Step 3 Material Flashcards
What are absolute contraindications to living organ donation?
Inability to consent (i.e. age < 18; intellectual disability; untreated psychiatric disorder)
DM
HTN with end-organ damage
BMI > 35
Malignancy
What does it mean if a study result includes the null value?
The result is not statistically significant
What is the etiology of vaginal lesions that turn white with application of acetic acid?
Anogenital warts (condylomata acuminata) caused by HPV
What are the preferred treatments for anogenital warts?
Trichloroacetic acid: can be used internally
Podophyllin: cannot be used internally and contraindicated during pregnancy
What is the treatment of neuroleptic malignant syndrome?
Dantrolene
What is an important consideration when initiating warfarin?
Can initially increase coagulability so must bridge with heparin
What is the next step in management for a woman > 45 years of age with anovulatory bleeding?
Endometrial biopsy
What is the difference between the Pearson chi-squared test and Fisher’s exact test?
Pearson chi-squared test: compares the association between categorical (not numerical) values
Fisher’s exact test: compares the association between categorical (not numerical) values when the sample size is small
What are the findings on echo in stress-induced (takotsubo) cardiomyopathy?
LV apical and basilar hypokinesis
What is seen on ECG in stress-induced (takotsubo) cardiomyopathy?
ST elevation in precordial leads (V1-V6)
What is the next step in management if US is equivocal and concern is still high for cholecystitis?
HIDA scan
What is seen on peripheral smear in malaria?
Ring-form trophozoites
Which medications can induce fertility in PCOS?
Letrozole and clomiphene
What is the mechanism of action of letrozole?
Works on the ovary to inhibit aromatase in order to prevent conversion of androgen –> estrogen in order to increase GnRH release and FSH production
What is the next step if CT or MRI is negative with a high suspicion for pheochromocytoma?
MIBG scan
What is the treatment for intraoperative hypotension with pheochromocytoma?
NS bolus followed by pressors if unresponsive
What is the presentation of angiodysplasia?
Painless rectal bleeding
Which drug can commonly cause acute hemolysis in a patient with G6PD deficiency?
Trimethoprim-sulfamethoxazole
What type of anemia does thalassemia cause?
Microcytic
How is hereditary spherocytosis diagnosed?
Osmotic fragility test
Which drugs commonly increase and decrease serum warfarin levels?
Causes of increased warfarin levels (must decrease dosage of warfarin): metronidazole; amiodarone; quinolones
Causes of decreased warfarin levels (must increase dosage of warfarin): rifampin; phenytoin; OCPs
Which knee injury presents with a “popping” sensation followed by swelling and hemarthrosis?
ACL injury
What is the presentation of a meniscal tear?
Subacute or chronic catching or locking sensation
What is the appearance of basal cell carcinoma?
Pearly white nodule with telangiectasias and central ulceration
What is the preferred initial therapy for COPD?
LAMA monotherapy (i.e. tiotropium)
How is carbon monoxide poisoning diagnosed?
Carboxyhemoglobin level on ABG
What is the usual history for sporotrichosis?
Inoculation with decaying plant matter or soil, commonly in gardeners and landscapers
What is the treatment for sporotrichosis?
Itraconazole
What is the preferred agent for awake intubation?
Ketamine
Which functions are preserved in ALS?
Ocular, sensory, bowel, bladder, and cognitive
What is riluzole?
Treats ALS
What is the consequence of reduced sample size on research error?
Increases type II error (false negative)
How does tinea manuum present?
Unilateral erythema and scaling
What opening pressure suggests idiopathic intracranial hypertension (AKA pseudotumor cerebri)?
> 20-25 cm H2O
What is the most common complication of acute diverticulitis?
Colonic abscess
What type of follow up should patients with acute diverticulitis receive?
Colonoscopy 6-8 weeks after symptom resolution to rule out colon cancer
What is the definition of primary nocturnal enuresis?
Urinary incontinence in healthy children > 5 years old with no previous history of nighttime dryness
What is the exam hallmark of necrotizing fasciitis?
Pain out of proportion to exam
What is the most common bacteria that causes necrotizing fasciitis in previously healthy patients?
Strep pyogenes (group A Strep)
What amount of cow’s milk increases the risk of iron-deficiency anemia in children > 1 year old?
> 24 oz/day
What is the first-line treatment for insomnia in elderly patients?
CBT
Who is screened annually for gonorrhea and chlamydia with NAAT?
Sexually active women < 25 years old
What is the recommendation for hepatitis C testing?
One-time testing in patients 18-79 years old and high-risk patients (i.e. IVDU, blood transfusion before 1992)
When does Pap screening start?
21 years old
What screening is indicated in patients with bicuspid aortic valve?
Imaging (i.e. echo) to evaluate for aortic root dilation that increases the risk for aortic aneurysm and dissection
What mutation causes Marfan syndrome?
Fibrillin
When should children start receiving the influenza vaccine?
> 6 months
What is the first-line treatment for dementia?
AChE inhibitors (i.e. rivastigmine, donepezil, and galantamine)
What is the most common risk factor for hepatitis C infection?
IVDU
What testing should be performed prior to surgery for carpal tunnel syndrome?
EMG and nerve conduction studies
What is the murmur in mitral prolapse?
Non-ejection click followed by systolic murmur that becomes louder with decreased venous return
What are the FSH and LH levels in primary vs. secondary hypogonadism?
Primary: high FSH/LH
Secondary: low or normal FSH/LH
What endoscopic finding is expected with pernicious anemia?
Absent rugae in the gastric fundus and body
What neonatal presentation is consistent with CF?
Meconium ileus
Which neonatal GI disorders are associated with Down syndrome?
Duodenal atresia and Hirschsprung disease
What will be the position of the hip in a patient with SCFE?
Externally rotated
Which SSRIs are preferred in breastfeeding mothers?
Sertraline and paroxetine
Which cell type on blood smear is consistent with thalassemia?
Target cells
What is Nelson’s disease and how does it present?
Pituitary microadenoma with suprasellar extension after bilateral adrenalectomy for Cushing’s disease
Presents with bitemporal hemianopsia and hyperpigmentation
Which neonatal cardiac abnormality can occur in children born to diabetic mothers?
Hypertrophic cardiomyopathy from glycogen deposition in the interventricular septum
Which congenital cardiac anomaly is associated with Noonan syndrome?
Pulmonary valve stenosis
What are some common ductal-dependent lesions?
Transposition of the great arteries and hypoplastic left heart syndrome
What is the most common long-term complication of IVC filters?
Recurrent DVT because the filters only prevent progression to PE
What is the most common cause of meningitis in HIV-positive patients with molluscum contagiosum?
Cryptococcal meningitis
What is the treatment for cryptococcal meningitis?
Induction: amphotericin B and flucytosine until symptoms resolve and CSF negative
Consolidation: high-dose fluconazole for 8 weeks
Maintenance: low-dose fluconazole for > 1 year
What is the treatment for condyloma acuminata (genital warts)?
Topical trichloroacetic acid
What is the hallmark of Kallmann syndrome?
Anosmia
What are the options for prophylaxis in a patient exposed to meningococcal meningitis?
Rifampin (contraindicated in women on OCPs), ceftriaxone, and ciprofloxacin
What are non-surgical options to treat low-risk squamous cell carcinoma of the face?
Radiation, electrosurgery, and cryotherapy
What skin finding is associated with celiac disease?
Dermatitis herpetiformis
At what gestational age can external cephalic version be offered?
> 37 weeks
What is the underlying concern for sudden-onset acanthosis nigricans in an older adult?
GI malignancy
What is the most common site of metastasis for squamous cell carcinoma of the head and neck?
Lungs
What is considered adequate intrapartum prophylaxis against GBS?
> 4 hours before delivery
What is the interferon-gamma release assay used for?
Detecting TB infection
What is the potential adverse effect when MAOIs are started in a patient previously on an SSRI?
Serotonin syndrome
Recommended wash-out period of 14 days (5 weeks for fluoxetine given the long half-life)
What kind of medication are phenelzine and selegiline?
MAOI
What is the primary symptomatic difference between serotonin syndrome and neuroleptic malignant syndrome (NMS)?
Serotonin syndrome: hyperkinesia
Neuroleptic malignant syndrome (NMS): bradykinesia and lead-pipe rigidity
What is the hallmark imaging finding for chronic pancreatitis?
Calcifications on MRCP
Which study characteristics are related to type I and type II errors?
Type I: power
Type II: significance
What is the appropriate diagnostic step for lobular carcinoma in situ (LCIS)?
Excisional biopsy
What is the murmur of VSD?
Harsh holosystolic murmur with a palpable thrill
What is the murmur of ASD?
Mid-systolic ejection murmur with wide and fixed splitting of S2
What is the appropriate treatment of health care workers with exposure to blood of HIV-positive patients?
Combination antiretrovirals for 4 weeks
What is the time frame for brief psychotic disorder?
< 1 month
What is Pott disease?
Active TB of the lungs and spine
For close contacts of a patient diagnosed with TB who have a negative skin test, what is the next diagnostic step?
Repeat skin test in 8-10 weeks
What is the treatment for latent TB?
Isoniazid and pyridoxine for 9 months
When should the baby be delivered in intrahepatic cholestasis of pregnancy?
37 weeks
What is the appearance of pemphigoid gestationis?
Periumbilical rash that spreads throughout the abdomen
What is the appearance on contrast enema of meconium ileus?
Microcolon
What is the primary cause of death in patients with tuberous sclerosis?
Epilepsy
What is the primary symptom of pufferfish poisoning?
Neurologic dysfunction
How is urethral hypermobility diagnosed?
> 30 degree angle of movement on the Q-tip test
How is a urethral diverticulum in a woman definitively diagnosed?
Pelvic MRI or transvaginal US
In what clinical setting has St. John’s wort been shown to be effective?
Effective in mild-to-moderate depression
Which class of medications is contraindicated in combination with St. John’s wort?
SSRIs due to the risk of serotonin syndrome
What are the symptoms of anterior uveitis (iritis)?
Pain, redness, possible visual loss, and a mid-dilated and irregular pupil
When during pregnancy does acute fatty liver of pregnancy typically present?
Third trimester
How do you prevent observer bias?
Double-blind study design
How do you prevent confounding factors?
Randomization
What is the hallmark of splenic vein thrombosis?
Variceal bleeding from isolated gastric varices
What is a common PMHx in patients with splenic vein thrombosis?
Pancreatitis or pancreatic cancer
What is the mechanism of action of glucocorticoids, beta-blockers, and PTU that allow them to be used in thyrotoxicosis?
Inhibits peripheral deiodination of T4 to T3
What is the mechanism of action of octreotide?
Decreases splanchnic blood flow
What is the INR threshold for FFP administration?
> 2
When should platelets be transfused in a patient with active GI bleeding?
Platelets < 50,000
Which medication class is used for prevention of further variceal bleeding?
Non-selective beta-blockers (i.e. propranolol; nadolol)
Which lab findings are commonly associated with primary biliary cholangitis?
Elevated alkaline phosphatase and anti-mitochondrial antibodies
What is the presentation of alpha-1 antitrypsin deficiency?
Cirrhosis and emphysema
What is the presentation of niacin (vitamin B3) deficiency?
Dermatitis, dementia, and diarrhea
What is the presentation of riboflavin (vitamin B2) deficiency?
Angular cheilosis and stomatitis
What can happen if a patient with untreated adrenal insufficiency receives levothyroxine?
Adrenal crisis due to increased metabolic demand and clearance of glucocorticoids
What is the clinical use of reverse T3?
Distinguishes euthyroid sick syndrome from central hypothyroidism
Euthyroid sick syndrome: high rT3
Central hypothyroidism: low rT3
When do symptoms of congenital hypothyroidism appear?
> 1 month because maternal T4 crosses the placenta and takes time to disappear in the child
What are the indications for OCPs in patients with acne?
Pre-menstrual flares and acne on the lower face and neck
What screening and anticipatory guidance is required when starting isotretinoin?
2 negative pregnancy tests and 2 concomitant birth control methods
When is a cerclage usually placed when indicated?
12-14 weeks of gestation
What is the management of pregnant patients with incidentally found cervical insufficiency and no history of preterm labor?
Serial US for cervical length measurements and vaginal progesterone
What is the treatment of arrhythmias in TCA overdose?
Sodium bicarbonate
When is genu varum normal?
Up to 2 years of age
What are the main indications for cell-free fetal DNA testing at > 10 weeks of gestation?
Maternal age > 35 and previous pregnancy with aneuploidy
What is the clinical triad of Legionella?
Pulmonary, GI, and neurologic symptoms
What emergency contraception should be used in the setting of acute cervicitis?
Ulipristal
When is hyperventilation contraindicated?
TBI and acute stroke
How do postural vs. structural kyphosis present?
Postural kyphosis: improves with hyperextension of the back
Structural kyphosis: does not improve with hyperextension of the back
What is spondylolisthesis?
Anterior slippage of a vertebral body with subluxation on XR
How does exercise induce amenorrhea?
Decrease in pulsatile LH secretion and therefore decreased estrogen production
What screening tests should be performed at 24-28 weeks of gestation?
H&H, antibody screening if Rh(D) negative, and a 50-gram glucose tolerance test
What screening test should be performed at 36-38 weeks of gestation?
GBS culture
What is the radiographic hallmark of benign pulmonary hamartoma?
Popcorn calcification
Which lab value is classically increased in PJP PNA?
Increased LDH
What are the typical lab findings in hypoaldosteronism?
Asymptomatic hyperkalemia with a mild metabolic acidosis
What does the kappa statistic indicate?
Reliability
What is the difference between type I and II errors?
Type I error: rejection of a null hypothesis when it is true
Type II error: failure to reject a null hypothesis when it is false
In patients with metastatic malignancy, which location should be the target of initial diagnostic biopsy?
Site of metastasis if possible
What are the guidelines for initiating bisphosphonates?
Low bone mass with a history of fragility fracture OR
T-score < -2.5 (definition of osteoporosis) OR
T-score between -1 and -2.5 (definition of osteopenia) with a 10-year probability of major osteoporotic fracture > 20% or hip fracture > 3%
Which type of CBT is indicated in OCD?
Exposure and response prevention therapy
What is psychodynamic psychotherapy?
Traces problems back to childhood origins
When should bite wounds be left to heal by secondary intention?
Animal bites (except to the face), wounds to the extremities, and wounds that are > 12 hours old
What is the treatment for CO poisoning?
100% O2 via non-rebreather mask
What is the presentation of Alport syndrome?
Hematuria and hearing loss
What are the diagnostic criteria for Kawasaki disease?
Fever for > 5 days + > 4 of the CREAM pneumonic
Conjunctivitis, rash, edema, adenopathy, and mucosal involvement
When should an echo be performed in patients with Kawasaki disease?
At the time of diagnosis and 2 and 6 weeks after completion of treatment
What is the management of vaccines after IVIG is administered in children?
Delay live vaccines (i.e. MMR, varicella) for 11 months after administering IVIG
What is the appropriate care of an amputated digit prior to surgery?
Wrap it in gauze, moisten it in saline, and place it in a sterile bag on top of ice mixed with saline
What does pulmonary HTN look like on CXR?
Prominent pulmonary arteries
What mean pulmonary arterial pressure indicates PAH?
> 25 mmHg
How is pulmonary capillary wedge pressure used in the diagnosis of PAH?
Pulmonary capillary wedge pressure < 18 mmHg rules out PAH secondary to left heart failure
Which medication classes are often used in PAH?
Endothelin receptor antagonists (i.e. bosentan), PDE-5 inhibitors (i.e. sildenafil), and prostacyclin agonists (i.e. epoprostenol)
What is the treatment for chlamydia during pregnancy?
Azithromycin because doxycycline is teratogenic
Which pregnancy complications are associated with BV?
Increased risk of preterm birth and contraction of STIs
What are the colorectal cancer screening guidelines for patients with first-degree relatives with colorectal cancer?
Colonoscopy at 40 or 10 years before the first-degree relative was diagnosed (whichever is earlier) and repeat every 5 years
When should colorectal cancer screening begin in average-risk individuals?
45 with a colonoscopy every 10 years
What is the most common presentation of hypophosphatemia?
Muscle weakness secondary to rhabdomyolysis
What is the impact of metabolic alkalosis on phosphate levels?
Shifts phosphate intracellularly and causes hypophosphatemia
What is the prognosis of seborrheic dermatitis?
Chronic relapsing condition that may require re-treatment every few weeks
Which medication class is contraindicated in patients with ACS and decompensated heart failure?
Beta-blockers because of decreased contractility and HR
What are the main causes of a diastolic murmur?
Aortic insufficiency and mitral stenosis
What are the symptoms of a fat embolism?
Respiratory distress, neurologic dysfunction, and petechial rash
At what age do children start to understand that death is final?
> 7
What are the common findings on ECG in “athlete’s heart?”
Sinus bradycardia +/- first-degree AV block (prolonged PR interval)
What are the common risk factors for Dupuytren’s contracture?
Alcohol, smoking, and diabetes
Which childhood tumor can present with HTN, flushing, and sweating?
Neuroblastoma secondary to catecholamine release and possibly compression of the renal artery
What differentiates an aplastic crisis and hyperhemolytic crisis in sickle cell disease?
Aplastic crisis: low reticulocyte count
Hyperhemolytic crisis: high reticulocyte count
What is the definitive treatment of Wolff-Parkinson-White syndrome?
Catheter ablation of the accessory pathway
Which stages of sacral ulcers require debridement?
Stage III (full thickness but no exposed bone, tendon, or muscle) and stage IV (full thickness with exposed bone, tendon, or muscle)
What is the appropriate secondary prevention of progression of atherosclerotic cardiovascular disease in patients with known risk factors?
Age < 75: high-intensity statin
Age > 75: moderate-intensity statin
What triglyceride level warrants treatment with fibrates (i.e. gemfibrozil)?
> 1000
What is Lhermitte’s sign?
Electric shock-like sensation upon flexion of the neck frequently seen in MS
What is the treatment of MS flare with optic neuritis?
IV methylprednisolone because PO prednisone is associated with an increased risk of optic neuritis recurrence
Which pregnancy complications are associated with MS?
Need for C-section and forceps delivery
What is the treatment of choice for MS-related fatigue?
Amantadine
What is pyridostigmine?
Cholinesterase inhibitor used in myasthenia gravis
What is the difference in analysis of data from per-protocol and intention-to-treat studies?
Per-protocol: excludes all non-compliant subjects (less reflective of reality)
Intention-to-treat: includes all subjects regardless of events during the study (more reflective of reality)
How is placenta previa diagnosed?
Transabdominal US followed by transvaginal US
What is the treatment for UTI during pregnancy?
Cefpodoxime or amoxicillin-clavulanate
What is the order of default surrogates if a durable power of attorney or advanced directive are absent?
In descending order: spouse, adult children, parents, adult siblings, nearest living relative, and close friend
What is the usual XR finding in Boerhaave syndrome?
Pneumomediastinum and/or pleural effusion in the L lung
What is the equation for number needed to treat?
1/ARR
What is the treatment for menopausal hot flashes in patients who need to stop hormonal therapy in the setting of a DVT/PE?
SSRI or SNRI
Which antihypertensive medications have minimal interactions with lithium?
Calcium channel blockers (i.e. amlodipine) and loop diuretics
What causes lichen simplex chronicus?
Persistent scratching
What are the common extrarenal manifestations of autosomal dominant polycystic kidney disease?
Berry aneurysms in the brain, hepatic cysts, and pancreatic cysts
Which antibody is associated with disease activity in lupus?
Anti-dsDNA
What is a major contraindication to codeine?
Age < 12 because of unreliable metabolism resulting in respiratory depression
Which anti-hypertensive drug class causes peripheral edema?
Calcium channel blockers
What is the most common adverse effect of amiodarone?
Pulmonary toxicity
What is the indication for D-penicillamine?
Wilson’s disease
Which diagnostic study is used to detect cardiotoxicity with anthracycline chemotherapy (i.e. doxorubicin and daunorubicin)?
Radionuclide ventriculography to detect changes in EF
What is the presentation of urinary schistosomiasis?
UTI symptoms, terminal hematuria, and peripheral eosinophilia
What is the treatment for urinary schistosomiasis?
Praziquantel
How is urinary schistosomiasis diagnosed?
Urine sediment microscopy
What is the purpose of chorionic villus sampling?
Assess for aneuploidy
What is factorial study design?
Study with numerous interventions and every combination of them
What is the hallmark of neurofibromatosis type II?
Bilateral acoustic neuromas leading to deafness
What are the HPV screening guidelines for women ages 30-65?
Cytology every 3 years OR cytology + HPV testing every 5 years
Which high-risk patients require prophylaxis against infective endocarditis in the setting of procedures?
- GI or GU procedure with active infection
- Manipulation of gingival or respiratory tract tissue
- Procedure on infected muscle or skin
- Placement of prosthetic cardiac material
What is the treatment for alopecia areata?
Topical or intralesional corticosteroids
What is the major complication of femoral neck fractures in the elderly?
Avascular necrosis
What is the initial management of dyspepsia in patients < 60 and > 60 without alarm signs?
< 60: test for H. pylori
> 60: EGD
What lithium level warrants hemodialysis?
> 4 or > 2.5 with neurologic or renal symptoms
What is the treatment for porphyria cutanea tarda in the setting of hepatitis C infection?
Interferon alpha
Which physical exam maneuver confirms complete Achilles tendon rupture?
With the patient prone and feet hanging off the table, squeeze the calf muscle and observe for absence of plantarflexion of the foot
What is the difference in lab abnormalities in 21-hydroxylase deficiency and 11-β-hydroxylase and 17-α-hydroxylase deficiencies?
21-hydroxylase deficiency: hyponatremia and hyperkalemia
17-β-hydroxylase and 17-α-hydroxylase deficiencies: HTN and hypokalemia
What lab test can confirm 21-hydroxylase deficiency?
Elevated 17-hydroxyprogesterone levels
What health maintenance should be performed in a new diagnosis of celiac disease?
DXA scan and pneumococcal vaccine
What is the hallmark of Whipple disease?
Arthralgias
What is the main difference between herpangina and herpes gingivostomatitis?
Herpangina: lesions on posterior oropharynx
Herpes gingivostomatitis: lesions on anterior mouth and lips
When should women with a history of spontaneous abortions receive a genetics consult?
> 3 spontaneous abortions (not including ectopic pregnancies)
Which organisms are catalase positive?
S. aureus, Burkholderia, Serratia, Nocardia, and Aspergillus
How can warfarin be rapidly reversed?
Prothrombin complex concentrate (rapid) + vitamin K (delayed)
What is the reversal agent for dabigatran?
Idarucizumab
What is the indication for vaginal progesterone therapy?
Short cervix (< 25 mm) seen on US at 18-24 weeks of gestation
What is the screening test for medullary thyroid cancer?
Serum calcitonin
Which cancer is associated with untreated celiac disease?
T-cell lymphoma of the jejunum
What is the typical presentation of a subarachnoid hemorrhage from a posterior communicating artery aneurysm?
CN III palsy with ptosis and anisocoria
Which site is associated with the least risk of CLABSI?
Subclavian vein
How does Ramsay Hunt syndrome present?
Vesicles on the external ear and ipsilateral facial paralysis
What is the first-line treatment for malignant otitis externa?
IV fluoroquinolone (i.e. ciprofloxacin)
What venous lead level is an indication for succimer chelation therapy?
> 45
Which 2 types of cancer most commonly metastasize to the brain?
Lung and breast
What is the most common adverse effect of isoniazid?
Asymptomatic hepatotoxicity
What is the most common adverse effect of ethambutol?
Ocular toxicity
Which diagnosis is associated with an elevated adenosine deaminase level in the pleural fluid?
TB
What is the purpose of radionuclide thyroid scans?
Differentiate between hyperthyroidism caused by Graves disease and nodular disease
Graves disease: diffuse uptake
Nodular disease: focal uptake
Which HbA1c level is diagnostic of DM?
> 6.5%
Which fasting blood glucose level is diagnostic of DM?
> 126
What is the antidote for ethylene glycol and methanol intoxication?
Fomepizole because it competitively inhibits ADH and prevents metabolism of ethylene glycol and methanol into toxic metabolites
When should patients with preeclampsia or HELLP receive hydralazine or labetalol for hypertension?
BP > 160/110
What factors are associated with worse prognosis in acute pancreatitis?
Obesity, older age, hematocrit > 44%, CRP > 150, and BUN > 20
What is the general indication for lidocaine in cardiology?
Ventricular arrhythmias
What is the treatment of organophosphate toxicity?
Atropine (competitively inhibits ACh) and pralidoxime (reactivates cholinesterase)
How does Meniere’s disease present?
Hearing loss, aural fullness, tinnitus, and episodic vertigo
What are the equations for positive and negative likelihood values?
Positive likelihood value = sensitivity / (1 - specificity)
Negative likelihood value = (1 - sensitivity) / specificity
What is the most common complication of rosacea?
Ocular complications
Which antihypertensive can cause a photosensitivity reaction?
Hydrochlorothiazide
What is the most common cause of postpartum hemorrhage and how is it treated?
Uterine atony is treated with uterine massage and oxytocin
What is the usual clinical triad of temporal arteritis?
Unilateral headache, vision change, and jaw claudication
What is the first-line medication for prevention of cluster headaches?
Verapamil
What is the management of acute cluster headaches that do not improve with analgesics?
Supplemental 100% O2 followed by IN sumatriptan in the contralateral nostril if no success
What is the first-line treatment for cocaine intoxication with cardiovascular signs and symptoms?
Benzodiazepines and nitroglycerin
Which medication class is contraindicated in cocaine-induced chest pain?
Beta-blockers due to risk of unopposed alpha-1-induced vasoconstriction
What is the next step in work-up of a patient with subclinical hypothyroidism?
Check anti-thyroid peroxidase (TPO) antibody levels
What is the difference in pupil size between anterior uveitis and acute angle-closure glaucoma?
Anterior uveitis: mid-dilated pupil
Acute angle-closure glaucoma: constricted pupil
What is the mechanism of action of toxic shock syndrome?
Circulating bacterial exotoxins act as superantigens that can directly activate T-cells
Which cancer is associated with Sjogren syndrome?
Non-Hodgkin B-cell lymphoma
Which malignancy is associated with actinic keratosis?
Squamous cell carcinoma
Which oral medications are ineffective against tinea versicolor?
Oral terbinafine and griseofulvin
When are VZV lesions no longer contagious?
When they are completely crusted over
What is the time frame of post-herpetic neuralgia?
> 4 months after rash onset
What is the most common neurologic presentation of Wilson disease?
Dysarthria
What is the definition of chronic hepatitis B?
Failure to clear HBsAg within 6 months
What is the presentation of carotid artery dissection?
Severe unilateral headache and ipsilateral partial Horner syndrome (ptosis and miosis without anhidrosis)
What is the treatment of actinic keratosis?
Topical liquid nitrogen cryotherapy
What is the treatment for ichthyosis?
Topical urea, lactic acid, or salicylic acid
When should an infertility work-up be started?
Women < 35: > 12 months of inability to conceive
Women > 35: > 6 months of inability to conceive
What is the confirmatory test for heparin-induced thrombocytopenia?
Serotonin release assay
Which diagnosis is associated with an elevated alpha subunit of TSH?
Pituitary adenoma
What is the initial management step in a pancreatic cyst to differentiate between benign and malignant etiology?
Endoscopic US with aspiration
What finding is pathognomonic of Chagas cardiomyopathy?
Left ventricular apical aneurysm
How do massive pRBC transfusions result in hypocalcemia?
Sodium citrate preservative in pRBC binds to ionized calcium
What is the clinical triad of mixed cryoglobulinemia?
Weakness, arthralgias, and palpable purpura
What is the most common disease association in patients with mixed cryoglobulinemia?
Chronic hepatitis C
Which groups should receive treatment for salmonella gastroenteritis?
Children < 12 months of age and immunocompromised individuals
What is the initial treatment of clubfoot?
Serial casting
What size is an indication for biopsy of actinic keratosis?
> 1 cm
What is the pattern of X-linked dominant disorders?
All females born to affected males have the disease
What is the x-ray finding with stress fractures in the first 2-3 weeks after symptom onset?
Normal x-rays
What is the treatment for allergic bronchopulmonary aspergillosis?
Steroids and antifungal (itraconazole or voriconazole)
What are the components of the MELD score to calculate estimated 90-day survival in patients with cirrhosis?
Bilirubin, INR, creatinine, and sodium
What are the components of the MELD score to calculate estimated 90-day survival in patients with cirrhosis?
Bilirubin, INR, creatinine, and sodium
What is the treatment for chlamydia in the settings of positive and negative gonorrhea?
Gonorrhea + chlamydia: ceftriaxone + doxycycline
Chlamydia alone: azithromycin
How is thyroid cancer initially staged?
US of neck and cervical lymph nodes
What are the guidelines for mammogram screening?
Every 2 years for women ages 50-74
What is the most feared adverse effect of propylthiouracil?
Hepatotoxicity
What is the hallmark of toxic thyroid nodule on radioactive iodine scan?
Increased uptake in the nodule and suppressed uptake in the remainder of the gland
What physical exam finding is often associated with alopecia areata?
Nail pitting
What is the hallmark of psychogenic erectile dyfunction?
Normal non-sexual nocturnal erections
How does polymyalgia rheumatica present?
Muscle pain and stiffness in shoulders and hips
What is an important characteristic of ecthyma gangrenosum that differentiates it from conditions such as gas gangrene?
Non-painful lesions
How long must a tick be attached in order to transmit Lyme disease?
> 36 hours
What is seen on Hb electrophoresis in alpha- and beta-thalassemia?
Alpha-thalassemia: normal
Beta-thalassemia: increased HbA2
At what beta-hCG level can an intrauterine pregnancy be visualized on US?
> 3500
What is the mechanism of action of glipizide?
Insulin secretagogue
When should an evaluation for primary amenorrhea be initiated?
No menses at > 15 with secondary sexual characteristics or > 13 without secondary sexual characteristics
Which adjunctive therapy is indicated for cataplexy in patients with narcolepsy?
SNRI or SSRI
How does amiodarone usually affect thyroid function?
Decreased peripheral conversion of T4 to T3 leading to increased T4 and decreased T3
What is propranolol’s impact on thyroid function?
Decreased peripheral conversion of T4 to T3 and can be used in thyrotoxic emergencies
What serum glucose level after a glucose challenge test should trigger a glucose tolerance test?
> 140
When should pregnant women be screened for gestational diabetes with a 50-g glucose challenge test?
24-28 weeks of gestation
What are the target fasting, 1 hour post-prandial, and 2 hours post-prandial blood glucose levels in women with gestational diabetes?
Fasting: < 95
1 hour post-prandial: < 140
2 hours post-prandial: < 120
What is the medical management of prolactinoma?
Dopamine agonists (i.e. cabergoline, bromocriptine)
What changes to breastfeeding are indicated in women who require metronidazole treatment?
Express and discard breast milk for 24 hours after administration due to risk of diarrhea and candidiasis in infant
What is the treatment for trichomoniasis?
Oral metronidazole
What is the risk of using antipsychotics in patients with dementia?
Increased mortality risk
What effect do salicylates have on respirations?
Tachypnea
What is the antidote for cholinergic toxicity?
Atropine
What are the treatments for salicylate toxicity?
Sodium bicarbonate, glucose, and activated charcoal (if < 2 hours after ingestion)
What are the most common symptoms of acute intermittent porphyria?
Acute abdominal pain and neuropsychiatric symptoms
What is the appropriate timing of anti-D Ig in Rh(D)-negative pregnant women?
28-32 weeks gestation and < 72 hours postpartum
What is the treatment of diffuse esophageal spasm?
Calcium channel blocker
What is the appearance of diffuse esophageal spasm on barium swallow?
Corkscrew appearance
What is the appearance of achalasia on barium swallow?
Proximal esophageal dilation with a bird’s-beak narrowing of distal esophagus
What is the clinical triad of Plummer-Vinson syndrome?
Iron-deficiency anemia, dysphagia, and esophageal web
What Cobb angle is associated with scoliosis?
> 10 degrees
How is scabies definitively diagnosed?
Skin scrapings with visualization under light microscopy
How can tinea corporis infections be definitively diagnosed?
KOH prep
Why is saw palmetto used?
Reportedly improves benign prostatic hyperplasia
What is the potential adverse effect of kava kava supplementation?
Liver damage
What is secondary hyperparathyroidism?
Compensatory rise in PTH secondary to hypocalcemia (commonly seen in CKD)
How does androgen insensitivity syndrome present?
Breast development but no pubic or axillary hair
What is the definition of primary amenorrhea?
No menarche at > 15 if breasts are present and > 13 if breasts are absent
What is the management of a non-tension pneumothorax?
Chest tube placement
What is the management of incidentally found adrenal tumors (incidentalomas)?
Assess for functional tumor with serum electrolytes, dexamethasone suppression test, and urinary metanephrines
How does tick paralysis present?
Ascending paralysis and absent deep tendon reflexes
What is the preferred inpatient antibiotic regimen for pelvic inflammatory disease?
Cefoxitin + doxycycline
What is primary, secondary, and tertiary prevention?
Primary: prevention of disease before it happens
Secondary: halt progression of disease in its early stages
Tertiary: limit impairment from disease after it has reached advanced stages
What is the most common inherited thrombophilia?
Factor V Leiden mutation
What is the mechanism of action of bupropion?
Norepinephrine and dopamine reuptake inhibitor
What is the most specific antibody for rheumatoid arthritis?
Anti-CCP antibody
What is the first-line treatment for rheumatic arthritis with joint erosion?
Methotrexate
What are the main risks of bisphosphonates?
Jaw osteonecrosis and pill esophagitis
What are the main risks of bisphosphonates?
Jaw osteonecrosis and pill esophagitis
What is the appropriate screening for DM in women with GDM?
Fasting blood glucose 24-72 hours after delivery; GTT 6-12 weeks after delivery; screening every 3 years
What diagnosis is associated with pulsus paradoxus?
Cardiac tamponade
Which imaging modality is used to assess disease status in multiple myeloma?
Whole-body low-dose CT
What is the pathophysiology of hyperviscosity syndrome in multiple myeloma?
Excessive production of IgM
What is the most common causative organism for croup?
Paraflu
What is per-protocol analysis?
Include only those subjects who completed the protocol in analysis (as opposed to intention-to-treat analysis)
What is the management of acute toxic megacolon in a patient with underlying IBD?
Steroids
Which laboratory test is used to diagnose systemic mastocytosis?
Elevated serum tryptase
What are the symptoms of Wernicke’s encephalopathy?
Encephalopathy, oculomotor dysfunction (i.e. lateral rectus palsy), and gait ataxia
What is the initial management of Wernicke’s encephalopathy?
IV thiamine THEN glucose
What are the symptoms of Korsakoff syndrome?
Amnesia and confabulation
What is the recommendation for statin therapy in patients with diabetes?
Statins are indicated for ALL diabetic patients (type I and II) > 40 years old
Which medications are indicated in refractory psychosis in patients with underlying Parkinson disease?
Quetiapine and clozapine due to the lowest risk of drug-induced Parkinsonism
What is the first step in diagnosis of oropharyngeal or esophageal dysphagia?
Nasopharyngeal laryngoscopy
What is the difference in location and risk factors for adenocarcinoma and squamous cell carcinoma of the esophagus?
Adenocarcinoma: from chronic GERD and Barrett’s esophagus; mid- to distal esophagus
Squamous cell carcinoma: from tobacco or alcohol; upper esophagus
What is the presentation of macular degeneration?
Loss of central vision
Which disorder is associated with late-onset depression?
Dementia
What is a common systemic consequence of compartment syndrome?
Rhabdomyolysis leading to acute renal failure
Which pressures indicate significant compartment syndrome?
Pressure > 30 mmHg or delta pressure (diastolic BP - compartment pressure) < 30 mmHg
What is the difference between provisional tic disorder and chronic tic disorder?
Provisional tic disorder: motor OR verbal tic < 1 year
Chronic tic disorder: motor OR verbal tic > 1 year
What is the first step in diagnosing impaired gastric emptying?
EGD to rule out mechanical obstruction
What is the first step in diagnosing impaired gastric emptying?
EGD to rule out mechanical obstruction
What is the first-line medication for diabetic gastroparesis?
Metoclopramide
When should post-exposure prophylaxis against HIV be initiated?
Within 72 hours of high-risk exposure
What is the mechanism of breast milk jaundice?
High levels of beta-glucuronidase in breastmilk deconjugates bilirubin and causes increased intestinal absorption and enterohepatic circulation of bilirubin
What are the first-line drugs for atrial fibrillation?
Beta-blockers or non-dihydropyridine CCB* (i.e. verapamil, diltiazem)
*CCB contraindicated in hypotension or decompensated CHF
What are the first-line treatments for suspected uncomplicated cystitis in an adult?
Bactrim or nitrofurantoin
How does overflow incontinence present?
Constant urinary leakage
How does urge incontinence present?
Overwhelming urge to urinate followed by involuntary loss of urine
What is the first-line treatment for early Parkinson disease with mild symptoms in patients < 65?
Dopamine agonists (i.e. pramipexole, bromocriptine) in order to reserve levodopa for more severe symptoms
What is seen on echo in patients with dilated cardiomyopathy?
LV dilatation with reduced EF
What is the single most important risk factor for osteopenia and osteoporosis?
Age
What is the standard of care for community-acquired PNA treatment in the inpatient setting?
Ceftriaxone + azithromycin OR levofloxacin
What is the equation for calcium correction for albumin level?
Corrected calcium = (measured calcium) - 0.8(4 - measured albumin)
What is the typical presentation of cryptococcal infection?
Meningoencephalitis
Where does aspergillus usually manifest itself?
Lungs or sinuses
What is a unique feature of medial medullary syndrome?
Ipsilateral tongue weakness with deviation toward the side of injury
What is the best modality to diagnose a subphrenic abscess?
Abdominal US
What is the appropriate treatment for urethritis associated with neutrophils but no organisms on Gram stain?
Azithromycin or doxycycline to treat chlamydia because gonorrhea would show up as Gram-negative diplococci on Gram stain
What is the treatment for bacterial prostatitis?
6 weeks of Bactrim
What are the first-line treatments for cystitis during pregnancy?
Cephalexin, fosfomycin, or Augmentin
Which thyroid labs are used during pregnancy?
TSH and total T4
Which lung fields are most commonly implicated in aspiration PNA?
Right middle and lower lobes
What is the management of torsades de pointes if magnesium sulfate fails?
Transvenous pacing
What is the appropriate diagnostic test in patients with suspected active TB on CXR?
Sputum sample
What is midodrine?
Alpha-adrenergic agonist used to treat orthostatic hypotension
Why is Bactrim avoided in breastfeeding mothers?
Risk of neonatal kernicterus
What is the most effective form of contraception?
Progestin implant
What is the treatment for neonatal toxoplasmosis?
Pyrimethamine, sulfadiazine, and folinic acid
What are the Rinne and Weber test results in sensorineural hearing loss?
Rinne: air > bone in both ears
Weber: lateralizes to unaffected ear
How is gout diagnosed?
Arthrocentesis showing needle-shaped and negatively birefringent monosodium urate crystals
What is the difference between gout and pseudogout under polarized light?
Gout: needle-shaped negatively birefringent crystals
Pseudogout: rhomboid-shaped positively birefringent crystals
What is the treatment for gout?
NSAIDs or colchicine if NSAIDs contraindicated (i.e. renal failure, liver failure, heart failure, anticoagulated)
What is the definition of hypomanic?
Manic symptoms for > 4 days
Which paraneoplastic condition is associated with squamous cell carcinoma of the lungs?
Hypercalcemia from PTHrP
Which paraneoplastic condition is associated with small cell carcinoma of the lung?
SIADH
What are the common presenting symptoms of dengue?
Retroorbital pain, arthralgias, and myalgias
What is the most serious complication of dengue?
Dengue shock syndrome with circulatory collapse
What is the post-exposure management of rabies in patients with and without previous rabies vaccine?
With previous vaccine: repeat rabies vaccine
Without previous vaccine: rabies vaccine and immune globulin
Which prognostic factor is most important in predicting a poor outcome in COPD?
FEV1 < 40%
What is the presentation of pineal gland tumors?
Parinaud’s syndrome with loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus, and ataxia
What is the classic presentation of craniopharyngioma?
Diabetes insipidus
Which allergen is most closely associated with asthma?
House dust mite
Which risk factor is most strongly associated with expansion of an asymptomatic abdominal aortic aneurysm?
Current cigarette smoking
Which population must be screened for abdominal aortic aneurysm?
Abdominal US in men ages 65-75 who have ever smoked
Which labs can be used to monitor disease activity in lupus nephritis?
Complement and anti-dsDNA
Which bacteria causes otitis media with purulent conjunctivitis in children?
Non-typeable H. flu
What is the formula for attributable risk?
Attributable risk = (RR - 1) / (RR)
Which conditions are associated with pulsus paradoxus?
Cardiac tamponade, asthma, COPD, and significant obesity
What surveillance is required after diagnosing hydatidiform mole?
Weekly beta-hCG until decreasing and then monthly beta-hCG for 6 months until undetectable in order to monitor progression to gestational trophoblastic neoplasia
What is the first-line treatment for gestational trophoblastic neoplasia?
Methotrexate
What is the most common site of metastasis for gestational trophoblastic neoplasia?
Lungs
What is the treatment for antipsychotic-induced akathisia?
Trial of reducing antipsychotic dosage followed by propranolol if that fails
What is the treatment for hepatorenal syndrome?
Midodrine and octreotide
How does anserine bursitis present?
Pain at medial knee
Which physical exam maneuver can help to diagnose patellofemoral pain syndrome?
Pain and/or crepitus with extension of the knee while compressing the patella (patellofemoral compression test)
What are the potential adverse effects of licorice?
HTN and hypokalemia
What is the main adverse effect of black cohosh?
Hepatotoxicity
What are the potential adverse effects of Ginkgo biloba and ginseng?
Increased bleeding risk
What is the INR goal in mechanical aortic and mitral valve replacement?
Mechanical aortic valve: 2-3
Mechanical mitral valve: 2.5-3.5
Which disease are patients with renal transplantation most at risk of developing within the first several months?
Diabetes
What is the threshold for a positive tuberculin skin test?
> 10 mm induration at 48 hours
What is the treatment for severe glyburide overdose with refractory hypoglycemia?
Octreotide because it blocks insulin release
What is the main indication for radionuclide bone scans?
Identify bony metastasis from prostate or breast cancer
How does congenital rubella present?
Sensorineural hearing loss, cataracts, and PDA
What is the management of pyelonephritis during pregnancy?
Treatment followed by antibiotic suppression until 6 weeks postpartum
Which systemic diseases are associated with widespread seborrheic dermatitis?
HIV and Parkinson disease
What are the coronary heart disease risk equivalents?
Non-coronary atherosclerosis, DM, and CKD
What is the definitive treatment for medullary thyroid cancer?
Thyroidectomy
Which medication is typically prescribed to patients with Marfan syndrome to prevent aortic root weakening?
Beta-blocker to reduce myocardial contractility
Which neurologic condition is associated with Ehlers-Danlos syndrome?
Berry aneurysms
What is the difference in lens dislocation between Marfan syndrome and homocystinuria?
Marfan syndrome: upward dislocation
Homocystinuria: downward dislocation
What is the presentation of homocystinuria?
Downward lens dislocation (as compared to Marfan syndrome), venous thromboembolism, and intellectual disability
What is the most significant adverse effect of trastuzumab?
Reversible cardiotoxicity
What is the treatment of lead toxicity by venous lead level?
45-69: DMSA
> 70: dimercaprol + EDTA
What is the appropriate diagnostic test for hematochezia with hemodynamic instability?
EGD
What is the feared adverse effect with clozapine?
Agranulocytosis
What is a common adverse effect of olanzapine?
Weight gain
What are the benefits of tight glycemic control (HbA1c < 7%) in patients with type II DM?
Reduces risk of microvascular complications such as nephropathy and retinopathy
What is the main indication for raloxifene?
Post-menopausal osteoporosis
What urine osmolality and urine sodium levels are highly suggestive of SIADH?
- Urine osmolality*: > 100
- Urine sodium*: > 40
What is the timing of acute stress disorder vs. PTSD?
Acute stress disorder: 3 days-1 month
PTSD: > 1 month
What is an indication for C-section in pregnant women with HIV?
Third trimester viral load > 1000
What is an indication for C-section in pregnant women with HIV?
Third trimester viral load > 1000
What is the main indication for thrombolysis in PE?
Hemodynamic instability
What is the treatment of active TB?
Rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) for 4 months followed by rifampin and isoniazid for 2 months
What is the clinical triad of hemolytic uremic syndrome (HUS)?
Microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure after an acute bloody diarrheal illness
What are the cortisol and ACTH levels in central (pituitary-dependent) Cushing disease?
High cortisol and normal or high ACTH
What is the treatment for neonatal gonococcal conjunctivitis?
IM ceftriaxone or cefotaxime
What is the treatment of scleroderma renal crisis?
Captopril
What is the treatment of neurologic dysfunction in the setting of scleroderma renal crisis?
Nitroprusside
What is the acute management of hypertriglyceridemia-induced pancreatitis?
Insulin
What is the mechanism of hematochezia in diverticulosis?
Injury to an exposed artery
What is the mechanism of hematochezia in hemorrhoidal bleeding?
Dilation of the submucosal venous plexus
What is the preferred treatment for plantar warts?
Salicylic acid followed by application of duct tape for 48-72 hours
What is the treatment of an acute gout attack in patients with CKD?
Intra-articular corticosteroids because NSAIDs and colchicine should be avoided in CKD
What diagnosis is suggested by bloating and watery diarrhea in a patient with systemic sclerosis?
SIBO
What is the first-line antihypertensive medication in patients with gout?
Losartan
What is the first-line treatment for agitation with PCP intoxication?
Benzodiazepines
What is the management of acute decompensated heart failure that does not respond to initial diuretic therapy?
Vasodilator such as nitroglycerin
What is the first-line treatment for ADHD in preschool-aged children?
Behavioral therapy
What is the effect of thiazide diuretics, NSAIDs, and ACE inhibitors on lithium levels?
Increases serum lithium levels
What is the presentation of roseola?
Fever and rash with onset after defervescence
Which electrolyte abnormality is associated with chronic hypothyroidism?
Hyponatremia
What are the lab findings in G6PD deficiency in the newborn period?
Unconjugated hyperbilirubinemia and anemia
What is the time window for considering thrombolysis in ischemic stroke?
< 4.5 hours since symptom onset
What is the first-line antibiotic regimen for postpartum endometritis?
Clindamycin and gentamicin
What is the most important risk factor for postpartum endometritis?
C-section
Which medication class artificially elevates BNP levels?
Angiotensin receptor-neprilysin inhibitor such as sacubitril-valsartan
What is the indication for methylnaltrexone?
Reverses opioid-induced constipation while maintaining analgesic effects
What is a unique hallmark of juvenile myoclonic epilepsy?
Myoclonus upon awakening
What is seen on EEG in juvenile myoclonic epilepsy?
Bilateral polyspike and slow-wave discharges during the interictal period
What are the common adverse effects of valproic acid?
Thrombocytopenia, hepatotoxicity, and pancreatitis
What are the first-line treatment options for Raynaud phenomenon?
Dihydropyridine calcium channel blockers such as nifedipine or amlodipine
What are the classic lab findings in Paget disease of bone?
Increased alkaline phosphatase and normal calcium
What are the main non-modifiable risk factors for SIDS?
Prematurity, low birth weight, and maternal age < 20
What does a negative cardiac stress test mean?
< 1% risk of cardiovascular events in the next year
What is the criteria for starting women on antibiotic prophylaxis for recurrent UTI?
2+ UTIs in 6 months or 3+ UTIs in 1 year
What is the recommendation for follow-up colonoscopy in patients with villous adenoma or tubular adenoma > 10 mm?
Colonoscopy in 3 years
What is the classic eye finding in tuberculous meningitis?
Yellow-white nodules near the optic disc called choroidal tubercles
What is the classic brain imaging finding in tuberculous meningitis?
Basilar meningeal enhancement
What is the most common type of breast mass in adolescent girls?
Fibroadenoma
What is the definitive treatment for normal-pressure hydrocephalus?
VP shunt
What type of cardiomyopathy is caused by anthracyclines vs. radiation?
- Anthracyclines*: dilated cardiomyopathy
- Radiation*: restrictive cardiomyopathy
At what age should abdominal thrusts be performed in choking children?
> 1 year of age
How does cyanide cause its harm on a molecular level?
Inhibits mitochondrial oxidative phosphorylation and thereby prevents the formation of ATP
What is the classic skin finding in cyanide poisoning?
Cherry-red skin
Which medication can treat widespread actinic keratosis?
Topical 5-FU
What is the treatment for rosacea?
Doxycycline
What is the diagnostic criteria for ADHD?
Onset before 12 years of age and duration for > 6 months
What are the ECG findings in Brugada syndrome?
RBBB and ST elevation in V1-V3
What is the indication for starting Bactrim prophylaxis in HIV-positive patients?
CD4 count < 200
What is the management of mild nausea and vomiting during pregnancy?
Vitamin B6 and H1 antihistamine
What is the presentation of granulomatosis with polyangiitis?
Glomerulonephritis, pneumonitis, and recurrent sinusitis or otitis media
What is the Seidel’s test?
Fluorescein uptake with waterfall sign indicates an open globe injury and is an ophthalmologic emergency
What is the first-line treatment of rhinosinusitis?
Augmentin
What is the BP goal after thrombolysis with tPA?
< 180/105
When are antiplatelet or anticoagulants started in stroke patients who receive tPA?
24-48 hours after tPA due to the initial risk of conversion to hemorrhagic stroke
When does kidney disease usually present in patients with type I DM?
> 5 years after diagnosis
What is the classic presentation of Vibrio vulnificus infection?
Cellulitis with hemorrhagic bullae and/or necrotizing fasciitis
What is the treatment for cellulitis caused by Vibrio vulnificus?
Ceftriaxone and doxycycline
What is the best diagnostic modality for pneumothorax in an acute setting?
US
What is the ethical principle of proportionality?
Ensures that a medical intervention is necessary, appropriate, and not excessive
What is the timeframe for delivering activated charcoal in the setting of acetaminophen overdose?
Within 4 hours of ingestion
Which adverse effect is associated with combined estrogen/progesterone hormonal replacement in all age groups?
Ischemic stroke
Which structure is typically injured when the knees are injured by hitting into a structure during a motor vehicle accident?
PCL
What work-up is required in the setting of an ischemic stroke with a negative in-hospital etiology work-up?
Cardiac imaging (i.e. cardiac MRI) and ambulatory cardiac monitoring for 30 days
What is the first-line treatment for photoaged skin?
Topical tretinoin
Which disease is associated with lichen planus?
Hepatitis C
How can significance be determined with confidence intervals?
Confidence intervals that cross 0 are not significant
What is the next step in management when idiopathic Parkinson disease is diagnosed clinically?
Trial of carbidopa-levodopa
What is the first step in management of a child with chronic cough > 4 weeks?
Spirometry to differentiate between obstructive and restrictive lung disease
What is the relationship between BNP levels and obesity?
Obesity can cause falsely low BNP levels
What monitoring is required for patients on oral retinoids?
LFTs and lipids
What is the most common site of metastasis of prostate cancer?
Bone
What is the hallmark of cardiac syncope?
No autonomic prodrome
What size of ocular melanoma is appropriate for watchful waiting and close follow-up?
< 10 mm in diameter and < 3 mm in thickness
What is the initial management of ocular melanoma?
Radiation
How is Lyme disease diagnosed at the early disseminated and late stages?
ELISA followed by confirmatory Western blot
What is the treatment of Lyme disease complicated by carditis with AV block or meningitis?
IV ceftriaxone rather than oral doxycycline
What is the purpose of a funnel plot?
Analyzes publication bias
What is the recommended screening for prostate cancer?
PSA in men ages 55-69
How does HSV keratitis appear on fluorescein staining?
Dendritic ulceration
What is the appropriate treatment of aspiration PNA?
Ceftriaxone and azithromycin to target normal CAP organisms because anaerobic bacteria predominate in a minority of cases
What is the first step in management after a caustic ingestion?
Laryngoscopy to determine airway patency
Which nerve is typically damaged in shoulder dislocation?
Axillary nerve
What is the management of levothyroxine dosages during pregnancy?
Increase levothyroxine dose by 30% at the time of a positive pregnancy test and check TSH levels every 4 weeks
What is a common contraindication to cerclage placement in women with cervical insufficiency?
Prolapsed amniotic membrane
What type of evaluation is indicated in patients with suspected neurofibromatosis?
Ophthalmologic evaluation to assess for bilateral optic gliomas that can impact vision
What is the most common complication of transurethral resection of the prostate?
Retrograde ejaculation
What is the primary purpose of intention-to-treat analysis?
Preserves randomization
Which cancer is most associated with Hashimoto thyroiditis?
Thyroid lymphoma
What are the appropriate empiric antibiotics for septic arthritis in children < 3 months and children > 3 months?
< 3 months: vancomycin + cefotaxime
> 3 months: vancomycin
When is lymphadenopathy expected to resolve after infectious mononucleosis?
Within 4 weeks
How do granulomatous disorders cause hypercalcemia?
Extrarenal production of 1,25-vitamin D
What is the typical x-ray appearance of transient tachypnea of the newborn?
Flattened diaphragms and fluid in interlobar fissures
What is the mechanism of action of dobutamine?
Beta-1 agonist that increases inotropy
What is the presentation of hypoglossal nerve injury?
Tongue deviation toward the side of injury
What is the pathophysiology of methemoglobinemia?
Iron within hemoglobin undergoes oxidation to form methemoglobin, which cannot bind O2
What is the appearance on x-ray of Pneumocystis pneumonia?
Diffuse interstitial infiltrate
Which medication is often given preoperatively in the setting of symptomatic leiomyomas with heavy bleeding?
GnRH agonist
What is the management of auricular hematoma?
I&D to prevent abscess and permanent deformities
At what point do infants no longer require frequent feedings every 2-4 hours and can safely sleep through the night without feeds?
4-6 months of age
What is a common adverse effect of pioglitazone?
Pulmonary edema due to sodium reabsorption in the collecting duct
What is the mechanism of acute mitral regurgitation in patients with underlying connective tissue disorder?
Rupture of chordae tendineae
What are the criteria for transitioning from IV insulin to SQ insulin in the setting of DKA?
Anion gap < 12, serum bicarbonate > 15, and pH > 7.3
What is the difference in results of radioactive iodine uptake in Graves disease vs. postpartum thyroiditis and silent thyroiditis?
Graves disease: high uptake
Postpartum thyroiditis and silent thyroiditis: low uptake
How are thyroid labs usually altered during pregnancy?
Elevated total T4
What is the thyroid physical exam in subacute granulomatous (de Quervain) thyroiditis?
Tender
What is the first-line treatment for HTN in patients with HOCM?
Beta-blockers
What is the length-time bias?
Identification of more benign cases gives the impression that the screening tool improves survival
What is the typical time of onset of Dressler syndrome after an MI?
Several weeks after an MI
What is the management of peri-infarction pericarditis?
High-dose aspirin
Why is epinephrine contraindicated in the setting of MI?
Stimulation of alpha-1 and beta-1 receptors increases myocardial oxygen demand
What is the treatment of invasive pulmonary aspergillosis?
Voriconazole because fluconazole has no activity against Aspergillus
What is the primary presenting symptom of acute colonic ischemia?
Bloody diarrhea
What is the treatment of polymyalgia rheumatica?
Low-dose steroids
Which joint is usually affected in pseudogout?
Knee
What is placenta previa and how does it present?
Implantation of the placenta over the cervix that presents with painless vaginal bleeding
What is the hallmark of schizoaffective disorder?
Delusions or hallucinations that occur for > 2 weeks in the absence of depressive or manic symptoms
How does diaphragmatic paralysis present?
Dyspnea while supine
What is the treatment of symptomatic Paget disease of bone?
Bisphosphonates
What is the treatment for lichen sclerosus?
High-potency topical corticosteroids
How can iron-deficiency anemia be differentiated from thalassemia based upon labs alone?
Mentzer index (MCV/RBC)
Iron-deficiency anemia: index > 13
Thalassemia: index < 13
What is the indication for octreotide in GI bleeding?
Upper GI bleed secondary to variceal hemorrhage
What is the preferred treatment for rheumatic fever?
Monthly penicillin G
What has been shown to decrease the progression of CKD in diabetic patients with significant albuminuria?
Intensive BP control
Which vitamin deficiency is most associated with a vegan diet?
Vitamin B12 deficiency
What is the major adverse effect of GnRH agonists?
Decreased bone mineral density
Which cancer type is associated with acromegaly?
Colon cancer
How does non-classical CAH present in boys?
Public and axillary hair growth without associated testicular enlargement
What is considered excessive alcohol intake in a day, a sitting, and a week for men and women?
Men: > 4 in a day, > 5 in a sitting, and > 14 in a week
Women: > 3 in a day, > 4 in a sitting, and > 7 in a week
When should pediatricians screen children for dyslipidemia?
Between the ages of 9-11 and 17-21
When should delivery take place in pregnant women with preeclampsia?
34-37 weeks of gestation
How does serum sickness present?
Rash, renal failure, and polyarthralgia
What is the mechanism of action of carbidopa?
Prevents peripheral conversion of L-DOPA to dopamine to increase dopamine levels in the brain and prevent adverse effects
How do chikungunya infections present?
Fever and polyarthralgia
What is the treatment of severe long-term polyarthralgia after infection with chikungunya virus?
Methotrexate
What is the classic skin finding in typhoid fever?
Rose spots
What is the presentation of meralgia paresthetica (lateral femoral cutaneous nerve entrapment)?
Numbness over anterolateral thigh
When is prednisone indicated in Graves disease?
Ophthalmopathy
Which labs should be followed after starting anti-thyroid medications for hyperthyroidism?
Free T4 and total T3
Which types of infections are most common in patients with chronic granulomatous disease?
Infection with catalase-positive organisms including S. aureus, Burkholderia, Aspergillus, Nocardia, and Serratia
What is the purpose of cross-sectional studies?
Simultaneously estimates the prevalence of a risk factor and disease
What is a case-control study?
Identifies cases of a specific disease and determines past exposure to risk factors
What is an absolute contraindication to oral codeine and tramadol treatment?
Age < 12 due to ultra-rapid metabolism with the risk of severe respiratory depression
What is the appearance of constrictive pericarditis on CXR?
Calcified cardiac border
What is the definition of chronic bronchitis?
Cough for > 3 months in 2 consecutive years
Which antibody is highly associated with drug-induced lupus?
Anti-histone antibody
Which medications are first-line treatments of claudication?
Aspirin and high-intensity statin
What lifestyle modifications are indicated for the initial management of claudication?
Smoking cessation and a supervised exercise program
What is the inheritance pattern of Duchenne, Becker, and myotonic muscular dystrophies?
Duchenne and Becker muscular dystrophies: X-linked recessive
Myotonic muscular dystrophy: autosomal dominant
What is the first step in management of a breast mass in women > 30 years of age?
Mammogram
How is C-peptide used in evaluating the etiology of hypoglycemia?
C-peptide is low with exogenous insulin administration
What is the initial management of dumping syndrome?
High-protein diet and small portion sizes
What are appropriate treatment options for acute mania during pregnancy?
Lithium and first- and second-generation antipsychotics
What is the mode of transmission for molluscum contagiosum?
Skin-to-skin contact or exposure to infected fomites
What is the next step in management if an SSRI fails to treat premenstrual dysphoric disorder?
Trial another SSRI
What is the management of anticoagulation during pregnancy for women with a mechanical heart valve?
First trimester: replace warfarin with LMWH (i.e. Lovenox)
Second and third trimesters: continue warfarin
Before delivery: replace warfarin with unfractionated heparin
Which autoimmune disorders are associated with Turner syndrome?
Hypothyroidism and celiac disease
Which neuropsychiatric condition is associated with fragile X syndrome?
Autism spectrum disorder
What is the inheritance pattern of Turner syndrome?
Usually a sporadic event with no genetic inheritance
What is the treatment of active TB during pregnancy?
Rifampin, isoniazid, and ethambutol but not pyrazinamide because it has uncertain safety during pregnancy
When should erythropoietin be initiated in patients with CKD?
Hgb < 10
How is chronic granulomatous disease (CGD) diagnosed?
Dihydrorhodamine 123 oxidation test
Which drugs are typically used to treat symptomatic HOCM?
Beta-bockers and/or verapamil in order to increase preload and reduce left ventricular outflow obstruction
Which bacteria is most often responsible for erysipelas?
S. pyogenes
What is the treatment of post-cholecystectomy diarrhea?
Cholestyramine
What is the indication of magnesium in preterm prelabor rupture of membranes?
< 32 weeks gestation to prevent fetal neurologic complications
Why do people usually use ginkgo biloba?
Supposedly improves memory
What is the treatment of H. pylori in patients with significant penicillin allergies?
PPI, clarithromycin, and metronidazole
At what ages should children receive the hepatitis B vaccine?
0, 2, and 6 months of age
What is the underlying mechanism of urge incontinence?
Detrusor muscle overactivity
Which hemodynamic measurement is most associated with cardiogenic shock?
Low cardiac index
What is the standard treatment for non-metastatic vocal cord cancer?
Radiation
What are the typical lab findings in central precocious puberty?
Elevated LH and FSH
What is the clinical triad of McCune-Albright syndrome?
Irregular cafe-au-lait spots, fibrous dysplasia of the bone, and peripheral precocious puberty
What are the fundoscopic findings in central retinal artery occlusion?
Ischemic fundus with cherry-red spot
What is the criteria for placement of a biventricular pacer in patients with heart failure?
EF < 30%, symptomatic heart failure, and LBBB with QRS > 150 msec
What is the medical management of acute aortic dissection?
Beta-blocker + sodium nitroprusside if systolic BP > 120 after beta-blockade
What is the treatment for prolactinoma?
Dopamine agonists since prolactinoma resection is rarely required
What is the management of cyanide toxicity secondary to nitroprusside?
Sodium thiosulfate
What is the difference between active and latent medical errors?
Active: errors of front-line personnel
Latent: system errors
Which antipsychotics are most associated with hyperprolactinemia?
First-generation antipsychotics and risperidone
Which medications for diabetes are most associated with hypoglycemia?
Insulin secretagogues including sulfonylureas (-ide) and meglitinides (-nide)
What is capitation?
Reimbursement based upon the number of patients served
What is the management of bariatric surgery and pregnancy?
Delay pregnancy for 1 year after bariatric surgery due to the risk of nutritional deficiencies
When is the Tdap vaccine indicated during pregnancy?
> 28 weeks gestation regardless of vaccination history
What estrogen and testosterone levels are expected in PCOS?
Elevated estrogen and testosterone levels
What is the indication for tocolytics?
Preterm labor at < 34 weeks gestation
What is the first-line treatment for psoriatic arthritis?
Methotrexate
Which disorders are associated with a low maternal serum AFP?
Aneuploidies such as trisomy 18 and 21
Which type of study design is most helpful in assessing outbreaks?
Case-control study
What is the strongest risk factor for recurrent pelvic inflammatory disease?
Multiple sexual partners
Which tocolytics are used in preterm labor?
< 32 weeks: indomethacin
32-34 weeks: nifedipine
What is the indication for corticosteroids in preterm labor?
Labor at < 34 weeks gestation
Which risk assessment tool is used to determine if anticoagulation is needed in patients with atrial fibrillation?
CHA2DS2-VASc score with score > 2 requiring anticoagulation
CHF, HTN, age > 75 (2), DM, stroke/TIA (2), vascular disease, age 65-74, sex category female
What type of imaging is indicated for suspected appendicitis during pregnancy?
Graded compression abdominal US
What prolactin level is expected in prolactinoma?
> 200
Which medication is indicated to prevent preeclampsia in women with a history of preeclampsia?
Aspirin started between 12-16 weeks gestation
What is the management of porcelain gallbladder?
Prophylactic cholecystectomy due to increased risk of malignancy
What is the gold standard for diagnosing abdominal compartment syndrome?
Measurement of bladder pressure with a Foley catheter
What size of kidney stone can be managed conservatively on an outpatient basis?
< 10 mm
Which pregnant patients should not exercise?
Active vaginal bleeding and risk of preterm delivery (i.e. cerclage placement)
What is a long-term risk of kidney donation in women?
Pregnancy complications
What is the timeframe of chronic bacterial prostatitis?
Symptoms for > 3 months
What is the hallmark of constitutional pubertal delay?
Delayed bone age
What is the main contraindication for rasburicase?
G6PD deficiency because it can precipitate methemoglobinemia and hemolysis
What is the second-line treatment for hypertrophic cardiomyopathy when beta-blockers cannot be tolerated?
Verapamil
What is the treatment for chronic giardiasis?
Tinidazole or nitazoxanide
What is the first-line treatment for non-typhoidal Salmonella?
Ciprofloxacin
Which type of fracture is associated with spondylolysis?
Fracture of pars interarticularis
Which medication can be used in adults with ADHD in order to avoid addiction potential?
Atomoxetine
What is the treatment for local anesthetic toxicity?
IV lipid emulsion
