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USMLE Step 2 CK > Uworld Pass 2a > Flashcards

Uworld Pass 2a Flashcards

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USMLE® Step 1 flashcards
1
Q

nonhemolytic tranfusion reaction? Management

A

1-6 hours after transfusion

transient fevers, chills, malaise

Management: stop transfusion -> use leukoreduction for all future transfusion

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2
Q

CMV vs. rubella?

A

Rubella has cardiac defects, CMV does not

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3
Q

Long-term treatment for cocaine?

A

12 step program and individual therapy

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4
Q

painless muscle weakness associated with weight gain, bone loss, hypertension, hirsutism?

A

Hypercortisolism (Cushing’s syndrome)

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5
Q

Leading cause of diabetes retinopathy in the US? Signs?

A

Diabetic retinopathy

Types: 1. microaneurysms, hemorrhages, exudates, retinal edema

  1. cotton wool spots
  2. newly formed vessesl
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6
Q

Most common causes of aortic regurgitation in developed countries?

A

Dilation of the aortic root, congenital bicuspid valve

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7
Q

Signs of opiod overdose

A

reduction in both respiratory rate, tidal volume, respiratory acidosis, hypothermia

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8
Q

Side effects of mirtazapine?

A

SNRI, dedating, increase apetite

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9
Q

Signs of testicular torsion?

A

bell-clapper deformity (high riding testes) decreased crenasteruc refkex

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10
Q

abdominal pain, emesis, 24-36 hours after blunt abdominal trauma in children? Diagnostic method?

A

duadenal hematomas

Ct imaging is diagnostic

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11
Q

Contraindications in the infant for breast feeding?

A

Galactosemia

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12
Q

Probenecid MoA?

A

Increases uric acid secretion in the kidneys

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13
Q

Most common injury in a midshaft humerus fracture?

A

Radial nerve

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14
Q

Causes of idiopathic intracranial hypertension?

A

growth hormone, tetracyclines, excessive vitamin A (and derivatives)

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15
Q

Breath sounds in consolidations?

A

Increased

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16
Q

How does a pheochromocytoma act?

A

increased catecholamine secretion

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17
Q

What is an Ergot?

A

5-HT agonist

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18
Q

When to expect Shy-Drager syndrome (multiple system atrophy?)

A

Person with Parkinsonism experiences orthostatic hypotension, impotence, incontinence, or other autonomic symptoms

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19
Q

bright red, firm, friable, exophytic nodules in HIV infected patient?

A

bacillary angiomatosis, caused by Bartonella, a Gram-negative bacillus

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20
Q

Should natrexone and naloxone be given for opiod withdrawals?

A

No, they worsen them

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21
Q

Features of 11beta-hydroxylase?

A

Ambiguous gentialia in firls, fluid and salt retention, hypertension

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22
Q

Signs of mitral regurgitation?

A

sever pulmonary edema, hypotension, with hyperdynamic precordium

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23
Q

When is cholithiasis risk increased in TPN?

A

> 2 weeks of TPN admission -> increased cholestasis

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24
Q

Wernicke encephalopathy presentation?

A

altered mental status, ataxia, nystagmus

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25
Q

Polyarteritis nodose

A

skin lesions and myalgias, and necrotizing vasculitit

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26
Q

extranodal marhinal zone b lymphoma in mmucosa-associated lympnoid tissue (MALT) of the stomach risk factor?

A

H. pylori

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27
Q

What is a confounding error?

A

mixing up of the effet of exposure with the effect of an extraneous factor, must have properties linking it with the exposure of interest

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28
Q

What affect do diuretics and vomiting have on pH? Bicarb levels?

A

Metabolic alkylosis, increased serum bicarb

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29
Q

Pseudoallergic reaction

A

NSAID reactions are not IgE-mediated

asthmatic symptoms, basal and ocular symptoms, facial flushing 30 minutes to 3 hours after NSAID ingestion

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30
Q

Vitamin deficienies in Cf?

A

ADEK

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31
Q

COntraindications to amnionfusion?

A

Previous uterine surgery

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32
Q

Nerve damage being risked in anterior dislocation of the shoulder?

A

Axillary

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33
Q

Name this image and treatment?

A

Regular, wide complex tachycardia consistent with monomorphic ventricular tachycardia

Treatment: Amiodarone

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34
Q

Central cord syndrome

A

Hyperextention of the neck -> upper extremity weakness

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35
Q

Most common sign of meckel’s diverticulum?

A

painless, hematochezia

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36
Q

How to confirm the diagnosis of ankylosing spondylitis?

A

X-ray of the sacroiliac joints

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37
Q

Neonatal disorder associated with peripheral cyanosis?

A

polycythemia

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38
Q

Systolic mumur over the apex that prolongs with valsalva?

A

mitral valve prolapse

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39
Q

Emphyseatous cholecystiti Treatment?

A

emergency cholecystectomy, broad spectrum abx (including clostridium (am-

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40
Q

Cardiac manifestations of alcohol abuse? Method to improve?

A

Dilated cardiomyopathy

Improve with EtOH abstience

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41
Q

Mosquito prophylaxis in central emerica, caribbea?

A

Chloroquine

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42
Q

Yellow streaks in hands? with mily blood samples? Cause? Risk? Treatment?

A

xanthomas with severe hypertriglyceridemia

Cause: familial dusbetalipoproteinmia

Risk: Pancreatisi

Treatment: fenofibrate

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43
Q

Abx treatment for aspiration pneumonia?

A

Clindamycin

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44
Q

Managment of suspected bacterial meningitis in children

A

Lumber puncture, abx

No need for imaging because the fontanelle is open and herniation is unlikely

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45
Q

Hashimoto thyroiditis? Lab findings?

A

High TSH, low T4

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46
Q

polymyalgia rheumatica-characteristics, labs? Treatment? Associates risk?

A

Characteristics >50, stiffness > pain in shoulders, hip girdle, neck

Labs Elevated ESR, CRP

Treatment: glucocorticoids (rapid improvment)

Associated risk: Giant cell (temporal) arteritis

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47
Q

Cardiac changes in sarcoidosis?

A

complete AC block (most common, restrictive cardiomyopathy (early), dilated cardiomyopathy (late)

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48
Q

Most common organisms in central line-associated bloos stream infections?

A

coagulase-negative staph

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49
Q

Pappollary thyroid cancer characteristics

A

slow spread into local tissues and regional lymph nodes

path findings: large cells with group glass cytoplasm, pale nuclei, inclusion bodies , and central groovin and hrainy, lamellated calficiations (psammoma bodies

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50
Q

When GBS is diagnosed, what critical test must be done?

A

Spirometry (specifically forced vital capacity

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51
Q

Presentation on esophageal performation

A

left-sided eggusion (dullness/diminished breath sounds)

mediastinal emphysema -> mediastinitis -> septic shock -> death

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52
Q

Physical manifestations of pancreatic cancer?

A

obstructive jaundice (congated hyperbilirumia), epigastric pain, weight loss, pancreatic mass on CT

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53
Q

how is congenital toxoplasmosis spread?

A

Raw or undercooke meat, unwashed fruits, vegetables, cat feces

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54
Q

Tension pneumothorax signs?

A

acute severe dyspnea, tachycardia, tachypnea, hypotension, neck vein distention

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55
Q

Esophageal performation

A

chest/abdominal pain, ubcutaneous emphysema, hamman sign (crunching on chest auscultation

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56
Q

Tuberculosis effusions

A

high protein (<4), lymphocytic leukocytosis, low glucose

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57
Q

Smudge cells are associated with that disease?

A

chronic lymphocytic leukemia

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58
Q

Arterial emoboli vs arterial thrombosis

A

thrombosis - form from atherosclerotic plaques, due to collatorals are less severe, and see acute

Emboli- from the heart, (left atrial/ventricular) following myocardial infarction, infective endocarditis

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59
Q

Signs of lactase deficiency?

A

diarrhea, abdominal pain, flatulence after milk, etc

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60
Q

Risk associated with claudation of the limbs?

A

coronary arter disease (MI), only 1-2% need ampulation of limb

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61
Q

ANOVA use?

A

Three or more outcomes

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62
Q

When to do c-section vs oxytocin

A

C-section when no cervical change for 4 hours (6 with inadequate labor contractions)

Oxytocin is for inadequate labor strenght

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63
Q

Where are pheochromocytomas located?

A

Adrenal medulla

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64
Q

Diagnosis?

A

Avascular necrosis

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65
Q

Gonioscopy diagnoses? Findings?

A

acute closure gaucoma

severe eye pain, headache, nausea, vomiting, dilated and fixed pupil

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66
Q

What injury risks the radial nerve?

A

Mid humerus fractures

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67
Q

Vasovagal syncopy signs?

A

nausea, pallor, diaphoresis leading to falls

Can be associated with micturition syncopy that occurs when urinating

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68
Q

When to use antibiotic prophylaxis for dental work?

A

Prosthetic heart valve, previous IE, structually abnormal valve in a transplanted heart, congenital heart disease

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69
Q

Cause of amaurosis fugax?

A

painless, rapid, transient monoocular vision loss causd by atherosclerotic emboli originating from the ipsilateral carotid artery

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70
Q

Effective method to prevent episodes of torsades de pointe

A

magnesium

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71
Q

Most common organisms in brain acscess?

A

Strep viridans, s. aureus

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72
Q

Risks of sotalol?

A

QT prolongation -> TdT

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73
Q

Complications from CLL?

A

infections, autoimmune hemolytic anemia, secondary malignancies (richter transformation)

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74
Q

Lab findings in hemophilia? Treatment

A

pprolonger aPPT, decreased or absent factor VIII, IX

Treatment: replace missing factors

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75
Q

Signs of cataract? Earliest sign of cataract?

A

painless blurring of vision, halos around lights, , worsening of distance vision,

Loss of red reflex

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76
Q

Most common cause of pneumonia in sickle cell patients? Sepsis, meningitis

A

Strep. pneumoniae

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77
Q

causes of reactive thrombocytotis?

A

cytrokine release driven by inflammatory states (infection, recent surgery, malignancy) sometimes pneumonia

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78
Q

Risks accociated with combined contraceptives?

A

venous thromboemvolism, hypertension, hepatic adenoma, very rate stroke and myocardial infarction,

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79
Q

Onion-skin appearance of bone tumor in children

X-ray shows osteolytic lesions with periosteal reaction that prodces layers of reactive bone

A

Ewing

Less likel due to lower prevalence and poor x-ray characteristics

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80
Q

Cause of HTN when mixing triptans and ergots?

A

prolonged vasoconstrition -> HTN, Mi, stroke

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81
Q

What valve is most commonly damaged in infective endocarditis? What abnormality?

A

Mitral valve, mitral valve prolapse

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82
Q

Urine pH > 8, suspect? MoA

A

urease -prudcing bacterium (proteus mirabilis, klebsiella pneumoniae) because urease splits urea into ammonia and carbon dioxide, which alkalizes the urine

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83
Q

Type A vs type B adverse drug reaction?

A

Type A is dose dependent,

Type B is dose independent

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84
Q

REM sleep behavior disorder?

A

repeated episodes of complex motor behaviors or vocalization during REM sleep

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85
Q

TRALI reaction to blood?

A

respiratory distress and signs on noncardiogenic pulmonary edema

within 6 hours of transfusion

Caused by doner anti-leukocyte antibodies

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86
Q

First step in evaluating thyroid nodule?

A

TSH, US, clincal evaluation

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87
Q

First step of HIV testing?

A

HIV p24 antigen and HIV antibodies

If negative with high clinical suspicion, order HIV RNA

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88
Q

Scratching the anal region at bedtime, not during day, type of infection?

A

Helminth, specifically enterobius vermicularis

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89
Q

What masses are in the anterior mediastinum?

A

Thymoma, teratoma, retrosternal thyoi, terrible lymphoma

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90
Q

Boerhaave syndrome

A

Spontaneous esophageal rupture

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91
Q

precipitating factors for hepatic encephalopathy?

A

infection, electrolyte abnormalities, high nitrogen states (GI bleeds, dietary changes

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92
Q

Lipid profile measurements in people with 7.5% cardiac risk index should be measures?

A

Every 5 years

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93
Q

Progressive duspnea, orthopnea, lower extremitiy edema, bibasilar lung crackles

A

decompensated congestive heart failure

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94
Q

suppurative infection of the thyroid glan

A

rare condition -> high grade fever, pain at the thyroid, patients are euthyroid

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95
Q

What should an 18 month old be anle to do?

A

running, kicking a ball, walk without support

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96
Q

What is this? What does it increase the risk for?

A

Hereditary spherocytosis -> increased risk for gallstones

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97
Q

Treatment for bullous pemphigoid?

A

high potency steroids

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98
Q

How does risperidone cause prolactinoma?

A

agonism of dopamine

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99
Q

x-ray findings in osgood-schlatter disease?

A

anterior soft tissue swelling, lifting of the tubercle from the shaft, irregularity or fragmentation of the tubercle

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100
Q

thrombocytopenia, decreased fibrinogen, increased INR

A

Disseminated intravascular coagulation

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101
Q

Milk or soy protein induced proctocolits signs? Treatment?

A

Signs-eczema, regurgitation, vomiting and/or painless bloody stools

Treatment: eleiminate all dairy and soy friom diet, switch to hydrolyzed formula

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102
Q

How to treat cyanide poisoning?

A

Hydroxocobalamine or sodium thiosulfate

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103
Q

Anaphylatic blood transfusion reaction?

A

Rapid onset of shock, angiodema, within seconds to minutes of tranfusion, caused by anti-IgA antiibodies in the recipient blood

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104
Q

What conditions can cause basophilic stippling?

A

Lead poisoning, alcohol abuse, thalassemias

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105
Q

medication use in a depressed patient with poor sleep and appetite

A

mirtazapine

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106
Q

parallel study

A

randomized one treatment to one group and a different treatment to another

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107
Q

Ferritin serves as an

A

acute phase reactant

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108
Q

Name this image and treatment

A

Supraventricular tachycardi, adenosine

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109
Q

Breath sounds in mucous plugging?

A

Absent

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110
Q

What type of vasculitis is granulomatosis with polyangiitis?

A

nexrotizing vasculitis

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111
Q

ovalomacrocytosis and neutrophils with reduced segmentation, think?

A

myelodysplastic syndrome

Perofrm bone marrow biopsy

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112
Q

Cause of falls in parkinson disease?

A

dopaminergic neuron degeneration

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113
Q

Prophylatic treatment for rheumatic fever

A

intramuscular penicillin G every 4 weeks

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114
Q

Side effects of nifedipine as tocolytics? When to use?

A

tachycardia, palpitations, nausea, flushing, headaches

32-34 weeks

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115
Q

First line for COPD?

A

Long acting anticholinergic inhaler

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116
Q

De Quervain tenosynovitis

A

Occurs post pregnancy due to overused to the extensor pollicis vrevis and abductor pollicis longus “baby wrist”

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117
Q

If a minor has active plans of suicide, what is the course of action?

A

Inform parents, admit with/without permission

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118
Q

CYP450 inhibitors (increased warfarin activity)

A

Acetaminophen, NSAIDS, antibiotics/antifungals, amiodarone, cimetidine, cranberry juice, omeprazole, throid hormone, SSRI

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119
Q

Signs of arrhythmias?

A

Sudden-onset syncope without prodrome

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120
Q

What test can be used to diagnose spherocytosis?

A

eosin-5-maleimide binding test

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121
Q

If no heart tones on doppler in pregnancy, what should the next step be?

A

Ultrasound

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122
Q

When does the risk of endometrioma decrease?

A

After menopause

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123
Q

With a non-viable fetus, what delivery should be used?

A

vaginal, no point in risking mother

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124
Q

Postprandial right UQ pain with radiation to the shoulders post Roux-en-y? Complication

A

cholecystitis

Complications: gallstones due to rapid weight loss

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125
Q

What is the cause of the second heart sound?

A

aortic valve closure

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126
Q

CML Pathogenesis, treatment?

A

BCR-ABL, imatiman inhibits the product

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127
Q

Osgood-schlatter disese

A

13-14 year old males

AKA :traction apophysitis

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128
Q

HCTZ- use?

A

hypertension, congestive heart failure

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129
Q

Diagnosing warn autoimmune hemolytic anemia? Treatment?

A

direct antiglobulin (Coombs) test - IgG, or completment components (C3)

Treatment: high dose glucocorticosteroids (decrease autoantibody production)

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130
Q

“knife-crasp” grip is seen in?

A

puramidal tract disease

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131
Q

Treatment for severe depression when not eating?

A

Electroconvulsive therapy

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132
Q

Tuberculosis meningitis CSF findings?

A

markedly low glucose, elevated protein, lymphocytic pleocytosis

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133
Q

Laboratory findings in alcoholic hepatitis?

A

Increased AST: ALT (2:1), GGT, ferritin

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134
Q

How to treat generalized anxiety disorder?

A

SSRI and CBT

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135
Q

What ALT is suggestive of gallstone pacreatits? Treamtnet?

A

150U/L, cholecystectomy after medically stable

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136
Q

Ciprofloxacine coverage

A

gram-negative

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137
Q

First step in the workup of hypertension and hypokalemia?

A

Plasma aldosterone and renin ratio

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138
Q

lung mass with progressive dyspnea, coough, sputum, wheezing

A

Bronchogenic carcinoma

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139
Q

A child exposed to varicella-zoster that is not immune mean? What should be the next step? When is vaccination done?

A

Non-immune, has not received 2 doses of vaccination, no prior exposure)

Vaccination occurs at 1 and 4 years

If exposed, give vaccine

If exposured and immunicompromised, give immuniglobulin

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140
Q

Side effects of indomethacin as tocolytics? Use?

A

Maternal: gastritis, platelet dysfunction

fetal: oligohydramnios, closure of ductus arteriosus

<32 weeks duration

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141
Q

What is the normal amylase content of pleyral effusions?

A

Very high, due to saliva

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142
Q

anterior cord syndrome?

A

bilateral hemiparesis, dimished bilateral pain and temperature, intact bilateral proprioception, vibratory, and light touch

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143
Q

Pancoast tumor presentation

A

shoulder pain, horner syndrome, altrophy of intrinsic hand muscles, 4/5th finger paresthesias, supraclavicular lymph node enlargement, weight loss

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144
Q

Signs of lumbar stenosis?

A

lower extremity pain with extension, relieved by leaning forward, walking uphill,

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145
Q

Regular schedule for meningococcal vaccination? High risk?

A

primary vaccination 11-12, booster 16-21. if primary before 16

High risk (vaccinate even if >21):

complement deficiency, asplenia, college studies in housing, travel to endemic areas, exposure

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146
Q

Bisphosphonate MoA

A

inhibit osteoclast and suppress bone turnover and are the preferred therapy

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147
Q

Best prognostic indicator in astrocytoma?

A

degree of anaplasia, rarely developes mets

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148
Q

Best drug for depression, quit smoking, and weight loss?

A

Bupropion

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149
Q

What cancers do OCPs reduce the risk for? Increase?

A

Decrease: Ovarian and endometrial cancer

Increase: cervical and breast

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150
Q

Greatest risk for adverse clinical events during shift change overs? how to combat?

A

communication failures between providers

implementing a signout checklist overcomes there errors

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151
Q

mallory-Weis trear?

A

sudden increase in intraabdominal pressure (retching) leading to a mucosal trear and hematemesis

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152
Q

Rash associated with celiac disease? Description of rash

A

dermatitis herpetiformis

erthematous papules, vescicles, bullae that occur symmetrically in groups clusters on the extensor surfaces of the elbows, knees, buttocks

Autoimmune dermal reaction due to dietary gluten

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153
Q

NF type 2? chromosome?

A

bilateral acoustic neuromas

Chromosome 22

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154
Q

pleuritic chest pain, long-distance flight, hemoptysis, tachypnea, tachycardia, oral contraceotive use?

A

Pulmonary embolism -> pulmonary infarction

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155
Q

Test used to compare 2 means?

A

Two-sample t test

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156
Q

Name this structure

A

Aspergilloma

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157
Q

Child with palable, nonblaching, symmetric purpuric lesions on the buttocks and lower extremities with joint pain? Other findings? Path findings?

A

henoch-Schonlein purpura

Other signs: abdominal pain and renal failure

Path IgA deposition and neutroogukuc snakk vessek vasculitis in the post capillary venules

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158
Q

Diagnosis?

A

Seborrheic keratosis

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159
Q

Ethylene glycol crystals?

A

calcium oxylate crystals in urine

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160
Q

Most comon cause of spinal epidural abscess?

A

S. Aureus

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161
Q

cirrhosis, lethargy, asterixis hepatic encephalopathy

A

hepatic encephalopathy

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162
Q

How to confirm brain abscess?

A

gadolinium enhances brain MRI

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163
Q

leukocytosis with variant lymphoctes with a large, vacuolated cytoplasm (atypical lymphocytes)

A

Infectious mononucleosis

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164
Q

Risk factors for esophageal performation

A

malignant strictures, sever esophagitis, history of radiation therapy, prior perforation

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165
Q

In a patient with several weeks of lower abdominal pain, bloody diarrhea, fecal urgency, suspect? If also fever, abdominal distention, leukocytosis and tachycardia?

A

Inflammatory bowel disease

Toxic megacolon

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166
Q

Contraindications in bipolar?

A

SSRI- creates mood instability

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167
Q

Findings in pagent disease? Pathogeneisis? Imaging findings?

A

Increased alkaline phosphatase and focal bone pain

Path: abnormal osteoclast activity leading to increased bone turnover and disordered bone remodeling

Imaging: increased cortical thickennig and osteolytic of mixed lyic/sclerotic lesions on x-ray

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168
Q

Complications fo roux-en-Y gastric bypass surgery?

A

Early: anastomotic leak (sepsis), bowel ischemia

Late: anastomotic stricture, marginal ulcer, cholecystitis, dumping syndrome

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169
Q

Cause of DKA

A

insulin deficiency

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170
Q

Long term management of laryngomalacia?

A

Reassurance

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171
Q

pericardial thickening murmur?

A

Friction rub

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172
Q

Contraindications to yellow fever vaccination

A

allergy to components (eggs)

AIDS, immunodeficiencies, immunosuppressive therapies

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173
Q

Opiod withdrawal treatment?

A

Buprenophine

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174
Q

Common cause of acute pancreatitis?

A

gallstones, alcohol

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175
Q

Factorial design study?

A

2 + experimental interventions with 2 + variables being studies independently

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176
Q

What drugs treat bladder obstruction disorders?

A

alpha-adrenergic antagonist (terazosin, doxazosin)

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177
Q

dolutegravir MoA? side-effects?

A

integrase stand transfer inhibitor

side effects: hyperglycemia, increased transaminases

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178
Q

Abacavir and lamivudine MoA, side effects?

A

nucleoside reverse transciptase inhibitors

side effects: insomnia, depression, lactic acidosis, hepatotoxicity

Abacavir is also associated with potentially fatal hypersensitivity reactions

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179
Q

What drugs can increase the levels of digoxin?

A

Amiodarone (reduce digoxin level 25-50% when using), verapamil, quinidine, propagenone

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180
Q

When do yse leukoreduced blood?

A

Chronically transfused patients

CMV seronegative at-risk patients (AIDS)

potential transplant recipients

previous febrile non-hemolutic transfusion reaction

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181
Q

How does ADH work?

A

Promotes reabsorption on water

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182
Q

Most common cause of chronic sinusitis?

A

S. aureus

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183
Q

granulomatous vasculitis is seen in?

A

akayasu arteritis, graulomatosis with pokyangiitis, eosinophilic granulomatosis with pokyangiitis

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184
Q

loss of intramural neurons in the lower esophagus is found in?

A

Achalasia

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185
Q

atrial septal defect cardiac findings?

A
  1. wide and fixed splitting S2
  2. mid-systolic or ejection murmur over the left upper sternal boarder (increased flow across pulmonary valve)
  3. mid-diastolic rumble (across tricuspid valve)
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186
Q

Reaction formation

A

Turning something negative into something positive

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187
Q

Gi complications of systemic sclerosis

A

smooth muscle atrophy and fibrosis, hyomotility and incompetence of the lwoer esophageal sphincter

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188
Q

E,physematous cholecystitis?

A

Fever, right upper quadrant pain, nasea/vomiting, creitus in abdominal wall adjacent to gallbladder

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189
Q

adenosine deaminase deficiency

A

impaired t-cell development -> severe combined immunodeficiency

patient experiences severe, recurrent viral, fungal, bacterial, failure to thrive

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190
Q

Risk factors for peripheral artery disease? Diagnostic test?

A

decreases distal extremity sensation, atherosclerosis, hypertension, diabetes

Diagnosis is by ankle-brachial index

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191
Q

modalities for diagnosing ureteral stones?

A

Ultrasonography, noncontrast spiral CT

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192
Q

cluster analysis

A

randomization at the level of groups, instead of individuals

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193
Q

Diagnosis?

A

Squamous cell carcinoma

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194
Q

Best modality to evaluate pituitary mass?

A

MRI

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195
Q

Cirrhosis with fever, ascites, diffuse abdominal tenderness, tachycarida, mental status changes, think? Pathogenesis?

A

Spontaneous bacterial peritonitis

Pathogenesis: translation of bacteria across the intestinal wall and seeding of peritoneal cavity

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196
Q

Signs of carbon monoxide poisoning

A

Headache, confusion, dizziness

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197
Q

Prolactin levels that is diagnostic of prolactinoma?

A

>200ng/mL

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198
Q

Most common cause of sterile pyuria (WBC without bacteria) and urethritis in females?

A

Chlamydia trachomatis

199
Q

At faster hear rates, what drugs can cause widening of the QRS complex?

A

Class 1 antiarrhytmic drugs (flecainide and propafenone

200
Q

Roseola signs? Alternative name?

A

Human herpesvirus 6

3-5 days high fever followed by blanching maculopapular rash

201
Q

Imaging characteristic of chronic pancreatitis?

A

Calcifications

202
Q

Atlantoacial instability? Associations?

A

Excessive lacity in the posterior transver ligament, -> increased mobility between the atlas and the axis (C1, C2)

Signs: behavioral changes, torticollis, urinary incontinence, vertebrobasilar symptoms (dizziness, vertifo, diplopia), clonus is often present

Association: Down syndrome

203
Q

Tension pneumothorax can compress what structure?

A

Superior vena cava

204
Q

Most common complication of influenze?

A

Pneumonia

205
Q

Bullous pemphigoid-pathogeneisi

A

autoimmune blistering with subepidermal cleavage at the basement membrane of hemidesmosomes

206
Q

aspriin-exacerbated respiratory disease-pathogenesis?

A

arachidonic acid -> shunted to leukotrienes via 5-lipooxygenase pathway (COX1, COX2)

207
Q

Chronic lymphocytic leujemia Clinical presentation? Treatment?

A

lmpadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, lymphocytic predominent leukocytosis

Pathogenesis: Rituximab, against CD20 on B lymphoctytes

208
Q

Erythema multiforme signs?

A

Targetoid rash

209
Q

intersitial lung disease

A

progressive duspnea, nonproduct cough, find bibasilar crackles,

x-ray demonstrated reticular or nodular opacities

210
Q

Light’s criteria for exudative?

A

Pleural fluid protein:serum ration >0.5

Lactate dehydrogenase:serum LDH is > 0.6

Pleural fluid LDH > 2/3 upper limit of normal LDH

pH is notmally 7.4-7.55 for systemic causes

211
Q

Signs on decreased ionized calcium?

A

crampy pain, paresthesias, carpopedal spasm

212
Q

17alpha-hydrozylase deficiency

A

phenotypically female, fuid and salt retention, hypertension

213
Q

Most common brain tumor in adults?

A

Astrocytoma

214
Q

Primary vs secondary adrenal insufficiency?

A

Primary - severe, hyperpigmentation, hyperkalemia, hyponatremia, hypotension

Seconary- less severe, no HTN, no hyperkalemia, possible hyponatremia

215
Q

neuroleptic malignant syndrome signs? Cause?

A

Signs: mental status change, rigidity, fever, autonomic dysregulation

Cuase: dopamine antagonist medications

216
Q

If the ANA is positive in Raynaud’s what is the next step?

A

Order specific antiboies (anti-topoisomerase-1 for systemic sclerosis)

217
Q

high leukocyte alkaline phosphatase score, late neurtophil precursors (metamyelocyes, bands; rather than promyelocytes, myelocytes)

A

leukomoid reaction

218
Q

What can be administered to reduce the risk of gallstones post Roux-en-Y?

A

ursodeoxycholic acid

219
Q

Metyrapone

A

cortisol synthesis inhibitor, used to treatment Cushing syndrome while waiting for definitive surgery

220
Q

hyperthyroidism post viral infection with neck pain?

A

subacute thyroiditis (dequavian

221
Q

Miliary TB chest x-ray findings?

A

diffuse retulonodulary pattern

222
Q

Physical exam findings of severe aortic stenosis?

A
  1. pulsus parvus and tardus (dimished and delayed carotid pulse
  2. mid- to late- peaking systolic murmur
  3. soft and single second heart sound
223
Q

Diagnosis of atlantoacial instability? Treatment?

A

X-ray (mouth open)

Treatment: surgical fusion of C1 and C2

224
Q

Signs of cerebellar dysfunction

A

progressive gait dysfunctrion, truncal ataxia, nystagmus, intention tremor or dusmentria (limb-kinetic tremor)

225
Q

Amp-gent coverage

A

Gram-negative aerobes

226
Q

Side effects of terbutaline? MoA?

A

MoA: beta agonist

side effects: tachycardia/arrhythmias, hypotension, hyperglycemia, pulmonary edema

227
Q

Most common arrhmthmia associated with digoxin?

A

atrial tachycardia with AV block

228
Q

Treatment for Atrial fibrillation?

A

Rate control - beta-blocker, diltiazam, verapamil

anticoagulation

229
Q

thin, shiny, hairless skin on extremtiies with non-healing ulcer?

A

peripheral vascular disease

230
Q

Is a bag of worms in the testicles chronic or urgent?

A

Chronic, no urgent evaluation needed

231
Q

X-ray findings in cardiac temponade?

A

enlarged cardiac shadow

232
Q

constipation, polyuria, possible abdominal pain with a Ca2+ of 11.4?

A

hypercalcemia

233
Q

Initial treatment for myasthenia gravis?

A

Pyridostigmine, acetylcholinesterase inhibitor

234
Q

Tenderness at the tibial tuberacle, suspect?

A

Osgood-schlatter disease

235
Q

noew-onset intense back pain unaffected by movement and hypotension?

A

Reuptured abdomainl aneurysm

236
Q

When should a woman get a mammogram? How often?

A

50-70 years of age

every 2 years

237
Q

Complications of interstitial lung disease?

A

digital clubbing cor pulmonale

238
Q

Benefits for breast feeding to the mother?

A

Reduced risk of breast and ovarian cancer

239
Q

Diagnose? Cause?

A

Early decelerations, head compression

240
Q

GI discomfort, malabsorption, arrival from resource-limited country, with pulmonary symptoms and eosinophilia? Diagnostic test?

A

ancylostoma duedenale, necator americanus

Diagnosis: stool and ova parasite

241
Q

Recommended first line therapy for bipolar? Alternative/

A

First line- Lithium, valproate, quetiapine, lamotrigine

Alternative: lithium of valproate combined with a second generation antipsychotic (quetiapine)

242
Q

Glomerulonephirtis findings on urinalysis?

A

nrphritic syndrome, hematuria (RBC casts), edema, HTN, proteinuria

243
Q

Optic neuritis

A

monocular vision loss, “washed-out” colors, afferent pupillary defect, centeral scotoma

Associated with MS

244
Q

Which beta-blockers have been shown to improve CHF long-term survival?

A

metoprolol succinate, carvedilol, bisoprolol

245
Q

Quickest way to decrease pain in myocardial ischemia?

A

venous dilation (nitrates MoA)

246
Q

Cause of Raynaud phenomenon?

A

upopposed alpha activity in the peripheral vasculature that may promote vasoconstriction

247
Q

Beside antipsychotics, which other drugs can cause extrapyramidal symptoms?

A

antiemetics: metocloramide, prochlorperazine, prmethazine

248
Q

Signs of hyperthyroidism?

A

wieght loos, palpitations, hypertension, menstral irredulaties, onycholysis (separation of the nail from the bed), nail clubbing, mild hypercalcemia

249
Q

How to diagnose zenker’s diverticulum? Contraindicated methods?

A

contrast esophogram

Contraindicated: upper GI endoscopy due to concern for perforation

250
Q

Methanol poisoning signs? Labs?

A

Signs: visual blurring, central scotomata, afferent pupillary defect, altered mentaiton

labs: high osmolar gap, increased anion gap, metabolic acidosis

251
Q

Stroke on aspirin therapy, add?

A

dypridamole or clopidogrel

252
Q

Demential with lewy body- histology findings?

A

round, eosinophilic, intracytoplasmic inclusions in the neuron of the substantia nigra

253
Q

Lab findings in ethylene glycol poisoning?

A

metabolic acidosis with increased gap, very low bicarbonate and compensatory drop in pCO2

254
Q

Africa, Oceania, Asia malaria chemophrophylaxis?

A

Mefloquine 2 weeks before until 2 weeks afterwards

255
Q

Signs of HSV encephalitis?

A

normal glucose, RBC elevation (hemorrhagic destruction of frontotemporal lobes), lymphocytic pleocytosis, elevated protein

256
Q

Digeorge syndrome? Order immediately?

A

Conotruncal Cardiac defects

abnormal facies

thymic aplasia.hypoplasia

Cleft palate

hypocalcemia

CATCH-22

Order calcium level, echo

257
Q

Tactile fremitus in effusion vs consolidation?

A

Increased in consolidation, decreased in effusion

258
Q

chi-square test

A

categorical data and proportions

259
Q

jaundice, weight loss, abdominal discomfort (without prominent abdomain pain), fullness in the upper right quadrant?

A

Pancreatic cancer

260
Q

Gastrin-secreting pancreatic tumor signs?

A

chronic diarrhea, weight loss, dyspepsia

261
Q

Autoimmune hemolytic anemia vs hereditary spherocytosis

A

AIHA- negative family history, positive coombs (warm agglutinin) IgG autoantibody

Hereditary- postive family history, negative coombs

262
Q

Lymphocytic hypophysitis?

A

lymphocytic infiltration of the pituitary gland

263
Q

What is efairenz? side effects?

A

non-nucleoside reverse transcriptase inhibitor

Side effects: sizziness, insomnia, vivid or bizarre dreams, anxiety or depression

264
Q

What viral HIV load should get a c-section?

A

>1,000

265
Q

nephrotic syndrome patients are at an increased risk for?

A

infection (loss of immunoglobins), thrombosis (antithrombin, plasminogen), and protein malnutrition

266
Q

low leukocyte alkaline phosphatase score, peripheral smear with absolute basephilia and early neutrophil precursor cells

A

Chronic myelogenous leukemia

267
Q

CMV retinitis complications

A

blindness, retinal detachment

268
Q

Risk associated with endoscopic stricture dilation

A

esophageal performation

269
Q

Treatment for urge incontinence?

A

bladder training, oxbutynin (antimuscarininc or anticholinergic) that relaxes detrussor muscles and reduces spasms

270
Q

Risk associated with nitrate use?

A

profound hypotension, treat with NS bolus

271
Q

flat and gradmented left femoral head with alternative regions of lucency and density?

A

avascular necrosis

272
Q

Murmur in aortic regurgitation?

A

decrescendo diastolic murmur

Best heart of the left sternal border at the third and fourth intercostal spaces

If dilated aortic root, it moves toward the right side

273
Q

late systolic murmur in the cardiac apex?

A

mitral valve prolapse

274
Q

After stabilization, next step in managing acetaminophen overdose?

A

Refer to transplant center

275
Q

Role of pyridoxine in synthesis? Laboratory signs?

A

Protoporphyrin synthesis -> microcytic anemia

Laboratory signs: “dimorphic RBC” population - microcytic and normacytic

276
Q

Diagnosis? Syndrome, if in children? Treatment

A

QT prolongation

Syndrome: Jervell-Lange-Nielsen syndrome (autosomal recessive) -> defects in K+ channels

Treatment: normalize Ca2+, K+, MG2+, beta blockers, pacemaker

277
Q

Hazard ratio

A

chance of an event occurring in the treatment group compared to the chance in the control group over a set period

< 1 = more likely in the control group

278
Q

Pathophysiology of hypertrophic cardiomyopathy?

A

Mutations in sacromere protein genes

279
Q

lennox-Gastaut syndrome

A

Children less than7 with wide array of seizure types accompanies by mental retardation

280
Q

right upper sternal border mumur that radiates to the carotids?

A

aortic stenosis

281
Q

Orthostatic hypertension? Medication causes?

A

prodromal dizziness and blurred vision in the setting of rapidly transitioning from supine to standing

Medications: antihypertensive, alpha blockers

282
Q

Common causes of carpal tunnel syndrome?

A

diabetes, hypothyroidism, pregnancy

283
Q

What happens to calcium in alkalosis? Acidosis?

A

Decreased ionized calcium

Acidosis: increased ioninzed calcium

284
Q

holosystolic murmur heard best at the left sternal border wall?

A

VSD

285
Q

High fevers, severe polyarthralgias, lymphopenia, throbocytopenia, caribbean recently?

A

Chikungunya fever

286
Q

Bilious emesit in a neonate workup?

A

Abdominal X-ray -> water soluble contast enema

287
Q

Management of akathsia?

A

Decrease antipsychotic, treat symptoms with beta blocker or benzotropine

288
Q

Central cord syndrome?

A

decreased sensation, motor dunction in the arm with relateive sparing of lefs after forced hyperextention

289
Q

Significant demographic risks for h. pylori?

A

low income country, high prevalence

290
Q

Signs of leukocytes adhersion deficiency?

A

impaired neutrophil migration, delayed umbilical cord sepration, recurrent non-purulent skin infections, severe periodontitis, marked neutrophilia

291
Q

ECG manifestions of hypoekalemia

A

broad, flat T waves, U waves, ST despression, premature ventircular beats

Also, a fib, TdP, ventricular fibrillation

292
Q

Risk factors for the development of abdominal aortic aneurysm?

A

olger age (>60), cigarette smoking, family history, white race, atherosclerosis

293
Q

Cardiac defect strongly associated with digeorges syndrome?

A

truncus arteriosis

294
Q

High fever, maculopapular rash, following cough, conjuctivity, coryza? Treatment?>

A

Rubeola (measles)

Treatment: supportive, vitamin A for hospitalized patients

295
Q

First line therapy for a specific phobia?

A

Behavioral therapy, exposure

296
Q

Hurthle cells

A

follicular thyroid cancer, but nonspecific

297
Q

Signs of autoimmune hemolytic anemia?

A

elevated indirect bilirubin, increased serum lactate dehydrogenase, decreased haptoglobin, splenomegaly, spherocytes, reticulocytosis

298
Q

Enzyme elevated in liver parenchyma?

A

aminotransferases

299
Q

hypokalemia and impaired renal bicarbonate absorption?

A

Type II renal tubular acidosis

300
Q

Signs of adrenal insufficiency?

A

Weakness, abdominal pain, loss of appetite, mild hyponatremia, postural hypotension, hyperkalemia

301
Q

Dilated left ventricle and apical hypokinesis and engorgement of the inferior vena cava?

A

cardiogenic shock

302
Q

Signs of dessiminated tuberculosis?

A

back pain, subacute illness with intermittent fevers, radiographic evidence of pulmonary and spinal disease with normocytic anemia and chronic inflammation

303
Q

Lab findings after splenic removal?

A

dramatic thrombocytosis (failure to remove bad ones)

304
Q

Congenital Toxoplasmosis treatment

A

Pyrimethamine, sulfadiazine, folate

305
Q

Comorbities in CF?

A

Chronic rhinosinusitis, infertility (mostly males), pancreas enzyme deficiency

306
Q

Diagnosis

A

Slipped Capital fermoral epiphysis

307
Q

Diagnosis? Treatment?

A

Basal cell carcinoma

Mihs micrographic surgery

308
Q

pancreatic pseudocyst

A

days to weeks after blunt abdominal trauma

309
Q

Best diagnosis of meniscal tear?

A

MRI

310
Q

What amino acids are converted to pyruvate during fasting states?

A

Lactate, Alanine

311
Q

Use for TNF-alpha inhibitors?

A

rheumatoid arthritis, chron disease

312
Q

Isopropyl alcohol ingestion signs? Lab?

A

CNS depsression, disconjugate gaze, absent ciliary reflex

Labs: high osmolar happ, no increased anion gap, no metabolic acidosis

313
Q

Role of haptoglobin?

A

binds free hemoglobin and promotes exretion by the reticuloendothelial system

314
Q

pyoderma gangrenosum?

A

inglammatory papule/pustule that progresses to painiful olcer

315
Q

Doagmpse. Treatment?

A

Ichthosis vulgaris, scaly skil

Treatment: emollients or keratolytics (coal tar, salicyclic acid)

316
Q

When to use washed platelets?

A

IgA deficiency

Complement-dependent autoimmune hemolytic anemia

Continued allergic reaction dispite antihistamine

317
Q

Nummular eczema?

A

scattered round eczematous plaques on the back and extremities

318
Q

Where is the mass located in Bartholin glands?

A

labium majus

319
Q

Signs of digoxin toxicity

A

Anorexia, nausea and vomiting, abdominal pain, fatigue, confusion, weakness, color vision alterations

320
Q

Chronic granulomatous disease- cause?

A

Oxidative burst defect

321
Q

enlarging nodule with thicked, rough surface or ulcerated with crusting and bleeding?

A

squamous cell carcinoma

322
Q

After diagnosing adenocarcinoma, what should be the next step?

A

CT to stage

323
Q

Risks for being sickle cell trait

A

Isosthenuria (inability to concentrate urine)

hematuria

324
Q

Characteristic presentation of Grave’s disease?

A

diffuse goiter and eophthalmopathy (porptosis, periorbital edema, extraocular muscle weakness)

325
Q

SLE manifestations: physical? Lab?

A

Constitutional: Fever, fatique, weight loss

Symmetrical, migratory arthritis

butterfly rash & photosensativity

serositis: pleurisy, pericarditis, peritonitis

Lab: low C3/C4 complement levels, ana + (sensitive), dsDNA + and anti-Sm (specific), proteinuria and elevated creatinin (renal involvement)

326
Q

gamma-glutamyltransferase location?

A

Liver and other cells

327
Q

Cause of sickle cell disease?

A

beta globin gene has a valine in place of a glutamic acid

328
Q

Cause of renal damage in multiple myeloma?

A

myeloma cast nephropathy, monoclonal light chains clog the renal tubules

329
Q

pulmonary, facial edema, hypertension, abnormal urinalysis with proteinuria and microscopic hematuria suggests?

A

Acute nephritic syndrome with fluid overload

330
Q

Caridac features on untreate acromegaly?

A

cardiomyopathy, hypertension, heart failure, valvular disease (mitral and aortic regurgitation)

331
Q

D-xylose

A

Tests absorption in the proximal small intestine, tests for celiac disease

332
Q

Reaction associated with lamotrigine?

A

Steven-Johnson syndrome

333
Q

delayed hemolytic blood transfusion reaction?

A

mild fever, hemolytic anemia

2-10 after transfusion

positive direct coombs test, positive new antibody screen

caused by anamnestic antibody response

334
Q

Lab findings in DKA?

A

hyperglycemia (>200), low serum bicardonate (<15), elevated anio gap (>14)

335
Q

First step in managing a fever in a chemo patient?

A

Broad spectrum abx

336
Q

How to reduce the risk of aspiration pneumonia?

A

elevate the head of the bed

337
Q

Are c-sections used in chorioamnionitis?

A

No, not unless fetus is breached

338
Q

first-like treatment for acute episode of glaucome?

A

mannitol intravenously

339
Q

How to diagnose CLL?

A

monoclonal C cell lymphocytes on flow cytometry

340
Q

CPY450 induces (decrease warfarin effect)

A

carbamazepine, phenytoin, genseng, st. john wart, ora contraceptives, phenobarbital, rifampin

341
Q

Skin findings in carbon monoxide poisoning?

A

pinkish-red skin hue

342
Q

Major components exposed to during a house fire?

A

hydrogen canide, carbon monoxide

343
Q

X-linked agammaglobulinemia vs common variable immunodeficiency

A

X-linked agammaglobulinemia contains low B cells, whereas common variable has normal b cell count

344
Q

Cause of early decelleratoins?

A

Head compression

345
Q

Sensitivity

A

correctly identify people with disease

346
Q

Accomodative esotropia

A

strabismus that arisis in children <2, eye deviation when trying to focus on objects

347
Q

How to diagnose echinococcus granulosus? Treatment

A

positive serology (sensitivity) and/or ultrasound

Treatment: <5cm albendazole

larger require percutaneous therapy or surgery

348
Q

Kernig sign

A

inability to extend kneees > 135 while hip in flexed

349
Q

Most common coagulopathy in patients with malignancies?

A

DIC

350
Q

Breast feeding benefits to the infant

A

Improved immunity, prevention of otitis media, respiratory illnesses, URI, gastroenteritis, decreased risk of childhood cancer, MD type 1, necrotizing enterocolitis

351
Q

When does muscular dystrophy present?

A

Childhood

352
Q

How to contraol rapid a fib?

A

beta blockers or CCB

353
Q

Signs of hypokalemia?

A

Muscle weakness, paresthesia

354
Q

Where does the acid in septic shock come from?

A

LActic acid production in peripheral tissues due to inadquate O2 delivery

355
Q

Best treatments to reduce COPD symptoms?

A

inhaled bronchodilators, especially anti-cholinergic medications (ipratroprium, tiotropium)

356
Q

Familial dysautonomia

A

autosomal recessive disease in children of Ashkenazi Jewish ancestory Characterized by gross dysfunction of the autonomic nervous system with severe orthostatic HTN

357
Q

Small bowel overgrowth signs? reatment?

A

Signs: abdominal pain, diarrhea, bloating, flatulence, malabsorption, weight loss, vitamin deficiency

Treatment: dietary changes (low-carb, high-fat, antibiotics (rifaximin, amox-clau)

358
Q

Medications that can predispose towards gallstones?

A

oral contraceptives, ceftriaxone, octreotide

359
Q

Risk factors for preterm labor?

A

Prior spontaneous preterm labor (major risk)

multiple gestations, short cervical length, cervical surgery, cigarette use

360
Q

electromyography diagnoses?

A

neuropathy, normally done via physical exam

361
Q

Signs of alcohol poisoing? Labs?

A

Sympathetic overactivity-tachycarida, elevated blood pressure, restlessness, tremulousness

epigastric tenderness, GI bleeds

Labs: elevated liver enzymes

362
Q

Long term risk of pagent’s disease?

A

hearing loss

363
Q

Pharmacological therapy for cocaine use disorder?

A

None

364
Q

Temporal lobe epilepsy vs absence

A

Temporal lobe- post-ictal stage

Absence- no post ictal stage, children

365
Q

Treatment target in rheumatoid arthritis?

A

interleukin-1

366
Q

IgA vs postinfection glomerulonephritis

A

IgA - normal serum components, mesangial IgA deposits on kidney biopsy

PIGN=- low C3, elevated anti-streptolycin O and/or anti-DNAse B, kidney biopsy shows subepithelial humps consisting of C3 complement

367
Q

Follicular thyroid cancer characteristics

A

invasion fo the tummor capsule and/or blood vessels, metastasize via hemotogenous spread

368
Q

When to use hypertonic saline?

A

hyponatremia (<130(_ with coma and seizure (or other severe symptoms)

369
Q

milk-alkali syndrome

A

hypercalcemia, renal insufficiency, mentabolic acidosis

370
Q

Indications for electroconvulsive therapy?

A

treatment resistance, psychotic heatures, emergency conditions (pregnancy, refusal to eat/draink. imminent risk for suicide

371
Q

Chron’s disease vs ulcerative cholitis

A

Chron’s fistulas (transmural inflammation and nonbloody diarrhea

UC- bloody diarrhea and toxic mega colon

372
Q

Signs of digoxin toxicity?

A

Diarrhea, nausea, fatiqgue, confusion, weakness

373
Q

Signs of primary hyperaldosterone? Diagnosis? Managmenet?

A

hypertension, hypohkalemia alkalosis

diagnosis: elevated plasma aldosterone, best sccreening test is morning plasma aldosterone concentration

Managment: CT scan to determine unilateral or bilater

unilater (adrenalectomy), bilateral (aldosteron antagonists such as spironolactone, eplerenone)

374
Q

low glucose, elevated protein, nutrophilic pleocytosis in CSF?

A

acute bacterial meningitis

375
Q

First step in managment of a subacute cough (<8 weeks) after URI?

A

anti-histamines

376
Q

Primary deficiency electrolyte required for energy in refeeding syndrome?

A

Phosphorus

377
Q

Signs of epidural abscess?

A

fever back pain, and/or neurological deficits, and tenderness to palpation of the vertebrae or paraspinal muscles

378
Q

Treatment for pagent’s disease?

A

Bisphosphonates

379
Q

What type of vancomycin in affective again C. Diff

A

Oral. IV is not excreted in the colon

380
Q

partially acid-fast gram positive, branching rods?

A

Norcadia

381
Q

Comfirmatory test for amyloidosis?

A

Tissue biopsy, abdominal fat pad

382
Q

Repeat soft tissue and skin abscesses with a variety of catalase-positive organisms? Diagnostic methods? Organisms?

A

Chronic granulomatous disease

Diagnostic methods: dihydrorhodamine 123 test, nitroblue tetrazolium text

Organisms: S. Auerus, Serratia, Burkholeria, Aspergillus

383
Q

What medicaiton should be avoided in acute angle glaucoma?

A

Atropine (causes dilation of the pupil and worsening of the glaucoma

384
Q

large ovarian mass with thich septations, solid components, pree peritoneal fluid

A

malginacy signs, think epithelial ovarian carcinoma

385
Q

Diagnostic workup for amenorrhea?

A

FSH (if not breast development)

Pituitary MRI if FSH is decreased

karyotyping if FSH is increased

386
Q

Trimethoprim-sulfamethoxazole coverage

A

gram positve and gram negative poor anaerobic

387
Q

21-hydrozylase deficiency

A

ambiguous genitalia in girls, salt wasting (vomiting, hypotension, hyponatremia, hyperkalemia)

388
Q

Course of action when endrometriosis is found incidentally?

A

Observation

389
Q

Best diabeted drug if weight gain is desires?

A

GLP=1 receptor agonists (Exenatide)

390
Q

Cause of red blood cell casts?

A

glomerular etiology

391
Q

How to diagnose PE in pregnanc?

A

V/Q is first step, followed byy CT angiogram of the chest, if V/Q is abnormal

392
Q

Rosl factors for pancreatic cancer?

A

cigarette, smoking, chronic pancreatitis, obesity

393
Q

cholestyramine -MoA, use?

A

MoA bile acid-binding resin that reduces LDL

394
Q

gold-standard for 21 hydroxylase partial deficiency diagnosis?

A

cosyntropin stimulation test

395
Q

two sample z test

A

compare two means, but population variances are employed (not usually known, so rarely used

396
Q

Most common heart disease with Rheumatic Fever?

A

Mitral stenosis

397
Q

How to diagnose Meckel’s diverticulum?

A

Technetium-99m pertechnetate scan

398
Q

How to approach someone with body dysmorphic disorder that desires surgery?

A

Acknowledge the surgery, suggest other treatment that may help

399
Q

Spinal epidural abscess triad?

A

fever, focal back pain, neurologic deficits

400
Q

When does the odds ratio approximately the relative risk?

A

When the disease is rare

401
Q

Antibiotics for spinal epidural abscess?

A

Vancomycin plus ceftriaxone

402
Q

Recent URI with sudden onset of cardiac failure in otherwise healthy patient

A

Dilated cardiomyopathy -> secondary to acute viral pericarditis

403
Q

Masses found in the middle mediastinum?

A

Bronchogenic cyst (benign), lymphoma, pericardial cysts, tracheal tmors, lymphnode enlargement, aortic aneurysms

404
Q

Patellofemoral stress syndrome

A

Overuse injury seen in runners, anterior knee pain that worsen upon descending steps or hills. Pain locatedes to the patella

405
Q

Statin use

A

lower cholesterol via 3-OH-3-methylflutaryl coenzyme A

406
Q

What factors should be avoided in premature atrial contractions?

A

tobaxxo, alcohol, smoking, caffeine

407
Q

Polymyositis antibodies?

A

Anti-Jo-1, ANA

408
Q

Signs of respiratory failure in asthma? Managment?

A

decreased pO2 and pH

Increased pCO2

altered mental status, persistent hypoxemia, hypercarbia

Intubation

409
Q

spirometry for restrictive diseases?

A

Decreased FEV1, FCV, total lung capacity, normal FEV1:FVC

410
Q

What are chemotherapy- immunocompromise patients at an increased risk of infection from?

A

Gram negative organism

411
Q

Ecthyma gangrenosum organism? Description? Treatment?

A

Pseudomonas aeruginosa

painless ulcer with black center after bulla reptured

Pathogenesis: bacterial invasion through the media and adventitia of blood vessels

Treatment: antipseudomonal penicillin

412
Q

Asbestosis increases the risk for what cancers?

A

Bronchogenic (most common), mesothelioma

413
Q

Choledocholithiasis means?

A

Gallstones in the bile duct

414
Q

Contraindications to trial of labor?

A

classical c-section, abdominal myomectomy with uterine cavity entery, abdominal myomectome without uterine cavity entry

415
Q

Congenital signs of rubella?

A

sensorineural hearing loss, cataracts, PDA

416
Q

uninary frequency, nocturia, frequent leakage?

A

urinary overflow

417
Q

Chagas disease? Signs?

A

Caused by trypanosoma cruzi

megacolon/megaesophagus (destruction of nerves in smooth muscle) and cardiac disease

418
Q

Causes of restrictive cardiomyopathy?

A

amyliodosis, sarcoidosis, hemochromatosis

419
Q

Signs of chronic pulmonary aspergillosis? Treatment

A

> 3 months of fever, weight loss, fatigue, cough, hemotpysis, and/or duspnea

Cavitary lesions containing debris, fluid, or an aspergilloma

Positive aspergillus IgG

Treatment: itraconazole, verizonazole, surgery, bronchial arter embolization (sever hemotpysis with extensive disease)

420
Q

Bluish discoloration of the lips, tongue, nailbeds,tachypnea and diaphoresis while breast feeding? Cause?

A

Central cyanosis

Cause: congenital heart disease

421
Q

x-ray findings for bronchogenic carcinoma?

A

bibasilar reticulonodular ingiltrates, honeycombing (cystic areas surrounded by parechymal fibrosis, pleural plaques

422
Q

Febrile nonhemolytic transfusion reaction

A

most common, occurs between 1-6 hours, transient fever, chills, malaise

423
Q

What does cyanide inhibit?

A

cytochrome oxidase a3, which binds ferric iron (Fe3+)

424
Q

Child with viral illness that develops vomiting, delirium, hyperventilation, hepatomegaly likely took?

A

Aspirin

425
Q

Heterophile antibodies test for?

A

Infectious mononucleosis, negative in 25% of the cases during the first week of infection

426
Q

Hemophilia inheritance pattern?

A

X-linked recessive

427
Q

Cutaneous larva migrans? Signs? Treatment?

A

Hookwork larve from contaminated sand or soil

Intensely pruritic, redish-brown cutaneous tracks,

ivermectin is treatment

428
Q

What benefits are dound with intensive glycemia control of DM type 2?

A

Microvascular complications (nephropathy, retinopathy

429
Q

Diagnosing spontaneous bacterial peritonitis? Treatment?

A

ascitic fluid neutrophil count >250, cultures are usually negative

Treatment: third generation cephalosporins, fluoroquinolones

430
Q

Side effects of sulfonylureas?

A

weight gain, hypoglycemia

431
Q

unexplained heart failure, proteinuria, easy bruisability, increase ventricular wall thickness with normal left ventricular cavity

A

amyloidosis

432
Q

leukocyte alkaline phosophatase score, use?

A

measure cytochemically normal neutrophils

433
Q

Anit-hypertensives for pregnancy?

A

labetalol and methyldopa

434
Q

Factious disorder vs malingering?

A

Malingering has an external reward (avoiding work responsibilities)

435
Q

Inheritance of Fredricks atarix?

A

Autosomal recessive, GAA expansion, chromosome 9

436
Q

When to use irradiated blood?

A

Bone marrow transplant recipients

Acquired of congenital cellular immunodeficiency

blood components donated by first or second degree relatives

437
Q

Cholinergic agonist treat what type of urinary leakage

A

neurogenic bladder

438
Q

Windows for therapeutic thombolytic therapy?

A

3-4.5 hours

439
Q

Displacement

A

Transferring emotions from one object to a safer one

440
Q

How does lithium cause nephrogenic diabetes insipidus?

A

induced ADH resistance by impairing water reabsorption in the collecting duct

441
Q

What is the translocation for CML?

A

9:22, BCR-ABL

442
Q

Risk factors for acute urinary retention?

A

Male, increasing age, history of neurologic disease, BPH, surgery

443
Q

What cancer produced 1,25 (OF) vitamin D?

A

lymphoma

444
Q

If a patient cannot take oxybutinin due to anticholinergic side effects, what pharmacotherapy is available?

A

mirabegron, a beta33 adrenergic receptor that can relax the bladder

445
Q

Post-menopausal cancer risk with urinary frequency, pain, bloating, abdominal distention?

A

Epithelial ovarian cancinoma

446
Q

Signs of esophageal dysmobility?

A

Food sticking in throat

447
Q

Affect of nitrates on preload?

A

decrease systemic afterload and preload

decreases left ventricular volume

448
Q

Anticoagulation for transient ischemic attack from thromboembolism in the setting of a flutter?

A

warfarin or nonvitamin K antagonist oral anticoagulation (Rivaxoaban) (if non-valvular)

449
Q

Diagnosis? Cause?

A

pleural plaques, asbestosis

450
Q

Malrotation X-ray? Treatment?

A

duodeum abnormally located in the right abdomen, cecum in the left

Treatment: surgical intervention

451
Q

Managment for meniscus tear?

A

Minimal limitations and short-term-observation

longer-term or limitation -> MRI consider for surgery

452
Q

Specificity

A

rules out a disease

453
Q

colitis and liver abscess, fever, right upper quandrant pain, smooth cystic subcapsular mass

A

entamoeba histolytica

454
Q

How to manage a patient with irregularly irregular, narrow complex tachycardia with fine fibrillatory waves? A fib with RVR that is hemodynamically unstable?

A

Synchronized cardioversion

455
Q

Signs of macular degeneration

A

central vision afftected, distorted vision and central scotoma

Inc. risk from cigarette smokint

456
Q

Common extrainterstinal symptoms of Chron’s?

A

uveitis, scleritis, erythema nodosum

457
Q

Sickle cell trait hemoglobin pattern? Inheritance? Risk?

A

50-60% hemoglobin A

35-45% hemoglobin S

< 2% hemoglobin F

Autosomal recessive, hematuria

458
Q

Tumor is the metaphyses of long bones without systemic signs?

tender, soft tissue mass

x-ray shos sunburst pattern, periosteal elevation?

Treatment?

A

Osteosarcoma

Treatment: surfical excision and chemotherapy

459
Q

What artery is torn in epidural hematoma?

A

middle meningeal artery

460
Q

Signs of cardiac tamponade?

A

pulse dissappears during inspiration (systolic blood pressure decrease) “pulsus paradoxus”, weakness, dizziness, syncope

461
Q

Sphincter of Odi dysfunction? Drug causes? Gold standard diagnosis?

A

dusepisodic right upper quadrant pain, aminotransferase and alkaline phosatase elevations, dilated common bile duct in the absence of stones

Drugs-opiods can cause sphincter contractions

Gold standard: manometry

462
Q

Delayed transfusion reactions

A

repeated transfusion with blood that is not properly mached, results in hemolytic anemia, jaundice, lactic acidosis, renal insufficiency, confusion, decreased mental status

463
Q

Signs of neurofibromatosis type 1?

A

Cafe–au-lait spots, multiple neurofibromas, lisch nodules, low-grade optic pathway gliomas

Chromosome 17

464
Q

Contraindications for selective estrogen receptor modulators? Name two.

A

Taxoxifen, ralocifene

Adverse effects: Hot flashes, venous thromboembolism

endometrial hyperplasia and carcinoma (tamoxifen only)

465
Q

acute hemolytic blood transfusion reaction

A

fever, flank pain, hemogloninuria, renal failure, DIC

within 1 hour, positive direct coombvs test, pink plasma

caused by ABO incompatibility

466
Q

Caues of tubuloinsterstitial nephritis in older woman? Urinalysis findings?

A

Tubulointerstitial nephritis

WBC casts, proteinuriam impaired urinary concentration

microscopic hematuria and renal colic may follow

467
Q

Adverse effect of hydroxyurea?

A

Myelosuppression

468
Q

diastolic collapse (dfailure of ventricular filling)?

A

cardiac temponade

469
Q

Signs of immunity due to natural HBV infection

A

Hepatitis C surface antibody +

Hepatitis B core antibody + (HBcAb)

470
Q

Psoriasis characteristics? Treatment/

A

hyperkeratosis, erythematous plaques with white or silver sclae on the extensor surfaces

Treatment: high dose corticosteroids, cit D derivatives (Calcipotriene)

471
Q

Skin findings in methemoglobunemia?

A

Bluish and cyanosis

472
Q

Chronic granulomatous disease

Diagnosis?

A

X-linked recessive, recurrent pulmonary and cutaneous infections by catalast positive organisms

Diagnosis: Testing neutrophil function

  1. dihydrorhodamine 123 test
  2. nitrovlue tetrazolium test
473
Q

Multisystem atrophy

A
  1. Parkinsonism, autonomic dysfunction, widespread neurological signs
474
Q

child between 4-10 with hip, groin, knee pain plus antalagic gait?

A

avascular necrosis

475
Q
A
476
Q

Hazard rate

A

Chance of an event occuring in one of the study groups during set period

477
Q

Atomoxetine

A

norephinephrine reuptake inhibitor used to treat ADHD

478
Q

Projection

A

Attributing feelings to someone else

479
Q

blurred vision, floaters, photopsia (flashing light sensation) in HIV patient with yellow-white, fluffy, exudated adjactent to vasculature

A

CMV retinitis

480
Q

If unable to locate a primary tumor but find a lymph node in the neck that is cancerous?

A

Panendoscopy

481
Q

Low-grad optic neuromas?

A

decreased visual acuity, alternation in color vision, optic nerve atrophy, proptosis

482
Q

Most common disease cause of superior vena cava syndrome?

A

malignancy, especially small cell, lymphoma

483
Q

In likely DVT, what is the initial step in managment?

A

Compression ultrasound

484
Q

hyposthenuris? Assocations?

A

impairment in the kidney’s ability to concentrate urine

Associated with sickle cell trait/sickle cell disease

485
Q

Injuries sustained from blunt abdominal trauam?

A

Laceration (liver, splenic)

486
Q

ocular toxoplasmosis?

A

chorioretinitis (eye pain, decreased vision, lesion in non-vascular distribution

487
Q

When should an amniotomy be performed?

A

Getal presenting part is well into the cervix

488
Q

Fractures, diarrhea, and microcytic anemia?

A

Celiac disease

489
Q

Risk when refeeding with inadequate electrolye repletion?

A

Cardiopulmonary failure

490
Q

Gold standard for diagnosising placenta previa?

A

Transabdominal ultrasound

491
Q

mallory-Weiss tear

A

incomplete mucosal tear at the gastroesophageal junction, usually due to protracted vomiting

self-limiting hematemesis without pneumomediastinum

492
Q

ITP

A

isolated thrombocytopenia with normal hematocrit and leukocyte count

normal fibrinogen and prothrombin time

idioopathic thrombocytopenic purpura

Caused by IgG again megakaryoctye production due to IgG against the platelet membrane glycoproteins

493
Q

Measles and rubella rash characteristics?

A

Erythematous macules and papules that start of the face and spread down the the body, fever is concurrent

494
Q

Bronchial breath sounds are associated with?

A

pneumonia

USMLE Step 2 CK (12 decks)

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