorder?
with counseling and renal ultrasound
141
How do you treat acute cystitis in pregnancy?
1. Nitrofurantoin
2. amoxicillin
3. cephalexin
142
What are the circumstances toddlers should undergo renal ultrasound for UTI?
If the child in under 2yrs of age with febrile UTI/recurrent UTIs
143
What is mixed cryoglobulinemia syndrome associated with?
chronic hepatitis C
144
What are the immune complexes associated with lupus nephritis?
1. anti double stranded DNA
| 2. Complement
145
Patient presents with fever, chills, myalgia that eventually evolve into hypotension and shock with a fast decline. What diagnosis are you thinking of?
Toxic shock syndrome
146
What is the treatment for cocaine induced hypertension?
benzos and nitroglycerin
147
If you have a patient with cocaine intoxication with persistent chest pain, what is the management?
CCB
148
If you have a patient with cocaine intoxication with persistent HTN, what is the management?
phentolamine
149
When does breast cancer screening begin?
Age 40-50
150
Patient has painless blisters, increased fragility of the skin and facial hypertrichosis and hyperpigmentation. What is the diagnosis?
porphyria cutanea tarda
151
How do you diagnose porphyria cutanea tarda?
urinary uroporphyrins
152
What disease is porphria cutanea tarda associated with?
hepatitis C
153
What is the treatment for scabies?
permethrin and ivermectin
154
Patient presents woth RUQ pain, fever and liver abscess. What is the diagnosis?
Entamoeba histolytica
155
What is the treatment for entamoeba histolytica?
metronidazole
156
If a patient ingests a coin when would you do flexible endoscopy?
greater than 24hrs of ingestion/unknown time of ingestion/symptomatic
157
When do you need to repair an abdominal aortic aneurysm?
size greater than 5.5cm, symptomatic, grown more than 0.5cm over a 6 month period
158
Women has a palpable breast mass and is under the age of 30 what do you do?
Ultrasound
159
Women has a palpable breast mass and is over the age of 30 what do you do?
Mammogram
160
What is the problem in a patient who has stress incontinence?
urethral hypermobility or decreased urethral tone
161
What is the problem in a patient who has urge incontinence?
destrusor hyperactivity
162
What is the problem in a patient who has overflow incontinence?
impaired detrusor contractility or bladder outlet obstruction
163
What is the treatment for kawasaki disease?
aspirin or IVIG
164
What are the complications for kawasaki disease?
coronary artery aneurysms, MI
165
What are the antibodies for lupus?
anti-double stranded DNA and Anti-smith antibodies
166
What condition is anti-mitochondrial antibodies found in?
primary biliary cirrhosis
167
What condition is antiperoxidase antibodies found in?
hashimotos thyroiditis
168
What condition is anti-centromere antibodies found in?
scleroderma
169
Patient has an upper GI bleed and is hemodynamically unstable what is the workup?
EGD-->angiography-->colonoscopy-->capsule endoscopy
170
Patient has a lower GI bleed what is the workup?
colonoscopy-->EGD-->capsule endoscopy
171
what is a common complication of compartment syndrome?
acute renal failure
172
How do you diagnose compartment syndrome?
tissue pressures
173
What tissue pressure is diagnostic of compartment syndrome?
>30mmHg
174
What is the most important factor in predicting complete functional recovery?
time to intervention
175
What is the treatment for compartment syndrome?
fasciotomy
176
What are the signs of cyanide toxicity?
flushing of the skin, cyanosis, HA, altered mental status, seizures, arrhythmias, abdominal pain, N/V
177
What is the treatment for cyanide toxicity?
sodium thiosulfate
178
What are the most common cardiac tumors?
atrial myoma
179
What is the most common complication of atrial myoma?
release of emboli into the systemic circulation
180
What is the most common cause of sudden death in steering wheel injuries?
Aortic injury
181
What are the symptoms of vasovagal syncope?
pallor, diaphoresis, nausea before or after event
182
What causes vasovagal syncope?
prolonged standing, stress, emotion or pain
183
What are common causes of secondary hypertension?
renal parenchymal disease in children and young adults and hyperaldosteronism and atherosclerotic renal artery stenosis in middle aged and older adults
184
What is the treatment for acute pericarditis?
NSIDS and colchicine
185
What is the management for peri-infarction pericarditis?
high dose aspirin
186
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?
Multifocal atrial tachycardia
187
How do you diagnose multifocal atrial tachycardia?
EKG
188
What is a common cause of MAT?
electrolyte disturbances (hypokalemia, hypomagnesium)
189
How do you treat MAT?
treat the underlying illness
190
What are patients with down syndrome at increased risk of developing later in life?
acute leukemia
191
Infant presents with bilateral hydronephrosis, dilated and thickened bladder and oligohydramnios. What is the diagnosis?
posterior urethral valves
192
How do you diagnose posterior urethral valves?
voiding cystourethrogram
193
How do you treat posterior urethral valves?
place foley catheter to relieve obstruction and then cystoscopy for ablation
194
How do you definitively diagnose aspiration pneumonia in parkinson disease?
videofluoroscopic swallowing study
195
When would you need to taper a steroid?
If you have used it longer than 3 weeks
196
What is the treatment for SIADH?
water restriction
197
What is the treatment for hypocalcemia?
calcium gluconate
198
What is the treatment for hyperkalemia?
calcium gluconate
199
What are the symptoms of hypocalcemia?
paresthesia, muscle spasms/cramps, hyperreflexia, seizures, chvistek and trousseau sign
200
How do you manage a patient with infectious mononucleosis with impending airway obstruction?
steroids
201
If a patient has been vaccinated with rabies vaccine and gets a second bite, how do you manage?
booster rabies vaccine
202
What pathogen is found in human bites?
Eikenella corrodens
203
How do you treat human bites?
amoxicillin-clavulanate
204
What medicine do you use to prophylax against meningococcal meningitis?
rifampin
205
How is Giardiasis contracted?
contaminated food or water
206
What are the symptoms of giardiasis infection?
loose, foul smelling fatty stools with abdominal cramps weight loss and vitamin deficiencies
207
How do you treat giardiasis infection?
metronidazole
208
What is the first line treatment for cat scratch disease?
azithromycin
209
How is congenital toxoplasmosis contracted?
raw or undercook meat, unwasged fruits/vegetables or cat feces
210
What are the clinical features of a patient with congenital toxoplasmosis?
macrocephaly, diffuse microcalcifications, chorioretinitis, hearing impairment
211
What is the treatment for congenital toxoplasmosis?
pyrimethamine and sulfadiazine
212
What are the clinical features of congenital rubella infection?
hearing impairment congenital heart defects, eye abnormalities
213
How does disseminated gonococcal infection present?
systemic symptoms(fever malaise), tenosynivitis, dermatitis
214
What are the centor criteria for strep?
1. Fever
2. tonsillar exudates
3. anterior cervical lymphadenopathy
4. absence of a cough
215
How do you treat HIV associated thrombocytopenia?
antiretroviral medication
216
How do you screen for osteomyelitis?
probe to bone testing then MRI
217
What is chagas disease?
Protozoan infection contracted in mexico or south america that causes dilated cardiomyopathy and ventricular apical aneurysms
218
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?
cutaneous cryptococcosis
219
What organism causes infection from tropical fish tank?
vibrio vilnificus
220
Which infection is seen in gardeners and landscapers that presents with skin papule with ulceration and proximal lesions along lymphatic chain
sporotrichosis
221
What diseases have low glucose in cerebrospinal fluid?
tuberculosis and viral
222
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?
glucagonoma
223
What do you typically see in a patient with glucagonoma?
rare pancreatic tumor with associated diabetes and classic skin rash (necrolytic migratory erythema)
224
What is the initial diagnostic test for active TB?
acid fast bacilli sputum culture
225
can you use acid fast bacilli sputum test for confirmatory diagnosis of active TB?
No
226
If the sputum acid fast bacilli results are negative was is a confirmatory test?
mycobacterium culture or nucleic acid amplification
227
What is the standard caloric intake for enteral feedings for a patient with normal nutrition?
30kcal/kg/day and 1g/kg/day of protein
228
If you had a malnourished patient who needed enteral feedings what would you recommend for caloric intake?
15kcal/kg/day and 1g/kg/day of protein
229
What tendon is likely to be ruptured in a patient who is pivoting or landing?
patellar tendon
230
What are the symptoms of a patellar tendon rupture?
difficulty weight bearing, popping sentation, pain and swelling
231
Patient presents who cannot actively extend the knee or raise the knee against gravity. What have they injured?
patellar tendon tear
232
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?
meconium ileus
233
What condition is meconium ileus pathognomonic for?
cystic fibrosis
234
Patient presents with small rough erythematous keratotic papules and a history of heavy sunlight exposure. What is the diagnosis?
actinic keratosis
235
What is the treatment of actinic keratosis?
5-fluorouracil cream
236
What is the gold standard for the diagnosis of cystic fibrosis?
sweat chloride test
237
What is the treatment for narrow complex tachycardia?
adenosine or vagal maneuvers
238
For patient using statins and get rhabdomyolysis. When should they restart statins?
When the CK levels normalize
239
What are the 3 medications used for meningitis prophylaxsis?
rifampin, ceftriaxone, ciprofloxacin
240
Which prophylactic medication for meningitis can not be used in patients taking oral contraceptives?
rifampin
241
Patients who have immune thrombocytopenia and risk of bleeding, what is the management?
IVIG
242
What is the most common side effect of valproic acid?
thrombocytopenia
243
What does the kappa statistic measure?
reliability
244
If you have a patient with syphillis who has neurological symptoms(headache, blurry vision) what should be your next step?
Lumbar puncture with cerebrospinal fluid analysis
245
When would you give Benzathine pencillin G single dose for syphillis treatment?
primary, secondary or early latent syphillis
246
When would you give Benzathine penicillin G for 3 weeks for syphillis treatment?
late latent, unknown duration, or Gumma/CV syphillis
247
When would you give aqueous peniciilin for syphillis treatment?
neurosyphillis or congenital syphillis
248
What are the symptoms of primary syphillis?
chancre
249
What are the symptoms of secondary syphillis?
diffuse rash, condyloma lata
250
What are the symptoms of tertiary syphillis?
neurosyphillis or aortitis
251
What is jarisch herxheimer reaction?
seen in spirochete infection after treatment you get a acute febrile reaction. No treatment for this, self resolves
252
What are the features of hashimoto thyroiditis?
symptoms of hypothyroidisim, diffuse goiter
253
What does diagnostic testing show in hashimoto thyroiditis?
positive TPO antibodies and variable iodine uptake
254
What are the clinical features of painless thyroiditis?
mild brief hypothyroid phase, small nontender goiter, spontaneous recovery
255
What does the diagnostic testing show in painless thyroiditis?
positive TPO antibody and low iodine uptake
256
What are the clinical features of subacute thyroditis?
prominent fever and hyperthyroid symptoms, tender goiter
257
What does the diagnostic testing show in subacute thyroiditis?
elevated ESR and CRP with low iodine uptake
258
What is the treatment for subacute thyroiditis?
NSAIDS and beta blockers
259
What is st john wort used for?
antidepressant, antiinflammatory conditions, wound healing
260
What is the biggest side effect of st john wort?
drug interactions with drugs like OCPs, anticoagulants, antiretrovirals, immunosuppresants
261
What is the treatment for acute herpes zoster?
oral antivirals for 7 days if present <72hrs from onset of symptoms
262
What is the treatment for postherpetic neuralgia?
gabapentin
263
What is the treatment for infant botulism?
botulism immune globin
264
What is the pathogenesis of infant botulism?
toxin inhibits presynaptic acetylcholine release
265
What effects does amiodarone have one thyroid function?
It causes the inhibition of conversion of T4 to T3 causes increased T4 and decreased T3 with normal to borderline elevated TSH
266
Is the effects amiodarone has on thyroid longterm? how do you manage?
No its short term normally 3 months. Just repeat levels in few weeks
267
How are patients with acute hepatitis managed?
Normally with supportive care and outpatient follow-up
268
When should a patient with acute hepatitis B be hospitalized?
hemodynamically unstable, coagulation issues, high fevers, fulminate liver failure
269
What is the likelihood of progression to chronic hepatitis B in adults?
<5%
270
What is the likelihood of progression to chronic hepatitis B in infants?
>90%
271
What is the likelihood of progression to chronic hepatitis B in kids age 1-5 y/o?
20-50%
272
What is the main reason for hypercalcemia in patients with sarcodosis?
overproduction of calcitriol
273
Power of a study is related to what type of error?
type 2 error
274
How do you treat H. pylori?
PPI, amoxicillin and clarithromycin
275
What is the treatment for lyme disease?
amoxicillin or doxycyclline
276
How do you treat gout in a patient with renal failure or recent renal transplant?
steroids
277
What is catatonia?
unresponsiveness, immobility, cataplexy where examiner is able to position your limbs in any position without resistance
278
What patients is catatonia seen in?
schizophrenia
279
What is the treatment for catatonia?
benzos
280
What is the empirical treatment for meningitis in infant population?
cefoxitin plus ampicillin
281
What is the empirical treatment for meningitis in children and adults?
ceftriaxone and vancomycin
282
What is the empirical treatment for meningitis in adults or alcoholics?
ceftriaxone, ampicillin and vancomycin
283
On blood culture you isolate gram negative bacilli what is the directed treatment?
ceftriaxone
284
On blood culture you isolate gram positive cocci in clusters what is the directed treatment?
nafacillin
285
On blood culture in a patient suspected of meningitis you isolate pseudomonas what is the directed treatment?
ceftazidime
286
On blood culture in a patient suspected of meningitis you isolate H. influenza what is the directed treatment?
ceftriaxone
287
What should a patient with a history of chemotherapy and new onset fever make you think of?
secondary infection from immunocompromised state
288
What bug is commonly the culprit in febrile neutropenia?
Psuedomonas
289
What are the most common pathogens for community acquired pneumonia?
strep pneumonia and H. influenza
290
What is the treatment for community acquired pneumonia?
either fluoroquinolone or cephalosporin + macrolide
291
How do you treat acute active tuberculosis?
2 months of 4 medications( INH, Rifampin, pyrazinamide, ethambutol and 4 months of 2 medications( INH and Rifampin).
292
What is the side effect of ethambutol?
optic neuritis
293
What is the side of effect of rifampin?
orange discoloration of fluids
294
What is the side effect of pyrazinamide?
hyperuricemia
295
What are the IV antibiotics of choice for acute bacterial prostatitis?
IV Ampicillin and gentamicin
296
What are the oral antibiotics of choice for acute bacterial prostatitis?
ciprofloxacin or bactrim
297
How do you differentiate a transudative pleural effusion from an exudative pleural effusion?
```
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
What conditions causes a exudative pleural effusion?
Malignancy, infection, PE, GI disease, Rheumatoid disease
299
What conditions causes a transudative pleural effusion?
nephrotic syndrome, cirrhosis, congestive heart failure, peritoneal dialysis
300
What are the initial orders for a patient with sickle cell?
Pulse ox, CBC with diff, BMP, blood cultures, urinalysis with culture, EKG, chest x-ray, supplemental oxygen, type and screen, IV access
301
What is the management for a patient with sickle cell disease?
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
What are vasopressors?
dopamine and phenylephrine
303
What are the treatments for hyperkalemia?
Calcium gluconate, sodium bicarbonate, kayexalate, insulin and dextrose
304
What is the diagnostic test for ulcerative colitis?
ESR, sigmoidoscopy or colonoscopy and rectal biopsy
305
What is the management for ulcerative colitis?
5-ASA compounds, mesalamine, antidiarrheals and antispasmodics
306
What is the diagnostic test for Irritable bowel syndrome?
CBC, BMP, ESR, FOBT, TSH, stool for ova/parasites/white cells/culture and 72 hr stool fat
307
What is the management for IBS?
diet changes, lactose free diet, reasurrence antidiarrheal, antispasmodics, behavioral treatment, biofeedback
308
What is the diagnostic workup for depression?
CBC, TSH, BMP, electrolytes, vitamin b12
309
What is the management for depression?
SSRI, patient education, regular exercise, medication compliance
310
A vaginal pH of >4.5 indicates what?
bacterial vaginosis or trichomonas
311
A vaginal pH of < 4.5 indicates what?
yeast infection
312
What are the diagnostic tests for vaginal yeast infection?
vaginal pH, wet mount, Gonorrhea culture, chlamydia culture, urinalysis, pap smear
313
What is the treatment for alzheimers?
Donepezil, vitamin E, antipsychotic
314
Patient with COPD exacerbation. What do you want to do right away?
pulse ox, cardiac monitor, oxygen, IV access, elevated head of bed
315
Once patient is stable in a COPD exacerbation, what are your next steps?
cbc, bmp, ekg, PEFR, chest x-ray , ABG
316
What is the therapy for COPD exacerbation?
inhaled bronchodilators, steroids, antibiotics, influenza vaccine, pneumococcal vaccine
317
What are the emergency orders for a patient with hypertensive emergency?
IV access, oxygen, pulse ox, cardiac monitor, BP monitor
318
After you get your emergency orders what is the next step in a patient with hypertensive emergency?
focused physical exam
319
After your focused physical exam what orders do you want in a patient with hypertensive emergency?
CT scan, EKG, CBC, BMP, chest x-ray, UA, lipid profile
320
When should you order IV hypertensive medication in a patient with hypertensive emergency?
after head CT scan to rule out stroke
321
What is the first line treatment for hypertensive emergency?
nitroprusside
322
What is the treatment for PID?
Cefoxitin plus doxycycline or gent clinda or ampicillin+sulbactam and doxycycline
323
hemophilia A has a deficiency in what factor?
8
324
hemophilia B has a deficiency in what factor?
9
325
What should patient with hemophilia avoid?
aspirin and contact sports
326
What are the stat orders for a patient presenting with chest pain?
IV access, oxygen, pulse ox, ekg, troponins, ckmb,, BP monitoring, cardiac monitoring, aspirin, nitroglycerin
327
A barking cough is pathopneumonic for what disease?
viral croup
328
What is the management for croup?
humidified oxygen, nebulized epinephrine, dexamethasone
329
What is the steeple sign pathopneumonic for?
viral croup
330
WHat is the treatment for viral pericarditis?
NSAIDs colchicine
331
What is the treatment for post MI pericarditis?
high dose aspirin
332
What is the treatment for cellulitis?
clindamycin, bactrim, doxycycline
333
If you think a patient needs surgery what orders should you automatically put in?
pain medicine, antibiotics, antiemetics, fluids, NPO, the surgery, consult service
334
What is the therapy for turners syndrome?
OCPs, growth hormone, calcium, vitamin D, psychiatry consult, ophthalmology consult, dietary
335
What is the workup for turner syndrome?
karotype, cbc, bmp, fsh, lh, tsh, peliv US, renal US, lipid profile, fasting glucose
336
What is post-exposure ppx treatment based on?
Exposure type and body fluids involved
337
What kind of exposure type and body fluids increases your risk for HIV infection?
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
What vaccines do adults with HIV require?
Hepatitis B, HPV, Infulenza, Meningococcus, pneumococcus (PCV13, PCV23), TDAP
339
When are live vaccines contraindicated in patient with HIV?
CD4 count <200
340
What are the common diagnostic test for tuberculosis?
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
What are signs of active TB infection?
upper lobe lung cavitation, hilar lymphadenopathy or pleural effusion
342
What is the gold standard for microbial confirmation for TB?
mycobacterial culture along with nucleic acid amplification testing
343
What is normal CSF findings?
1. WBCs: 0-5
2. Glucose: 40-70
3. Protein: <40
344
What is the CSF findings for bacterial infection?
1. WBCs: >1000
2. Glucose: <40
3. Protein: >250
345
What is the CSF findings for tuberculosis?
1. WBCs: 5-1000
2. Glucose: <10
3. Protein: >250
346
What is the CSF findings for viral infection?
1. WBC: 100-1000
2. Glucose: 40-70
3. Protein: <100
347
What is the CSF findings for guillian barre?
1. WBCs: 0-5
2. Glucose: 40-70
3. Protein: 45-1000
348
What is potts disease?
Active tuberculosis of the lungs and spine
349
What is the follow-up for a health care worker who is exposed to a patient with TB?
Should receive screening test with tuberculin skin test or interferon gamma assay. If negative repeat in 8-10 weeks
350
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?
Treat with PEP ppx
351
What happens with a serum sickness reaction?
antibiotics immune complex formation. symptoms include fever, skin rash, polyarthralgia
352
What is the treatment for serum sickness reaction
supportive care
353
What is a subphrenic abscess?
Seen in a patient with h/o abdominal surgery with a swinging fever, cough, shoulder tip pain and leukocytosis
354
What is the diagnostic test for subphrenic abscess?
abdominal ultrasound
355
What kind of patient would you see cutaneous cryptococcosis?
untreated HIV patient with CD$ count < 100
356
What is the characteristic symptom of cutaneous cryptococcosis?
widespread skin papules with umbilication and central hemorrhage/necrosis that resemble molluscm
357
How do you diagnosis cryptococcosis?
biopsy of the lesion
358
What is the treatment for cutaneous cryptococcosis?
Amphotericn B and flucytosine for 2 wks then flucanazole for 1 year
359
If a patient with cutaneous cryptococcosis develops signs of ICP what is the management?
serial lumbar punctures
360
What is the diagnostic steps to a patient with osteomyelitis?
1. Probe to bone testing
2. Plain film x-ray
3. MRI
361
What is the most common culprit in patient with osteomyelitis?
Staph aureus, gram positive cocci
362
What is the gold standard for guiding treatment in a patient with osteomyelitis?
bone biopsy with culture
363
What is the most common side effect of isoniazid?
hepatotoxicity that is asymptomatic
364
What is the side effect of pyrazinamide?
hyperuricemia
365
What is the side effect of ethambutol?
ocular toxicity
366
What are the symptoms of herangina?
Vesicles and ulcers on the posterior oropharynx with fever
367
What virus causes herpangina?
coxsackie virus
368
What are the symptoms of apthous stomatitis?
leads to recurrent ulcers on anterior oral mucosa with no fever or systemic symptoms
369
What are the symptoms of Herpes gingivostomatitis?
Leada to visicles and ulcers on the anterior oral mucosa and around mouth with fever
370
What are the symptoms for group A strep pharyngitis?
Tonsillar exudates, fever, anterior cervical lymphadenopathy and absence of cough
371
What are the symptoms of infectious mono?
Tonsillar exudates, fever, diffuse cervical lymphadenopathy, +/- hepatosplenomegaly
372
What are the signs of pulmonary aspergillosis?
cough, pleuritic chest pain, hemoptysis
373
What are the risk factors for pulmonary aspergillosis?
Stem cell or organ transplant, prolonged neutropenia, chronic steroid use, immunocompromised
374
What imaging test would you use to diagnose?
CT scan
375
What are the imaging finding you would see with pulmonary aspergillosis?
nodules with ground glass opacitites (halo sign) with air fluid levels
376
What is the treatment for aspergillosis?
Voriconazole
377
What is erysipelas?
Infection that causes a facial rash that is red, elevated and painful
378
What organism causes erysipelas?
Group A strep
379
Who should get influenza vaccine?
Recommended for all ages > 6months
380
What are the risk factors for congenital toxoplasmosis?
Exposure to raw or uncooked meats, unwashed fruits/vegetables, cat feces
381
What are the clinical features of congenital toxoplasmosis?
macrocephaly, diffuse intracranial calcifications, jaundice and growth restriction
382
How do you diagnosis congenital toxoplasmosis?
serology
383
What is the treatment for congenital toxoplasmosis?
pyrimethamine, sulfadiazine, folate
384
What is the most common cause of pneumonia in patients with HIV?
Strep pneumonia
385
What is the treatment for lyme disease?
doxycycline
386
How long does the tick need to be attached in order to transmit disease?
>36hrs
387
What are the symptoms of congenital rubella?
eye abnormalities, hearing abnormalities, heart abnormalities
388
What is the pathopneumonic symptom for diptheria?
grey patches/pseudomembrane that bleeds with scraping
389
What complication can develop for diptheria?
Myocarditis
390
What is the treatment for diptheria?
erythromycin or penicillin G
391
What are the symptoms of disseminated gonococcal infection?
Dermatitis, tenosynovitis, polyarthralgia
392
If you have a patient with disseminated gonococcal infection what test should be run?
Chlamydia, gonorrhea, HIV
393
What disease gives you a positive tourniquet test where you get petechia after sphygmomanometer?
dengue fever
394
What is the complication you can see with dengue fever?
circulatory failure or shock
395
What is the treatment for dengue fever?
Supportive care
396
What organism causes infection if you cut your hand and place it in a fish tank?
Vibrio vulnificus
397
What is the most common cause of pneumonia in preschool age children?
strep pneumonia
398
What is the most common cause of pneumonia in patient with bilateral lung findings?
mycoplasma pnuemonia
399
How do you treat pneumonia causes by mycobacteria?
azithromycin
400
How do you treat pneumonia caused by strep pneumonia?
amoxicillin
401
How do you diagnosis C.diff?
> 3 loose stools in a 24hr period plus a positive stool toxin
402
How do you treat C. diff?
oral metronidazole for 14 days
403
What population of people are at increased risk of C.diff?
People on gastric acid suppression, recent antibiotic exposure, recent hospitalization, advanced age
404
What are the common causes of acute otitis media?
1. Strep pneumonia
2. Non typeable H. Influenza
3. Moraxella catarrhalis
405
What is the treatment for acute otitis media?
High dose amoxicillin
406
If a patient get multiple ear infection within a month how would you treat the second infection?
Amoxicillin-clauvalenic acid
407
What organism causes infection with concurrent otitis media and purulent conjunctivitis?
Nontypeable H. Flu
408
What is the treatment for lactational mastitis?
dicloxacillin or cephalexin
409
What organism most commonly causes lactational mastitis?
Staph aureus
410
What is the mechanism of toxic shock syndrome?
widespread activation of T cells by exotoxins
411
What organism causes toxic shock syndrome?
staph aureus
412
What are the clinical symptoms of toxic shock syndrome?
hypotension, shock, GI, neuro, and muscular symptoms
413
What is the treatment for toxic shock syndrome?
IV fluids and antibiotics
414
Patient has white lesion on the oral mucosa that are removed with scraping and causes underlying hyperemia and bleeding. what is the diagnosis?
oral candidiasis seen in HIV
415
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?
Necrotizing fasciitis
416
What is the treatment for necrotizing fascitis?
surgical debridement and antibiotics
417
What organism causes necrotizing fasciitis in healthy patients?
Group A strep
418
What is the treatment for active TB?
INH, rifampin, ethambutol for 2 months followed by INH and rifampin for 7 months
419
Women who are undergoing treatment for active TB, what should they be supplemented with?
pyridoxine
420
Why are women being treated for active TB supplemented with pyridoxine?
Prevent neurotoxicitiy
421
What drugs can you use for UTI treatment in pregnancy?
1. Nitrofurantoin
2. cephalexin
3. amoxicillin- clauvanate
4. fosfomycin
422
What is the first line therapy for latent TB treatment?
INH for 9 months
423
What is the alternative therapy for latent TB?
Rifampin for 4-6months
424
What are the recommended vaccines for people age >65?
1. Annual flu vaccine
2. Td vaccine every 10 years
3. PCV13 followed by PCV23 on 6-12 months
425
Patient who have had BCG vaccine and is concerning for TB what screening test should they undergo?
Interferon gamma release assay
426
What patient with syphillis gets benzathine penicillin G single shot for treatment?
Primary secondary and early latent syphillis
427
What patient with syphillis gets benzathine penicillin G IM weekly for 3 weeks for treatment?
late latent, unknown or gummatous/CV syphillis
428
What is the treatment for neurosyphillis?
Aqueous penicillin G IV q 4hrs for 10-14 days
429
What is the treatment for congenital syphillis?
Aqueous penicillin G
430
What are the symptoms of primary syphillis?
Chancre
431
What are the symptoms of secondary syphillis?
diffuse rash, condylomata lata
432
What are the symptoms of tertiary syphillis
neurosyphillis, aortitis
433
What is the Jarisch Herxheimer reaction?
When a patient gets treated for syphillis infection and develops fever and generalized achiness due to release of spirochetes
434
Is there anything to prevent Jarisch Herheimer reaction?
No
435
How can you treat Jarisch Herxheimer reaction?
There is no treatment but could give tylenol for fever
436
What 3 things should you avoid in a patient with HIV during labor?
1. AROM
2. Fetal scalp electrode placement
3. Operative vaginal delivery
437
What viral load needs to be present for patient with HIV to have vaginal delivery?
<1000 plus being on ART
438
What viral load is present for a patient to have to have c-section with HIV?
viral load > 1000
439
What is the management for the infant Post partum?
If vaginal delivery then zidovudine
| If c-section them ART
440
What are the contraindications to breast feeding?
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
What medications can you take for chemoprophylaxsis for meningitis?
1. Rifampin
2. Ciprofloxacin
3. Ceftriaxone
442
When can you not use rifampin to ppx against meningitis exposure?
In a women taking oral contraception
443
What syndrome commonly develops in patient with HIV who are receiving treatment?
dyslipidemia and insulin resistance
444
If a patient had tuberculosis meningitis what treatment could reduce morbiditity and mortality?
steroids for 8 weeks
445
When a patient develops a rash with mono after receiving amoxillin what is the treatment?
To observe and stop antibiotics
446
What is the treatment for mono?
NSAIDs
447
What patients are candidates for oseltamivir who has the flu?
Patient who present with symptoms less than 48hrs, require hospitalization, severe or progressive illness, underlying medical conditions
448
What is the ppx treatment for PCP?
TMP-SMX
449
What is the most common bug found in human bites?
Eikenella corrodens
450
What is the treatment for a human bite?
Amoxicillin-Clavulanate
451
What is the prognosis for patients treated with lyme disease?
favorable and most patients completely recover
452
What is the treatment for cat scratch disease?
azithromycin
453
What are the principle pathogens that cause disease in patient with cystic fibrosis?
Staph aureus and pseudomonas
454
What bug is more likely in a patient with cystic fibrosis and older in age?
psuedomonas
455
What drugs can you use to treat a pseudomonas infection?
cefipime, ceftazidime, pipercillin-tazobactam, meropenam, aztreonam, amikacin
456
What is a complication of C.diff?
toxic megacolon
457
What is the treatment for severe C. diff?
vancomycin
458
What are the signs of severe C. diff
WBC count > 20,000
Cr > 1.5x baseline
lactate > 2.2
459
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?
Sydenham chorea
460
What disease is sydenham chorea commonly seen in?
Acute rheumatic fever
461
What are the major criteria in acute rheumatic fever?
JONES
1. Joints (migratory arthritis)
2. heart (carditis)
3. Nodules (subcutaneous)
4. Erythema marginatum
5. sydenham chorea
462
What is the treatment for acute rheumatic fever?
Penicillin
463
How long should a patient with acute rheumatic fever be treated?
Until adulthood
464
What is the treatment for strep pharyngitis?
Penicilin or amoxicillin for 10 days
465
What can happen if you dont treat a strep throat infection?
Can develop acute rheumatic fever
466
When is a person with active TB considered noninfectious?
After 3 consecutive acid fast bacilli smear negative results
467
When is a person with latent TB considered noninfectious?
People with latent TB are never infectious
468
What is the treatment for latent TB?
isoniazide for 6-9 months or rifampin for 4 months
469
What people with latent TB should receive treatment?
HCP, inmates, immunosupressive patients
470
What bug causes epiglottis?
H. influenza
471
What are the symptoms of epiglottis?
Dysphagia, drooling, high fever, tripod position (leaning forward with neck extended
472
What would you see on x-ray in a patient with epiglottis?
Thumb print sign
473
What is the management for epiglottis?
endotracheal intubation and antibiotics
474
Patient has loose fatty foul smelling stools, weight loss, and stool culture positive for multiple cyst, what is the diagnosis?
Giardiasis
475
What is the treatment for Giardiasis?
metroniadozole
476
What is the treatment for CAP in the outpatient setting?
macrolide or doxycycline (healthy)
| fluoroquinolone or macrolide + beta lactam (comorbidities)
477
What is the treatment for CAP in the inpatient non ICU setting?
fluoroquinolone or macrolide + beta lactam
478
What is the treatment for CAP in the inpatient ICU setting?
fluoroquinolone + beta lactam
479
Should live vaccines be delayed in children who live with pregnant women?
No
480
What is the treatment for BV?
Metronidazole or clindamycin
481
What is the gold standard of treatment for a skin abscess?
incision and drainage
482
When would you give antibiotics to a person with a skin abscess?
If there are systemic symptoms, evidence of cellulitis, abscess greater than 2cm
483
What is the most common bug in a patient with an skin abscess?
Staph aureus
484
What is the most common bug in a patient with skin cellulitis?
Strep pyogenes
485
What are the rules for tetanus ppx in patient with bite wounds?
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
What is centor criteria?
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
What patients do you typically see rhinocerebral mucormycosis in?
Patients with DKA
488
What is the treatment for rhinocerebral mucormycosis?
Surgical debridement and amphotercin B
489
Neonates with a sepsis picture, what antibiotics should be given during the workup?
Amp/gent or cefotaxime
490
In a new patient being treated for HIV where should their viral load be after 1 month of treatment?
<5,000
491
In a new patient being treated for HIV where should their viral load be after 2-4 months of treatment?
<500
492
In a new patient being treated for HIV where should their viral load be after 4-6 months of treatment?
<50
493
What is the most common complication of cat scratch disease?
suppuration of lymph nodes
494
What is the treatment for chronic bacterial prostatitis?
6 weeks of ciprofloxacin or TMX-SMX
495
Patient who immigrated from africa presents with terminal hematuria, dysuria, peripheral eosinophilia and increased frequency, what is the diagnosis?
Helminth infection
496
How doe you diagnose a helminth infection?
urine sediment
497
What is the treatment for a helminth infection
albendazole
498
Do patients who have undergone treatment for latent tuberculosis need to have repeat testing or treatment?
No
499
When would you need rabies vaccine and immunoglobin?
If you get bit by an animal with rabies and have never been vaccinated
500
If you were previously vaccinated for rabies and got bit by an animal with rabies what is the management?
2 doses of rabies vaccine
501
What lab do you follow to see there is improvement in a patient with osteomyeleitis?
ESR
502
What is otitis externa commonly associated with?
Swimming
503
What is the best initial test for malignant otitis externa?
CT or MRI
504
What is the most accurate test for malignant otitis externa?
biopsy
505
What is the treatment for malignant otitis externa?
surgical debridement and antibiotics against pseudomonas
506
What the mechanism of otitis media?
Swelling of the eustachian tube
507
What group of bugs cause sinusitis if its bacterial?
Strep pneumo, H. influenza, moraxella catarrhalis
508
What is the best initial test for sinusitis?
x-ray
509
What is the most accurate test for sinusitis?
sinus aspirate for culture
510
What is the diagnostic test for influenza?
viral rapid antigen test of nasopharyngeal swab
511
Is the influenza vaccine a live virus or inactivated virus?
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
Patient has a skin infection that causes weeping, crusting and oozing of the skin, what is the likely diagnosis?
Impetigo
513
What bugs cause impetigo?
Strep pyogenes or staph aureus
514
What is the treatment for simple impetigo?
Topical mupirocin
515
What is the treatment for severe impetigo?
oral dicloxacillin or cephalexin
516
Patient presents with a very bright red and hot appearing facial rash, what is the diagnosis?
Erysipelas
517
What is the best initial test for fungal infections of the skin and nails?
KOH preparation
518
What is the treatment for impetigo?
Topical antibiotic like mupirocin
519
What is the treatment for tinea vesicolor?
Topical antifungals
520
What is actinic keratosis?
premalignant condition caused by excessive sunlight
521
What does actinic keratosis increase your risk of?
squamous cell carcinoma
522
How does porphyria cutanea tarda arise?
deficiency of the uroporphyrinogen decarboxylase enzyme involved in the heme synthesis pathway
523
What is the treatment for porphyria cutanea tarda?
phlebotomy or hydroxychlorquine
524
What is seborrheic dermatitis?
erythematous pruritic plaques with greasy scales (Flaky and itchy scalp)
525
What is the treatment for seborrheic dermatitis?
topical antifungal (selenium shampoo, ketaconazole)
526
What is the longterm prognosis of seborrheic dermatitis?
Its a chronic relapsing condition where weekly retreatment could be needed to prevent recurrence
527
What is rosacea?
Characterized by redness in the central face with flushing telangiectasias and pustules
528
What is the treatment for rosacea?
topical metronidazole
529
What is the most frequent complication from rosacea?
Ocular abnormalities, recurrent chalazion
530
What is seborrheic keratosis?
Benign epidermal tumor due to proliferation of immature keratinocytes that cause round pigments well demarcated lesion with stuck on appearance
531
What is the treatment for herpes zoster?
valacyclovir
532
What is postherpetic neuralgia?
Persistent pain in patient with herpes zoster after 4 months
533
What is the treatment for postherpetic neuralgia?
gabapentin or TCA
534
What is the treatment for wrinkles?
tretinoin
535
What is alopecia areata?
discrete, smooth and circular areas of hair loss over the scalp
536
What other conditions are alopecia areata associated with?
Vitiligo, thyroid disease, pernicious anemia
537
What is the treatment for alopecia areata?
intralesional steroids
538
What are some ways to prevent sun damage?
sun protective behaviors, sunscreens and adequate hydration
539
What is the treatment for plantar warts?
Salicyclic acid
540
What causes plantar warts?
HPV
541
What is the management for melasma?
avoiding sun exposure and broad spectrum sunscreen
542
Seborrheic dermatitis is seen commonly in what kind of patients?
HIV and parkinson disease
543
What is the prognosis of chronic uticaria?
Self resolves in 2-5 years
544
What is the first line therapy for psoriasis?
topical steroids
545
What are the surgical options for squamous cell skin cancer?
1. Surgical excision
2. cryotherapy
3. radiation therapy
4. electrosurgery
546
What is the best initial test for PID?
Pregnancy test, gonorrhea and chlamydia
547
What is the most accurate test for PID?
laparoscopy
548
What is the outpatient treatment for PID?
Ceftriaxone and doxycycline
549
What is the inpatient treatment for PID?
cefoxitin and doxycycline
550
What is the alternative treatment for PID if patient is allergic to PCN?
Gentamicin and clindamycin
551
What disease presents with a painful and tender testicle that sits an a normal position in the scrotum?
epididymo- orchitis
552
What is the treatment for epididymo-orchitis?
ceftriaxone and doxycycline
553
What is the most accurate test in primary syphillis?
Dark field microscopy
554
Whats the diagnosis for a rare beefy red genital lesion that ulcerates?
granuloma inguinale
555
What is the treatment for uncomplicated cystitis?
TMP-SMX for 3 days
556
What is the treatment for complicated cystitis?
TMP-SMX for 7 days
557
What is the treatment for outpatient pyelonephritis?
Ciproflaxacin
558
You have a patient with diagnosed pyelonephritis that is on treatment but is not getting better, what diagnosis should you be considering?
perinephric abscess
559
What is the best initial test for prostatitis?
urinalysis
560
What is the most accurate test for prostatitis?
Urine WBCs after Prostate massage
561
What is the treatment for prostatitis?
TMP-SMX or ciprofloxacin for 2-6 weeks
562
Patient has fever with new heart murmur or change in murmur, what diagnosis are you thinking of?
Endocarditis
563
Roth spots, janeway lesion, osler noder and splinter hemorrhages are seen in what disease?
Endocarditis
564
What is the best initial test in a patient with endocarditis?
blood cultures
565
What is the 2nd best test in a patient with endocarditis?
echo
566
What is the treatment for endocarditis?
Vancomycin and gentamicin
567
What is the treatment for endocarditis ppx?
Amoxicillin
568
What are the side effects of the protease inhibitors used in HIV treatment?
Hyperlipidemia and hyperglycemia
569
What is the treatment of CMV in HIV?
ganciclovir
570
CMV is seen with what CD4 level?
<50
571
cryptococcus is seen with what CD4 level?
<50
572
Whats the initial test for cryptococcus diagnosis?
India ink stain
573
Whats the most accurate test for cryptococcus?
cryptococcal antigen test
574
CD4 count < 50 with blurry vision what are you thinking of?
CMV
575
CD4 count <50 with fever and headache what are you thinking of?
cryptococcus
576
CD4 count < 50 with focal neurological abnormalities, what are you thinking of?
Progressive multifocal leukoencephalopathy
577
Patient is a rabbit hunter and presents with an ulcer on his hand, lymphadenopathy and conjunctivitis. What is the diagnosis
tularemia
578
How do you diagnose tularemia?
Serology
579
What is the treatment for tularemia?
streptomycin or gentamicin
580
Patient has eaten some pork chops and CT scan shows thin walled cysts that are calcified, what is the diagnosis?
cysticercosis
581
What is the treatment for cysticercosis?
albendazole
582
What are the complications of lyme disease?
Joints involvement, AV nodal block, Bells palsy
583
If a patient has lyme disease with cardiac or CNS involvement what is the treatment?
Ceftriaxone
584
Patient presents with palatal ulcers and splenomegaly with a history of being in bat caves, what is the diagnosis?
Histoplasmosis
585
broad budding yeast is characteristic of what?
blastomycosis
586
How do you diagnosis angioedema?
Finding low levels of C2 and C4 of the complement pathway
587
Why does ACE inhibitors cause angioedema?
C1 esterase defiency
588
What is the treatment for angioedema?
FFP if acute, androgens if chronic
589
What is the treatment for allergic rhinitis?
intranasal steroids
590
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?
Beta blockers
591
Patient presents with recurrent sinopulmonary infections along with GI disturbances of diarrhea and malabsorption, what is the diagnosis?
Common Variable Immunodeficiency (CVID)
592
What is the issue in CVID?
Low levels of IgG
593
How do you treat CVID?
Infusion of immunoglobins
594
What is the most common primary immunodeficiency?
IgA deficiency
595
What are the characteristics caused by IgE syndrome?
Recurrent skin infections cause by staph aureus
596
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?
Pemphigus vulgaris
597
What is the treatment for pemphigus vulgaris?
Steroids
598
biopsy with immunoflorescent antibodies are positive and patient has thick walled bullae on skin, what disease is this associated with?
bullous pemphigoid
599
Which pemphigus disorder has oral lesions associated with it?
pemphigus vulgaris
600
What is the treatment for uticaria?
H1 antihistamines
601
What is erythema multiforme?
Its a rash that is medication induced that presents with target like lesions on the palms and soles
602
Painful, red, tender nodules on the anterior surface of the lower extremities is what diagnosis?
Erythema nodosum
603
If yiu have a fungal hair or nail infection what is the treatment?
Terbinafine or itraconazole
604
What is the side effect of terbinafine?
Hepatotoxicity
605
What are the side effects or oral ketoconazole?
Hepatotoxicity and gynecomastia
606
What is the best initial test for herpes?
Tzanck smear
607
What is the most accurate test for herpes?
viral culture
608
What is the management for non-immune adults that are exposed to chicken pox?
Should be given varicella immunoglobulin within 96hrs of exposure
609
What is imiquimod?
A drug used for the reomval of warts in HPV
610
If you have symptoms of primary syphillis what tests should you order?
Darkfiel microscopy
611
If you have symptoms of secondary syphillis what tests should you order?
VDRL, RPR
612
what is the treatment for lice and crabs?
permethrin cream
613
What is the treatment for anthrax?
Ciprofloxacin
614
what is the characteristic appearance of basal cell carcinoma?
pearly appearance
615
How do you diagnose basal cell carcinoma?
shave or punch biopsy
616
red itchy patches on the flexor surfaces are indicative of was disease?
atpic dermatitis
617
What is the lab abnormality in atopic dermatitis?
Elevated IgE
618
pruritic salmon colored erythematous patch is indicative of what disease?
pityriasis rosacea
619
What is the flow for acne treatment for mild to severe cases?
topical antibiotic-->topical retinoid-->benzoyl peroxide + retinoids-->oral antibiotics + isotretinoin
620
What HbA1C diagnosis diabetes?
HbA1C >6.5
621
What are the criteria for diabetes diagnosis?
1. Two abnormal fasting glucose >126
2. Random glucose >200 with symptoms
3. Abnormal glucose tolerance test
4. HbA1C >6.5%
622
What is the best initial therapy for diabetes?
Diet, exercise, weight loss
623
What is the best initial medical therapy for type 2 diabetes?
Metformin
624
What is a side effect of sulfonylureas?
weight gain, hypoglycemia, SIADH
625
How does metformin work and what are the advantages of using metformin?
Blocks gluconeogensis and it does not cause weight gain and does not cause hypoglycemia
626
What is the mechanism of action of sulfonylureas?
Increases insulin release from beta cells
627
What are examples of sulfonylureas?
gylburide, glipizide
628
What are the DPP-IV inhibitors?
saxagliptin, linagliptin, sitagliptin
629
How do the DPP-IV inhibitors work?
They increase insulin release and block glucagon
630
What are the thiazolidinediones?
rosiglitazone and pioglitazone
631
How doe thiazolidinediones work?
Increases peripheral insulin sensitivity
632
What are the alpha glucosidase inhibitors?
acarbose and miglitol
633
How do alpha glucosidase inhibitors work?
Blocks the absorption of glucose at the intestinal lining
634
What are the side effects of thiazolidinediones?
Worsens congestive heart failure
635
What are the side effects of alpha glucosidase inhibitors?
diarrhea, abdominal bloating
636
What are the long acting insulins?
Detemir, NPH, glargine
637
What are the best initial tests for DKA?
serum bicarbonate, beta hydroxybutyrate
638
What are the lab findings in DKA?
Metabolic acidosis, respiratory alkalosis
1. Low serum bicarboate
2. High glucose
3. Elevated potassium
4. elevated anion gap
639
High glucose plus low bicarboate =???
DKA
640
What is the management for DKA?
Fluids and insulin
641
What are the complications of diabetes thats needed to be checked in the office setting?
1. HTN ( Goal BP 130/80)
2. Lipid management ( <100)
3. retinopathy
4. Nephropathy (looking for albumin)
5. Neuropathy
6. Gastroparesis
642
What blood pressure medication is best for patient with diabetes?
ACE inhibitors
643
What is the most common cause of hypothyroidism?
Hashimoto thyroiditis?
644
What is the best initial test for hypothyroidism?
T4 and TSH
645
What thyroid disorders cause an elevated RAIU?
graves disease and pituitary adenomas
646
What is the treatment of hyperthyroidism?
PTU or methimazole then radioactive iodine to ablate the gland
647
What is the treatment for subacute thyroidits?
aspirin
648
What is the only cause of hyperthyroidism with an elevated TSH?
Pituitary adenoma
649
How does PTU work?
Blocks the conversion of T4 to T3
650
What is the treatment for thyroid storm?
1. Iodine
2. PTU or methimazole
3. Dexamethasone
4. Propanolol
651
What is the managment for solitary thyroid nodule?
FIne needle aspiration
652
How do thiazide diuretics cause hypercalcemia?
tubular reabsorption of calcium
653
Is high calcium inhibitory or hyper excitable?
inhibitory
654
What are the symptoms of hypercalcemia?
Kidney stones, osteoporosis, abdominal pain/constipation, confusion
655
What is the best inital test for cushing syndrome?
1mg dexamethasone test followed by 24hr urine cortisol
656
In terms of cushing syndrome diagnosis, if you have a low ACTH what should that tell you?
Cushing cause is from the adrenals
657
In terms of cushing syndrome diagnosis, if you have a high ACTH what should that tell you?
Pituitary or ectopic production
658
If you have a patient with cushing symptoms with elevated ACTH what is your next test?
High dose dexamethasone test
659
A thin patient with hyperpigmented skin and the symptoms of weight loss, fatigue, anorexia, hypotension?
Addison disease
660
What are the laboratory abnormalities for addison disease?
Hyponatremia, hyperkalemia, metabolic acidosis
661
What are the most accurate test for diagnosing addison disease?
cosyntropin stimulation test and CT scan
662
What is the management for addison disease?
hydrocortisone-->prednisone-->fludrocortisone
663
What are the features of hyperaldosteronism?
Hypertension, hypokalemia, metabolic alkalosis, low renin
664
If hyperaldosteronism is due to hyperplasia what is the treatment?
spironolactone
665
If hyperaldosteronism is due to adenoma what is the treatment?
surgical excision
666
What is the best initial test for pheochromocytoma?
Elevated urinary and plasma catecholamines and plasma free VMA and metanephrine levels
667
What is the most accurate test for pheochromocytoma?
CT or MRI
668
Episodic HTN is a clue for what?
Pheochromocytoma
669
What is the treatment for pheochromocytoma?
First phenoxybenzamine then propanolol
670
What is phenoxybenzamine?
Drug used to treat HTN in pheochromocytoma by blocking alpha receptors
671
What are the symptoms of 11 hydroxylase deficiency?
Hirsuitism, virilization and hypertension
672
What are the symptoms of 17 hydroxylase deficiency?
Hypertension, low androgens
673
What are the symptoms of 21 hydroxylase deficiency?
Hypotension, virilization and hirsuitism
674
How do you diagnose 21 hydroxylase deficiency?
17 hydroxyprogesterone level
675
What is the most accurate test for a prolactinoma?
MRI
676
What are some other causes of hyperprolactinemia besides a prolactinoma?
1. Prenancy
2. Drugs
3. hypothyroidism
4. stress
5. Nipple stimulation
677
What is the best initial therapy for prolactinoma?
bromocriptine and cabergoline
678
What are symptoms of prolactinoma in men?
gynecomastia, impotence, decrease libido, headaches, visual disturbances
679
What are the symptoms of prolactinoma in women?
ammenorrhea and galactorrhea
680
What is the best initial test for acromegaly?
Insulin like growth factor
681
What is the most accurate test for acromegaly?
Suppression of GH by glucose and MRI
682
What are the causes of primary amenorrhea?
Turner syndrome and testicular feminization
683
What are the causes of secondary amenorrhea?
Pregnancy, exercise, extreme weight loss, hyperprolactinemia, PCOS
684
What are the features of klinefelter syndrome?
XXY karotype, tall thin male. No testosterone production, high FSH and LH levels
685
Anosmia and hypogonadism is characteristic of what diagnosis?
Kallman syndrome
686
What are the lab abnormalities in Kallman syndrome?
Low GnRH, FSH and LH
687
What are the features of androgen insentivity syndrome?
Low testosterone, phenotypical female with genotypical male. Breast development, absent pubic, axillary hair, cryptorchid testes
688
How do thiazide diuretics work with calcium?
Reabsorbs calcium in the kidney and decrease calcium in the urine
689
What is the treatment for hypoparathyroidism?
Vitamin D, calicum, thiazide diuretic
690
How does insulin work with potassium?
Insulin promotes potassium entry into the cells
691
What is nelson syndrome?
Occurs when a patient with cushing disease has bilateral adrenalectomy and develops pituitary enlargement and hyperpigmentation
692
What are the complications of hyperthyroidism?
osteoporosis, arrhythmia, cardiomyopathy
693
How do you treat medullary thyroid cancer?
Thyroidectomy
694
What age should women be screened for breast cancer?
age 50
695
What age should men be screened for prostate cancer?
No recommended screening
696
What age should patients be screened for osteoporosis?
Age 65
697
What age should men be screened for abdominal aortic aneurysms?
Age 65
698
What age should patients be screened for colon cancer?
age 50
699
If you have lynch syndrome what age should colon cancer screening be performed?
age 25 and be done every 1-2yrs
700
What age does pap smear screening start?
age 21
701
What hage does hyperlipidemia screening start?
Men age 35
| women age 45
702
What age should people be vaccinated with meningiococcal vaccine?
age 11
703
What age should people be vaccinated with pneumococcal vaccine?
age 65
704
What age should people be vaccinated with varicella vaccine?
age 60
705
What age should you start offering HPV vaccine and what age is it stopped?
age 13-26
