VENI VIDI VICI 2

Question 1

Femoral nerve injury presentation

Answer 1

• weakness in quadriceps group ( inability to extend the knee against resistance)
• sensory loss in the anterior and medial quadriceps extends to the mid shin and towards arch of foot due to saphenous nerve ( root of femoral nerve)
• decrease or absence of knee jerk

Question 2

sciatic nerve injury presentation

Answer 2

• weakness of lower leg musculature including harmstrings.
• loss of sensation of lower leg
• knee jerk normal
• ankle jerl absent

Question 3

MCC of sciatic nerve injury

Answer 3

trauma
   hip disclocation, freacture, replacement
wayward buttock injection 
compression external sources
deep seated mass in pelvis.

Question 4

obturator nerve injury

Answer 4

weakness with adduction

sensory loss in small area of medial thigh

Question 5

common peroneal nerve injury presentation

Answer 5

acute foot drop

wekaness in dorseiflexion and eversion

Question 6

causes of bacterial enteritis- bloody stools

Answer 6

shigella, salmonella, campylobacter, E.coli, Yersinia

Question 7

Antibiotic treatment of E. coli O157:H7 can lead to HUS

Answer 7

true

Question 8

high risk patients for pancreatitis ( 5 groups)

Answer 8

1. HF or HTN ( Thiazides, furosemide, enalapril, losartan)
2. Autoimmune diseases (azathioprine, mesalamine, corticosteroids)
3. chronic pain(acetaminophen, opiates, NSAIDs)
4. Severe seizure disorder(VPA, CBZ)
5. HIV (lamivudine, TMPX, didanosine)

Question 9

diuretics that cause pancreatitis

Answer 9

chlorthalidone, hydrochlorothiazide, furosemide

Question 10

Effects of parathyroidectomy ( 1 gland or 31/2 glands)

Answer 10

hypocalcemia

1. Relative hypopTH- suppression of PTH by increased Ca levels in blood. Is transient and recovers in a couple od fays.
2. Hungry bone syndrome: sudden PTH withdrawal causes Ca influx into the bone- causing hypocalcemia- in days 2-4 pop.

Hypocalcemia sings ( perioral cyanosis, chvosteck, trousseau, are ALWAYS BILATERALLY SYMMETRIC)

Question 11

HIV triple PEP therapy

Answer 11

there are many combinations but tenofovir emtricitabine, raltegravir low SE profile initiate within 72 hrs and for 4 weeks.

Question 12

How does botulinum toxin works

Answer 12

in the presynaptic NM . inhibit release of ACH in the synaptic cleft by cleaving SNARE proteins

Question 13

tto of botulism

Answer 13

equine derived heptavalent antitoxin, only for >1 years of age.

Question 14

colonic ischemia presentation

Answer 14

hematochezia, diarrhea, leukocytosis, lactic acidosis

Question 15

CT and colonoscopy in colonic ischemia

Answer 15

CT: Increased wall thickness, pneumatosis, fat stranding
Endoscopy: edematous, friable mucosa, scattered pale patches

Question 16

Treatment for colonic ischemia

Answer 16

IV fluids, bowel rest( NG tube )
Anitbiotics (cipro/levo +MTZ)
Colonic resection if necrosis develops

Question 17

RF angiodysplasia of colon

Answer 17

Aortic stenosis
VonWillebrand disease
CKD

Question 18

Organisms causing pseudomembranous colitis

Answer 18

C.dif and Salmonella

Question 19

fat embolism presentation

Answer 19

triad: respiratory insufficiency + neurologic impairment + petequia
can also have fever, tachycardia, AMS

Question 20

Why does petechiae occur in fat embolism

Answer 20

there is occlusion of the dermal capillaries by fat globules, and extravasation of the RBCs.

There is no abnormalities with platelets.

Question 21

tto of fat embolism

Answer 21

supportive, early immobilization and operative fixation of fractures prevent more fat embolism.

Question 22

which systemic disorder is associated with pseudogout?

Answer 22

hemochromatosis

Question 23

patient with DM, with arhtralgia, now with knee pain with rhomboid shaped crystals, hepatomegaly

Answer 23

hemochromatosis

2nd and 3rd MCP are more commonly affected , also knees, ankles and shoulders.

Question 24

Endocrine manifestations of hemochromatosis

Answer 24

DM, hypogonadism, hypothyroidism

Question 25

Patients with hemochromatosis are susceptible to which infections

Answer 25

Listeria, Vibrio Vulnificus, Yersinia

Question 26

treatment of hemochromatosis

Answer 26

serial phlebotomies- but it does not help arthropathy | - reduces risk of hepatocellular carcinoma

Question 27

complications of hemochromatosis

Answer 27

20 fold risk of hepatocellular carcinoma | accounts for up to 45% deaths

Question 28

Light criteria

Answer 28

Exudate: 1. Pleural protein/serum protein > 0.5 OR 2. Pleural LDH/Serum LDH >0.6 or 3. Pleural LDH > 2/3 of the upper limit of normal serum

Question 29

Causes of exudate

Answer 29

``` Infection (TB, pneumonia) Malignancy Connective tissue disease PE Pancreatitis Post CABG ```

Question 30

Causes of transudate

Answer 30

``` nephrotic syndrome cirrhosis HF cONSTRICTIVE PERICARDITIS Hepatic hydrothorax ```

Question 31

What is hepatic hydrothorax, why does it happen?

Answer 31

occurs in decompensated cirrhosis pleural effusion occurs due to passage of peritoneal ascitis to the right pleura ( right sided diaphragm is thinner and more porous) transudative

Question 32

tto hepatic hydrothorax

Answer 32

tto:furosemide, spironolactone, Na restriction if refractory - transjugular intraheptic portosystemic shunt placement. is bad so start looking for liver transplant.

Question 33

Pleurodesis is effective for exudative but not transudates.

Answer 33

transudates will recurr.

Question 34

Who should undergo endoscopic screening for metaplastic changes in esophagus

Answer 34

``` chronic GERD >5 years At least 2 risk factors: > 50 male caucasian hiatal hernia obesity or increased waist circumference (>102) current or former tabacco first degree relative with Barret or gastric adenocarcinoma ```

Question 35

RF for Barret esophagus

Answer 35

``` > 50 male caucasian hiatal hernia obesity or increased waist circumference (>102) current or former tabacco first degree relative with Barret or gastric adenocarcinoma GERD ```

Question 36

dyspepsia vs. GERD

Answer 36

dyspepsia: postprandial fullness, early satiety, epigastric pain. - H.pylori GERD: heartburn that worsens at bedtime, with coffee,

Question 37

coin as foreign objects are considered low risk- nontoxic material and round. Management?

Answer 37

Weekly follow-up X rays. IF no transti endoscopic removal.

Question 38

When is a CT indicated in foreign body aspiration

Answer 38

When pt is symptomatic and the event was unwitness | or if in X rays it is not possibly to define if the object is high risk

Question 39

treatment for oral candidiasis

Answer 39

nystatin suspension or clotrimazole troches

Question 40

SE of amiodarone

Answer 40

``` photosensitivity skin discoloration LFTs Thyroid Pulmonary toxicity ```

Question 41

Pulmonary toxicity by Amiodarone presentation

Answer 41

Interstitial pneumonitis MC -- nonproductive cough, fever, pleuritic chest pain, fever, weight loss, dyspnea. Chest X ray with interstitial/diffuse or alveolar opacities. can also present with pneumonia respiratory distress and rarely, solitary pulmonary nodule.

Question 42

Pulmonary toxicity by Amiodarone

Answer 42

removal of the amiodarone is mainstay steroids can be used in severe cases

Question 43

High risk characteristics of pulmonary nodule

Answer 43

``` large size >2 cm advanced age female active or previous smoking family or personal hx of cancer upper lobe location spiculated ```

Question 44

organophosphates poisoning mechanism and presentation

Answer 44

``` inhibit Acetylcholinesterase - so high Ach Muscarinic effects: Diarrhea Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Salivation ``` Nicotinic effects: muscle weakness, paralysis, fasciculations CNS effects: Respiratory failure, seizure, coma

Question 45

organophosphates poisoning ttto

Answer 45

atropine (competitive inhibitor) | pralidoxime ( regenerates achase if given early)

Question 46

antimuscarinic toxicity presentation

Answer 46

``` fever dry/flushed skin dry mouth cyclopegia constipation disorientation ``` Elderly: acute angle closure glaucoma urinary retention Infants: hypertheramia

Question 47

antimuscarinic toxicity antidote

Answer 47

physostigmine

Question 48

H. pylori treatment - standard - if allergy to penicillin - if failure after 1 course

Answer 48

1. If no allergy to penicillin: Amoxi, Clarithromyicin + PPI for 10-14d 2. If allergy to penicillin: MTZ , Clarythromycin +PPI for 10-14 days 3 If failure or high resistance to macrolide or MTZ: - MTZ, bismuth, tetracyclin, PPI for 10-14 days. * *Advice stoping NSAIDs while in therapy * * PPI just used during the treatment timeframe

Question 49

H. pylori causes which diseases

Answer 49

Peptic ulcer disease gastric cancer MALT: Mucosa associated lymphoid tissue lymphoma

Question 50

patient with treated H,pylori infection comes after a month with persistent symptoms. next step?

Answer 50

stool antigen testing for h. pylori or urea breath testing is done >=4 weeks after treatment to conform erradication

Question 51

In which patients should you confirm H.pylori erradication

Answer 51

persistent symptoms h.pylori associated ulcer in endoscopy evidence of h.pylori associated malignancy (ie. malt)

Question 52

polymiositis vs. PMR

Answer 52

polymyositis (inflammatory myopathy): PAINLESS, PROXIMAL MUSCLE WEAKNESS, elevated CK and inflammatory markers- trigger is unknown, possibly viral difficulty climbing stairs, combing the hair, getting in or out of a car ( age >40) PMR: Stiffness and pain rather than weakness age < 50s), fever, ESR, systemic signs and symptoms, improve with steroids

Question 53

Polymyositis can also involve esophageal musculature leading to dysphagia, regurgitation, and aspiration

Answer 53

true

Question 54

definitive diagnosis of polymyositis

Answer 54

muscle biopsy - endomysial infiltrate patchy necrosis

Question 55

tto of Polymyalgia rheumatica

Answer 55

steroids

Question 56

tto of polymyositis

Answer 56

corticosteroid sparing agents (methotrexate, azathioprine

Question 57

Pt with polymyositis with shortness of breath, bibasilar fine crackles. Dx and next step

Answer 57

interstitial lung disease- do pulmonary function tests

Question 58

Complications of polymyositis

Answer 58

Interstitial lung disease ( associated wiht Jo-1) - on CT would be likeground glass opacities, reticular changes, honeycombing pattern. drug induced pneumonitis ( methotrexate induced) respiratory weakness

Question 59

say kyphosis and scoliosis algorithms

Answer 59

say it

Question 60

why symptoms of lactose intolerance are higher with milk and icecream , than yogurt or cheese

Answer 60

milk and ice cream have higher lactose content dx: lactose breath hydrogen test

Question 61

Mono, recs for sports

Answer 61

3 weeks from all sports since symptom onset | 4 weeks contact sports

Question 62

smoking cessation at least 4 weeks prior to surgery decreases the risk of posoperative pulmonary complications

Answer 62

true

Question 63

treatment for latent TB if resistance to INH

Answer 63

Rifampin 4 months

Question 64

acute gout treatment in CKD

Answer 64

intra articular steroids or if multiple joints involved then oral steroid

Question 65

acute gout tto

Answer 65

NSAIDs and colchicine | IN CKD: intra articular steroids or if multiple joints involved then oral steroid

Question 66

Why does porcelain gallbladder occur?

Answer 66

chronic gallbladder stones and inflammation

Question 67

Patients with porcelain gallbladder are at increased risk of

Answer 67

gallbladder cancer prophylactic surgery if symptomatic or punctuate calcifications. If curvilinear no increased risk, and no need for surgery

Question 68

treatment of toxic megacolon (> 6cm diameter in transverse colon)

Answer 68

if caused by C.diff: antibiotics- IV MTZ and PR Vancomycin If not caused by C. diff: steroids ** do not give sulfazalazine as they can precipitate attack.

Question 69

treshold for transfusion in stable pts with upper GI bleeding

Answer 69

<7 as it is associated with less complications

Question 70

treshold for transfusion in adults

Answer 70

< 7 if stable, and even with GI bleeding | < 8 if stable cardiovascular disease, malignancies,

Question 71

Characteristics of functional abdominal pain

Answer 71

chronic >= 2 months poorly localized or peri umbilical no vomiting, diarrhea, weight loss negative guaiac next step: symptom diary

Question 72

suspect gout, next step

Answer 72

arthrocentesis uric acid level is not as sensitive because it can be normal or even low in gout.

Question 73

RF for gout

Answer 73

``` volume depletion diuretics high protein or high fat increased alcohol consumption recent surgery or trauma ```

Question 74

contraindications of NSAIDs when considering gout tto

Answer 74

``` Kidney disease anticoagulated PUD CHF NSAID sensitivity ```

Question 75

Diverticulosis can cause hematochezia. while diverticulitis doesnt

Answer 75

diverticulosis - ok to do colonoscopy | diverticulitis - contraindicated to do colonoscopy due to risk of perforation

Question 76

complications of GERD

Answer 76

Esophageal: erosive gastrtitis, Barrets, stricture | Non esophageal: asthma, laryngitis

Question 77

GERD management

Answer 77

8 week trial of low dose PPI( Daily) | If they fail- and no risk factors: can do high dose ( BID) for other 8 weeks prior to ordering further testing

Question 78

Patient with recent MI with sudden onset periumbilical pain severe and constant. Dx, next step?

Answer 78

acute mesenteric ischemia | CT Angiography

Question 79

acute mesenteric ischemia can have elevated amylase and phosphate, in addtion to lactic acidosis and leukocytosis

Answer 79

true

Question 80

one to two thirds of ADHD adolescentes will have it in adulthood

Answer 80

``` if untreated: social underachievement underemployment antisocial behavior substance use motor vehicle collisions ```

Question 81

Stimulant therapy in ADHD does increase risk for substance abuse?

Answer 81

NOO! - Stimulants are the first line treatment for adolescents and school aged > 6 years . Even if the patient has a family history of substance abuse. However, if the patient had. PERSONAL history of substance abuse ( more than just trying some drugs) may consider non stimulants drug

Question 82

clinical features of meniscal tear

Answer 82

small effusion locking sensation inability to extend positive mcMurray test ( push medially knee and pull ankle)

Question 83

management of meniscal tear

Answer 83

if uncomplicated can be managed with RICE Rest, Ice Compression, Elevation Most cases are managed non operatively

Question 84

Best initial approach to difficult conversations of fear to die with cancer diagnosis is open ended question

Answer 84

true

Question 85

patient with HIV afraid of telling fiancee

Answer 85

first step is always to encourage them to tell the third parties. physicians should always report the HIV case to the Department of Public Health, but the disclosure to third parties varies among states

Question 86

contraindications for going to hospice care

Answer 86

none even if the patient is ill enough that is not able to decide to go to hospice, family works as surrogate deciison maker.

Question 87

forced sterilization is considered unethical even if patient is intellectual disable

Answer 87

she must decide, and if she doesnt want other contraceptive methods should be discussed instead also is important to identify guardanship for deicision making.

Question 88

patient with mild intelectual disability who is her own guardian, asking about contraceptive methods. After physician explains, she says whatever you decide Dr. Next step?

Answer 88

Assess Capacity- tell me your understanding about the options we just discussed

Question 89

Which are the systemic ss and cervical involvement seen in RA

Answer 89

Systemic symptoms: fatigue, weight loss, anemia | Cervical involvement: subluxation, and cord compression

Question 90

antibodies of rheumatoid arthritis

Answer 90

RF and anti-cyclic citrullinated peptide - associated with accelerated destruction If negative, less severe disease BUT RA can present with negative antibodies! So clinic suspicion is important and even if negative is OK to start methotrexate

Question 91

MOA methotrexate

Answer 91

inhibits dihydrofolate reductase | inhibits purine synthesis and DNA

Question 92

SE of Methotrexate

Answer 92

Hepatotoxicity, stomatitis, bone marrow suppression

Question 93

Patients with RA started on Methotrexate should receive supplementation with

Answer 93

Folate acid

Question 94

Predictors of poor outcome/worse severity in pancreatitis

Answer 94

``` Age > 55 Obesity BMI>30 Hematocrit >44 CRP >150 BUN >20 ``` CHAO-B

Question 95

scores for pancreatitis

Answer 95

Ranson criteria APACHE II SIRS Bedside indext for severity of pancreatitis

Question 96

Which patients can have catatonia

Answer 96

severely ill patients with: schizophrenia bipolar disorder with psychotic features major depression with psychotic features autism medical conditions (infectious, metabolic , neuro, rheumatologic)

Question 97

treatment of catatonia

Answer 97

BZD (especially lorazepam) and/or ECT Lorazepam challenge (1-2 mg ) pt improve within 10-15 min. If does not respond doesnt rule out catatonia and patient may need multiple doses.

Question 98

WHEN IS Dantrolene used

Answer 98

neuroleptic malignant syndrome

Question 99

neuroleptic malignant syndrome presentation

Answer 99

``` recent exposure to antipsychotics muscle rigidity fever altered mental status autonomic instability CK and leukocytosis ```

Question 100

cocaine in urine

Answer 100

only indicates recent use, the last 2-3 days

Question 101

patient who comes for asthma follow-up and is in a hurry, mentions that he left his home, moved with friends, lost school, and at exam septum perforated. Next step

Answer 101

brief counseling intervention

Question 102

Combination of psychotherapy and antidepressants is more effective than either alone in depresssion

Answer 102

true

Question 103

Treatment of Tourette

Answer 103

Habit reversal training ( form of behavioral training) Tetrabenazine ( dopamine depleter) antipsychotics ( Risperidone, aripiprazole) alfa 2 adrenergic receptor agonist (Clonidine, guanfacine)

Question 104

Bordeline personality

Answer 104

unstable relationship, suicide attempt after finishing relationship, long standing mood instability, marked impulsivity often have splitting-- saying first best things of boyfriend and then the opposite

Question 105

tto Bordeline personality

Answer 105

Primary tto is DIALECTICAL BEHAVIORAL THERAPY | and sometimes can add antipsychotics (2nd generation-risperidone, aripiprazole) and mood stabilizers

Question 106

Lithium can be used in pregnancy?

Answer 106

Although it causes ebstein abnormality in baby it can be used. However if bipolar pregnant with suicidal thoughts, is better to pursue ECT - acts faster

Question 107

Etiology of reactive arthritis

Answer 107

Gastroenteritis : Salmonella, shigella, yersinia, campylobacter, C. diff Genitorurinary infection: Chlamydia trachomatis

Question 108

extra MSK manifestations of reactive arthirits

Answer 108

ocular: uveitis, conjunctivitis Genital: urethritis, cervicitis, prostatitis skin: keratoderma blennorrhagica, circinate balanitis oral ulcers

Question 109

NAAT for chlamydia is done in URINE not from lesions

Answer 109

true

Question 110

Tto of reactive arthritis

Answer 110

antibiotics for chlamydia or non self resolving GI tract infection NSAIDs (naproxen, ibuprofen, indomethacine) If NSAIDs not helpful or contraindicated may add: intraarticular steroids or systemic steroids

Question 111

patient with acute diverticulitis who is on cipro and mtz but persists with abdominal painafter a week. next step

Answer 111

repeat CT scan to assess for complications: abscess, obstruction, fistula, perforation *pts usually improve with antibiotic therapy by 2-3 days

Question 112

most common complication of diverticulitis

Answer 112

colonic abscess - require percutaneous drainage and IV antibiotics followed by elective partial colectomy several weeks later

Question 113

when would be prudent make a colonoscopy in a pt with diverticulitis

Answer 113

6-8 weeks after resolution of ss

Question 114

patients who are actively suicidal and refusing treatment should be placed in 1:1 observation and hospitalize under involuntary status

Answer 114

true

Question 115

thyroglobulin and radioiodine intake in pt taking exogenous hormone

Answer 115

low and low

Question 116

drugs that cause serotonin syndrome

Answer 116

SSRiS interacting with IMAO (Phenelzine)or linezolid Intentional overdose with SSRIs MDMA

Question 117

CYPROHEPTADINE MOA

Answer 117

Serotonin antagonist

Question 118

tto of serotonin syndrome

Answer 118

Discontinuation of serotonin medications supportive care, sedation with BZDs Can give serotonin antagonist (cyproheptadine) if tto fails.

Question 119

serotonin syndrome presentation

Answer 119

``` triad of mental status changes ( Anxiety, delirium, confusion, restlessness) autonomic dysregulation (diaphroesis, hypertension, hyperthermia) neuromuscular hyperactivity( hyperreflexia, tremor, clonus) ```

Question 120

switch from SSRI to IMAO needs how many weeks to dont cause serotonin syndrome

Answer 120

5 weeks

Question 121

2 most common comorbidities in Tourette

Answer 121

ADHD, OCD

Question 122

HISTRIONIC PATIENT

Answer 122

excessive superficial emotionality and attention seeking. They may also have sexually provocative behavior

Question 123

when do you indicate cholecystectomy in gallbladder pancreatitis

Answer 123

if mild disease- usually within 7 days- so in the same hospitalization if severe disease is better to wait until inflammation has gone down, and there is resolution of complications. these patients need preoperative ERCP

Question 124

first line tto for ADHD in pre-school ages

Answer 124

nonpharmacological therapy - parent child behavioral therapy

Question 125

prior to prescribing methylphenidate the physician need to assess for

Answer 125

cardiac history and physical exam - assess for sudden death in the family - no need for routine ECG

Question 126

if no significant improvement with stimulants, or report od side effects, best option is to switch to another medication.

Answer 126

true

Question 127

Difference between somatic symptom disorder and illness anxiety disorder

Answer 127

somatic: excessive anxiety or preoccupation with >=1 unexplained symptom >=6 months illness: fear of having a serious illness despite few or no ss, and multiple negative evaluations.

Question 128

Difference between factitious disorder and malingering

Answer 128

factitious: intensional falsification of ss without external gain malingering: falsification or exaggeration of ss with external gain

Question 129

treatment of somatic symptom disorder

Answer 129

schedule regular visits with same physician develop a patient-physician relationship focus on functional improvement -limit workup and unnecessary testing/referrals

Question 130

lithium toxicity (5)

Answer 130

N/V/ diarrhea slurred speech confusion tremor ataxia therapeutic levels 0.8-1.2 toxicity >1.5

Question 131

Meds that increase risk of lithium toxicity

Answer 131

Thiazides ( chlorthalidone) ACEis NSAIDs (not aspirin) * also volume depletion/renal insufficiency

Question 132

Management of lithium toxicity

Answer 132

``` lithium levels every 2-4 hrs IV hydration (0.9%NS) Hemodialysis: > 4 mEq > 2.5 with ss or renal failure increasing levels despite IV fluids ```

Question 133

Patient with depression who was started on fluoxetine comes 2 weeks after initiation of treatment. Reports feeling better but has some nausea, anxiety and insomnia. Next step in tto?

Answer 133

Wait and re-evaluate at the 6 month period - pt is clinically improving - pt has mild SE of SSRIs for which is common develop tolerance and they will go away with time* ** SSRI erectile dysfunction is the only thing that will not go away and that warrants assessing other med.

Question 134

Pt with anterior knee pain, pain worse when squatting, prolonged sitting, climbing or descending stairs. Dx?

Answer 134

patellofemoral syndrome - + patellofemoral compression test : pain elicited by extending the knee while compression of patella

Question 135

patellofemoral syndrome vs patellar tendonitis

Answer 135

patellofemoral syndrome:anterior knee pain, pain worse when squatting, prolonged sitting, climbing or descending stairs.+ patellofemoral compression test patellar tendonitis: episodic pain and tenderness at interior patella and inferior tendon

Question 136

patellofemoral syndrome tto

Answer 136

exercises that strenghthen quadriceps

Question 137

prepatellar bursitis complication

Answer 137

septic bursitis by S.aureus

Question 138

presetnation of anserine bursitis

Answer 138

medial knee pain | ss are acute/episodic

Question 139

Osgood Schlatter syndrome

Answer 139

pain at the insertion of the patellar tendon in the anterior tibial tubercle in children/adolescent growth spurt localized pain at the tibial tubercle

Question 140

evaluation of acute dysentery ( bloody diarrhea)

Answer 140

stool pathogen panel, Shiga toxin, fecal leukocytes low leukocyte count- amebiasis

Question 141

Why antibiotics are adviced for all causes of acute dysentery except for EHEC?

Answer 141

antibiotic therapy in EHEC has been associated with high risk of HUS

Question 142

Antipsychotic extrapyramidal effects timing and tto

Answer 142

Acute Dystonia (4h-4d) Benztropine, dyphenydramine Akathisia (any time) - propanolol parkinsonism (4d-4m)- benztropine, amantadine Tardive Dyskinesia (1-6 m) - clozapine, valbenazine

Question 143

antibodies and their course in celiac disease

Answer 143

anti tissue transglutaminase anti gliadin antibody correlate with disease activity should decline by 50% in 8 weeks and normalize in 12 weeks after gluten free diet.

Question 144

beer can have gluten

Answer 144

true

Question 145

woman with menopause should be encouraged to have vit D and calcium supplementation

Answer 145

true

Question 146

Clozapine SE

Answer 146

``` agranulocytosis ( pts should have weekly ANC checks for 6 months and then every other week for 6 months, and then monthly) weight gain metabolic syndrome seizures pulmonary embolism myocarditis excessive salivation constipation ileus ```

Question 147

Indications for hospitalization in anorexia nervosa

Answer 147

``` hemodynamic instability: syncope, orthostasis, BP < 80/60, HR<40, hypothermia Refeeding syndrome < 70% of expected weight, or BMI<15 Acute food refusal suicidal, psychosis ```

Question 148

tto of anorexia

Answer 148

psychotehrapy and nutritional rehab

Question 149

clinical manifestations of refeeding syndrome

Answer 149

hypophosphatemia, hypokalemia, hypoMg, low thiamine Arrhythmia Congestive heart failure( pulmonary edema, peripheral edema) seizures Wernicke Korsakoff

Question 150

woman wit refeeding syndrome who has pulmonary edema as manifestation. tto?

Answer 150

replete electrolytes- phosphate. no need of diuretics- would worsen electrolyte derrangement

Question 151

3 types of colonic polyps

Answer 151

Hyperplastic - mucosal proliferation Hamartomas - juvenile and Peutz Jeghers Adenomas( pre-malignant)

Question 152

cancerous characteristics of polyps

Answer 152

sessile, villous villous> tubulovillous> tubular

Question 153

patient with small rectal hyperplastic polyps, when should be the next colonoscopy?

Answer 153

10 years

Question 154

patient with 1-2 small (<1cm) tubular adenoma, when should be the next colonoscopy?

Answer 154

5 years

Question 155

patient with the following, when should be the next colonoscopy? - 3-10 adenomas - any adenoma >1cm - adenoma with high grade dysplasia or VILLOUS

Answer 155

3 YEARS

Question 156

large sessile polyp or with adenoCa, next colonosocpy?

Answer 156

2-6 months

Question 157

anual colonoscopy is indicated in which patients

Answer 157

familial adenomatous polyposis

Question 158

First line treatment for insomnia

Answer 158

cognitive behavioral therapy

Question 159

Postcholecystectomy diarrhea and post short bowel syndrome diarrhea -underlying mechanism and tto

Answer 159

bile salt induced diarrhea Cholestyramine is a bile acid sequestrant

Question 160

history of attemted suicide is the strongest risk factor for suicide.

Answer 160

true

Question 161

pregnant women with gallstones but asymptomatic, next step?

Answer 161

reassurance, pregnant women are predisposed to gallstone formation. - if asymptomatic no surgery - if ss- IV fluids, pain control. If not able to control cholecystectomy in 2ND SEMESTER

Question 162

What happens in developmental hip dysplasia

Answer 162

abnormal acetabular development shallow hip socket and inadequate support for the femoral head. -hip clunk, asymmetric leg creases

Question 163

developmental hip dysplasia in adults that were not diagnosed

Answer 163

``` leg lenght discrepancy toe walking on affected side trendelenburg gait osteoarthritis activity related pain in the hip and groin ```

Question 164

antiseizure medications that decrease efficacy of OCPs

Answer 164

phenytoin, CBZ, ethosuximide, phenobarbital,topiramate

Question 165

Ovarian insufficiency can cause amenorrhea and likely presents with hypoestrogenism signs (vaginal dryness, hot flashes)

Answer 165

T

Question 166

Patient that calls the office with concerns for vaginitis , pruritus, discharge, malodour. next step?

Answer 166

Ask her to come to clinic, diagnosis of vaginitis ALWAYS NEED WET MOUNT MICROSCOPY OR NAT.

Question 167

Clues for metastatic brain tumor

Answer 167

multiple, well circumscribed areas ( can be enhancing lesions) with significant vasogenic edema as compared with the lesion. - small cell lung cancer has early metastasis to brain.

Question 168

presence of cremasteric reflex DOES NOT exclude testicular torsion

Answer 168

In testicular lesion moderate to severe always get doppler -significant swelling and or marked pain

Question 169

Testicular FNA is used to retrieve sperm in pts with male infertility but its not used for testicular evaluation of injury.

Answer 169

true

Question 170

Absent cremasteric reflex

Answer 170

is nonspecific finding- can or not occur in testicular torsion, can occur in testicular trauma, or jsut a normal variant.

Question 171

presence of cremasteric reflex does not exclude testicular torsion or trauma

Answer 171

T

Question 172

Management of scrotal trauma

Answer 172

mild- conservatively with angalgesics, ice | moderate to severe- US to assess for testicular injury.

Question 173

antenatal findings of PUV

Answer 173

Bilateral hydronephrosis, thickened and dilated bladder- olignohydramnios, dilation of anterior urethra

Question 174

PUV can cause POTTER Sequence

Answer 174

So babies with PUV that in the first hours of life have transient tachypnea think about that.

Question 175

PUV prsentation

Answer 175

besidesBilateral hydronephrosis, thickened and dilated bladder- olignohydramnios, dilation of anterior urethra can have: recurrent UTIs, respiratory distress, POTTER sequence, WEAK URINE STREAM

Question 176

What is the best dx study for posterior urethral valves?

Answer 176

voiding cystourethrogram - dx confirmed with dilation of proximal urethra when the catheter is removed.

Question 177

Next steps after VCUG confirms PUV

Answer 177

Foley cath to relieve obstruction | Then cystoscopy to allow direct visualizations and ablation of the valve

Question 178

tto of panic disorder

Answer 178

acute:BZD | long term SSRI AND/OR cognitive behavioral therapy

Question 179

Postmenopausal women need topical estrogen for vaginal dryness. SSRIs for postmenopausal ss wont help that

Answer 179

true assess particularly in the woman who complains about their sexual life.

Question 180

nightmares vs night terrors

Answer 180

nightmares: REM disorder, second half of the night. Will recall dream and have complete awakenings night terrors: non REM disorder, first half of the night, crying incosolably

Question 181

prognosis and tto of night terrors

Answer 181

resolve in 1-2 years | tto is reassurance , unless there is high frequency in episodes or impairment of day function- low dose BZD

Question 182

MOA Tamoxifen and Raloxifen

Answer 182

SERS - Selective Estrogen receptor modulators - competitive inhibitor of estrogen binding mixed agonist/antagonist options

Question 183

Indications of Tamoxifen /Raloxifen

Answer 183

tamoxifen: adjuvant tto in breast Ca raloxifen: postmenopausal osteoporosis

Question 184

SE Tamoxifen /Raloxifen

Answer 184

Hot flashes, DVT | Tamoxifen only: endometrial hyperplasia and Ca

Question 185

How to monitor for side effects of tamoxifen

Answer 185

thinking of endometrial hyperplasia, only if ss develop endometrial US or biopsy would be useful. Otherwise NOT!

Question 186

Woman who wants a bariatric surgery and then get pregnant, recommendation?

Answer 186

bariatric surgery and space pregancy for a year. Stabilize nutritional status prior to pregnancy. If during year of bariatric surgery can have bad outcomes in fetus (neural tube deffects due to poor folate) After the year risks of fetus are same than general population

Question 187

appendicitis can present with fever

Answer 187

true

Question 188

Pregnant women have atypical presentations of appendicitis

Answer 188

True- displacement of appendix by uterus | May not present with peritoneal signs or McBurney point

Question 189

imaging of choice for dx appendicitis in pregnancy

Answer 189

US | -when results are unconclusive-MRI

Question 190

complication of appendicitis/diverticulitis

Answer 190

pyeliphlebitis- infective suppurative portal vein thrombosis (portal vein drains all the abdomen)

Question 191

Pain management of opioid dependent pt who is victim of MVA

Answer 191

Obtain consent, discuss risks, | prescribe opioids- given tolerance this may be higher doses than usual for pain

Question 192

Dx of acute hemolytic transfusion reaction

Answer 192

positive direct coombs test pink plasma hemoglobinuria repeated cross match showing mismatch. - flank pain, hemoglobinuria, DIC

Question 193

Complications of breast implants

Answer 193

``` capsular contracutre (pain) distortion of shape implant deflation or rupture ```

Question 194

Silicone breast implants DO NOT CAUSE autoimmune, rheumatologic, or neuro complications

Answer 194

DO NOT CAUSE THAT

Question 195

Mammograms in women with breast implant

Answer 195

same as non-breast implant 50 to 54 years should get mammograms every year. 55 years and older every 2 years, or have the choice to continue yearly screening. In addition breast mplant: every 2-3 years MRI to assess for asymptomatic breakdown

Question 196

Presentation Henoch schonlein

Answer 196

palpable purpura arthralgias abdominal pain/intussusseption renal disease

Question 197

labs Henoch schonlein

Answer 197

Normal coagulation/plts. Normal to increased creatinine Hematuria, RBCs, Protein

Question 198

tto Henoch schonlein

Answer 198

supportive | In severe cases: steroids

Question 199

Hypothyroidism can produce hypoNa

Answer 199

true

Question 200

Evaluation of hyponatremia algorithm

Answer 200

say it

Question 201

postpartum thyroiditis presentation

Answer 201

brief thyrotoxic, then hypothyroid and then eu.

Question 202

Meds that interfere with folate metabolism leading to macrocytic anemia

Answer 202

MTX, TMP, phenyotin

Question 203

always that you guve mtx supplement with

Answer 203

Folinic acid (Leucovorin)

Question 204

How does BZD withdrawal present?

Answer 204

Elderly that has been on BZDs, discontinued due to fall or other SE Then presents with confusion, restlessness, hallucinations, psychosis, AUTONOMIC INSTABILITY TTO BZD- and then taper off.

Question 205

tto of keloids

Answer 205

intralesional glucocorticosteroids | but 30% recur

Question 206

patient on ACEi who develops edema, next step

Answer 206

stop ACE and give ARB

Question 207

first line tto for UTI in pregnancy

Answer 207

Nitrofurantoin for 5-7 days Cephalexin 3-7 days Amoxi-clavulanate 3-7 Fosfopmycin single dose **always repeat urine culture and analysis after a week to assure for cure

Question 208

tto of acute pyelo during pregnancy

Answer 208

complete course of antibitoics, then prophylactic dose durng and 6 weeks after birth to prevent recurrence

Question 209

first line tto for UTI in non pregnancy

Answer 209

TMP-SMX

Question 210

Why TMP SMX cannot be used in pregnancy

Answer 210

1st trim: neural tube defects | 3rd : kernicterus

Question 211

test for scabies

Answer 211

skin scrapings for exam under light microscopy --reveal mites, ova, and feces

Question 212

tto scabies

Answer 212

5% permethrin cream | oral ivermectine also alternative

Question 213

pt GBS positive in first trimester. next step?

Answer 213

treat with amoxi now, and then penicillin prophylaxis at labor

Question 214

Indications of GBS prophylaxis in labor

Answer 214

GBS bacteriuria or UTI in current pregnancy(regardless of tto) GBS positive rectovaginal culture during pregnancy Unknown GBS status PLUS one of the following: a. < 37w b. Intrapartum fever c. ROM> 18 Prior infant with early onset GBS infection

Question 215

hypokalemia from loop diuretics can cause ILEUS

Answer 215

TRUE

Question 216

POTTER sequence

Answer 216

P: pulmonary hypoplasia. O: oligohydramnios. T: twisted skin (wrinkly skin) T: twisted face (Potter facies: low set ears, retrognathia, hypertelorism)

Question 217

Diversion of medication

Answer 217

transferring medication that was prescribed to you, to another individual

Question 218

Misuse of medication

Answer 218

using higher doses to achieve euphoric effects, mixing with other drugs.

Question 219

SE of stimulants

Answer 219

weight loss, decreased appetite, dry mouth, irritability

Question 220

Why do patients take St.Johns wort?

Answer 220

depression, insomnia

Question 221

SE/Risks of St. Johns wort

Answer 221

- Interaction with drugs ( decreased efficacy of OCPS)nticoagulants, - Can cause serotoninergic syndrome (SO SSRIs + St Johns wort is contraindicated) -In depression the results are inconsistent-European study show that it may work for mild to moderate depression.

Question 222

When to administer anti D immunoglobulin

Answer 222

RH - moms, Rh + infant at 28 weeks and < 72 hours postpartum Generally 300 micrograms

Question 223

What is the dose of anti D immunoglobulin ? how to calculate

Answer 223

standard dose is 300 micrograms If fetomaternal hemorrhage it has to be adjusted. 1st rosette test to assess presence of fetomaternal hemorrhage If positive, then Kleihaure Betke to calculate the increase in dose based onpercentage of the RBCs in the maternal circulation - so if a mom received immunoglobulin and has low titersfrom previous pregnancy is because the dose was wrong after birth.

Question 224

When is early prophylaxis with anti D immunoglobulin indicated

Answer 224

If there is hemorrhage , vaginal bleeding or trauma < 28 weeks.

Question 225

psedofolliculitis barbae tto

Answer 225

pic, is painful | - stop shaving

Question 226

Complications of psedofolliculitis barbae

Answer 226

hyperpigmentation secondary bacterial infection keloid formation

Question 227

Role of vit E in alzheimer

Answer 227

It does NOT prevent it- nothing prevents it | But there has been some benefit in slowing progression in mild to moderate AD

Question 228

Clinical presentation of Duchennes muscular dystrophy

Answer 228

``` 2-3 years old Proximal muscle weakness (Gower sign,calf psudohypertrophy) hyporeflexia achilles waddling gait Dilated cardiomyopathy Scoliosis ```

Question 229

Diagnosis of Duchenne's

Answer 229

High CK level Genetic test: dystrophin deletion on X gene Muscle biopsy: fat, fibrosis, muscle degeneration GENETIC TESTS CONFIRM DX

Question 230

tto of Duchennes

Answer 230

Steroids

Question 231

Prognosis of duchenne

Answer 231

Wheel chair dependence by adolescence | Death at age 20-30 from heart or respiratory failure

Question 232

Characteristics of fibroadenoma

Answer 232

<30 unilateral, rubbery, mobila outer quadrant hormonal fluctuation

Question 233

The most common adverse events in non surgical and surgical patients

Answer 233

surgical- related to surgery ( wound infection, bleeding, DVT) non-surgical: adverse drug reactions 2nd most common cause for both is hospital acquired infections.

Question 234

Why do patients with PCOS have anovulation and infertility

Answer 234

chronically elavated estrogen due to peripheral conversion from androgens to estrone in adipose tissue , which contributes to anovulation and infertility

Question 235

womam with PCOS and infertility , next step

Answer 235

weight loss | letrozole (aromatase inhibitor) for ovulation induction

Question 236

tto for stress urinary incontinence

Answer 236

``` lifestyle modifications pelvic floor exercises pessary sometimes SSRIs surgery ```

Question 237

tto for urgency urinary incontinence

Answer 237

lifestyle modifications timed voids (every 3-4 hours) and bladder training antimuscarinic ( OXYBUTININ)

Question 238

tto for overflow urinary incontinence

Answer 238

bethanecol (cholinergic) intermittent cath

Question 239

location of lichen planus lesions

Answer 239

``` Flexural areas (wrists) - very itchy oral (Wickham striae) genital area (glans of penis,vulvar area) ```

Question 240

Dx of lichen planus

Answer 240

skin biopsy

Question 241

tto of lichen planus

Answer 241

antihistamines, steroids

Question 242

lichen planus is associated with which condition

Answer 242

HCV

Question 243

triad of mixed cryoglobulinemia syndrome

Answer 243

palpable purpura weakness - peripheral neuropathy also frequent arthralgia

Question 244

Mixed cryoglobulinemia is associated with which condition

Answer 244

Hep C (MCC) BUT can also be seen in Hep B, HIV, rheumatologic diseases

Question 245

labs in mixed cryoglobulinemia

Answer 245

elevated RF hypocomplementemia glomerulonephritis and high serum cryoglobulins

Question 246

In which disease do you see antiglomerular basal membrane antibodies

Answer 246

Good pasteur

Question 247

tto of mixed cryoglobulinemia

Answer 247

two parts: 1. initial immunosuppresive therapy- targers glomerulonephritis- rituximab and steroids 2. treat underlying cause- antivirals for Hep c

Question 248

risk factors for abruptio placenta

Answer 248

abdominal trauma, hypertension, cocaine, tobacco use

Question 249

Pt with abnormal Newborn screen with hypothyroidism

Answer 249

start immediately hormone replacement to prevent developmental delay if not started within 2 weeks order us of thyroid and refer to endocrine

Question 250

presentation of congenital hypothyroidism

Answer 250

at birth normal age <1 month: jaundice, poor feeding, hypothermia age 1-4 m: FTT, constipation

Question 251

If a patient is diagnosed with Turner, next step

Answer 251

Echocardiogram- coarctation of aorta, bicuspid valve, hypoplastic heart, MVP Visual/hearing TSH renal US

Question 252

presentation of uterine rupture while in labor

Answer 252

loss of fetal station fetal parts in abdomen loss of intrauterine pressure( seen in the contractions) decelerations

Question 253

RF for uterine rupture

Answer 253

previous C section, myomectomy,advanced maternal age, fetal macrosomia, interpregnancy interval < 18 months.

Question 254

tto uterine rupture

Answer 254

emergent laparotomy

Question 255

treatment of mild to moderate plaque psoriasis

Answer 255

HIGH potency topical steroids( fluocinonide, augmented bethametasone) ORAL STEROIDS are not recommended because risk of developing pustular psoriasis Low potency steroids ( hydrocortisone) only for face or intertriginous areas

Question 256

treatment of severe plaque psoriasis

Answer 256

methotrexate or phototherapy ORAL STEROIDS are not recommended because risk of developing pustular psoriasis

Question 257

guttate psoriasis tto

Answer 257

observation ( no tto) | phototherapy

Question 258

Patient who had resection of medullary cancer , and after 6 months still has elevated calcitonin. Next step?

Answer 258

CT neck and chest to evaluate metastasis * parafollicular cells do not store iodine so iodine scan not useful. * US bad to pick up metastasis

Question 259

turtle sign

Answer 259

retraction of the fetal head into the peritoneum once outside due to shoulder dystocia

Question 260

tto of shulder dystocia

Answer 260

``` BECALM Breath and push Elevate and flex legs to abdomen ( McRoberts) Call for help Apply pressure in suprapubic area EnLarge - episitomy Manuevers - deliver the posterior arm -rotate the posterior shoulder ( Woods screw) -Adduct posterior fetal shoulder(Rubin) Mother in 4 (Gaskin) Replace fetal head into pelvis for cesarean delivery (Zavanelli) ```

Question 261

RF for shoulder dystocia

Answer 261

``` prior shoulder dystocia macrosomy DM Maternal obesity post term pregnancy Operative vaginal delivery ```

Question 262

Physicians attending conferences cannot accept subsides from pharmaceuticals on travel, lodging, or other personal expenses. While physicians presenting can, but not medical slides and full disclosure is needed .

Answer 262

true

Question 263

prognosis of alopecia areata

Answer 263

``` hair can grow eventually, but there is high risk of recurrence despite successful treatment Particularly in patients: - longer duration of disease -onset in prepuberty -more extensive disease ```

Question 264

cause of alopecia areata

Answer 264

exact mechanism is unknown

Question 265

is alopecia areata associated with lymphoma?

Answer 265

NOOO! Is associated with some autoimmune diseases- vitiligo, pernicious anemia, thyroid disease

Question 266

tto of alopecia areata

Answer 266

topical or intralesional corticosteroids

Question 267

Complications of systemic sclerosis

Answer 267

lungs: interstitial lung disease, pulmonary arterial HTN renal: HTN, Microangiopathic hemolytic anemia Heart: heart fibrosis, pericarditis, pericardial effusion

Question 268

pelvic pain exacerbation with bowel movement, rectovaginal nodularity, ovarian mass

Answer 268

endometriosis

Question 269

why there is infertility in endometriosis

Answer 269

pelvic adhesions and inflammations tto: surgical resection or in vitro fertilization

Question 270

first line management for uterine atony

Answer 270

massage and oxytocin

Question 271

Victim of MVA who says that he doesnt want for him and his daughter blood transfusion given Religion, next step

Answer 271

- For the dad: try to do everything possible without blood transfusion - For kid: transfuse if needed, independent of parent wishes

Question 272

pruritus in pregnant , differential

Answer 272

pregnancy induced skin changes- due to hormonal changes, its focal. +/- transaminitis, normal bile. intrahepatic cholestasis of pregnancy- generalized pruritus, involves hands and foot. elevated bile and transaminases. Can lead to fetal demise, so delivery by 37. tto ursodeoxycholic acid, antihistamines

Question 273

dx of pemphigus gestationis

Answer 273

skin biopsy

Question 274

tto of pemphigus gestationis

Answer 274

topical high potency steroids- triamcinolone anti histamines if unresponsive systemic steroids and less common immunosuppresants cyclosporin, azathioprine

Question 275

Patient with lupus + glomerulonoephritis, next step?

Answer 275

US guided renal biopsy to classify it | there are 6 categories

Question 276

TTO OF LUPUS NEPHRITIS

Answer 276

Type I and II: nothing Type III and IV: immunosupression with steroids (MP), and mycophenolate or cyclophosphamide Type V: immunosuppression only if proliferative lesions Type VI: no benefit of immunossupresion

Question 277

How can you monitor active renal involvement and progression in lupus

Answer 277

Anti dSDNA and complement levels(low) lupus nephritis is a immune complex glomerular injury. Immune complexes mainly of Anti dsDNA and they deposit in different parts of the kidney immune complex deposition lead to complement fixation- so circulating complement is low

Question 278

lack of menses in < 15 years is normal if there are secondary characteristics ( breast developed)

Answer 278

true

Question 279

when doese thelarche and menarch occur

Answer 279

telarche 8-12 | menses 2-2.5 years after

Question 280

Causes of delayed puberty

Answer 280

Primary hypogonadism: Klinefelter Secondary: Constitutional, chronic illness, malnutrition Hypothyroidism, Kallman Sx, Craniopharyngioma

Question 281

Initial workup of delayed puberty

Answer 281

FSH, LH, Prolactin , testosterone, TSH

Question 282

treatment of primary dysmenorrhea (pain with menses)

Answer 282

NSAIDs e.g,Naproxen -in non sexually active | then OCPs

Question 283

treatment of immune thrombocytopenia

Answer 283

if asymptomatic nothing if bleeding ( even if its just mucosa), or platelet count 30,000 give IVIG

Question 284

Best contraceptive method for PCOS

Answer 284

PROGESTIN only

Question 285

patient with worsened acne, mood changes, and increased hirsutism, erythropoyesis ( elevated Hb and Hcto) that also goes to the gym

Answer 285

anabolic use

Question 286

SE of anabolic steroids

Answer 286

``` Mood changes, increased agressiveness worsening acne hirsutism men: decreased testicular size, sperm count, gynecomastia women eating disorder, bilateral temporal hair loss, ERYTHROPOYESIS hepatic dysfunction ovarian dysfunction decreased HDL ```

Question 287

Dx of cyclothymic disorder

Answer 287

2 years of hypomania and depressive ss

Question 288

Streptococcus treatment

Answer 288

10 days of penicillin if not able to tolerate oral: a single dose of IM Penicillin If allergic to penixillin - 5 days of azithro

Question 289

Strongest risk factor for PID

Answer 289

Multiple sexual partners MORE THAN - Prior PID - Inconsistent condom use - Partner with sexually transmitted infection

Question 290

tto of PID

Answer 290

Inpatient and outpatient: Ceftriaxone plus Doxycycline

Question 291

treatment of hepatic encephalopathy

Answer 291

lactulose, if it doesnt work in 48 hrs can change to Rituximab. its often triggered by hypokalemia and metabolic acidosis so if the patient already has lactulose treat electrolyte imbalance

Question 292

new onset psychosis in a patient, next step

Answer 292

first assess if this is substance related | and medical causes

Question 293

rupture ectopic pregnancy, next step

Answer 293

emergency laparoscopy

Question 294

ectopic pregnancy and hemodynamically stable, next step

Answer 294

iF B-HCG< 1500: repeat BHCG in 2 days | If bHCG > 1500: Repeat BHCH and transvaginal US in 2 days

Question 295

patient that presents with renal colic and has history of opioid/NSAIDS use. Dx

Answer 295

analgesic nepropahty - papillary necrosis

Question 296

Penicillin is indicated as prophylaxis in women < 37 weeks if unknown status Corticosteroids < 37 weeks ( or < 34 in DM) Magnesium < 32

Answer 296

true

Question 297

tto of acute bacterial prostatitis

Answer 297

TMP/SMX or Cipro | And empty bladder - often have urinary retention

Question 298

anterior uveitis ( iritis) presentation

Answer 298

``` red eye pain variable visual loss photophobia CONSTRICTED AND IRREGULAR IRIS LEUKOCYTES IN ANTERIOR SEGMENT OF EYE SEEN IN SLIT LAMP ```

Question 299

ACUTE CLOSED ANGLE GLAUCOMA PRESENTATION

Answer 299

``` red eye pain variable visual loss photophobia PLUS INCREASED INTRAOCULAR PRESSURE ```

Question 300

Suspect testicular cancer, next step? | presenting with enlarged testicle, hard, no translumination

Answer 300

bilateral US of testicle If solid lesion- order AFP, BhCG and CT chest , chest Xray to stage **dont biopsy due to risk of lymphatic spread and recurrence

Question 301

tto testicular cancer

Answer 301

radical orchiectomy plus chemotherapy is often curative | 5 year survival 95%

Question 302

varicocele does NOT transluminate

Answer 302

true

Question 303

management of subchorionic hematoma

Answer 303

expectant +/- serial US | it will be described as crescent hypoechoic lesion adjacent to gestational sac

Question 304

Indications of Kleihauer Betke test

Answer 304

IN MOM RH NEGATIVE AND hemorrhage at delivery, maternal trauma first trimester bleeding

Question 305

complications of subchorionic hematoma

Answer 305

``` spontaneous abortion abruptio placenta preterm delivery PPROM fetal growth restriction Intrauterine fetal demise ```

Question 306

patient with cryptoorchidism , next step

Answer 306

referral to surgery is indicated by 6 months( corrected for gestation) - no role of imaging. Early orchiopexy by 1 year optimizes fertility, testicular growth and decreases risk of testicular torsion risk of testicular cancer is decreased but not eliminated

Question 307

patient with cryptoorchidism , next step

Answer 307

referral to surgery is indicated by 6 months( corrected for gestation) Early orchiopexy by 1 year optimizes fertility, testicular growth and decreases risk of testicular torsion risk of testicular cancer is decreased but not eliminated

Question 308

patient with painless hematochezia( 2 episodes) and history of diverticulosis and internal hemorrhoids. cause of hematochezia

Answer 308

arterial erosion due to mucosal outcropping diverticulosis: outpouching in the weakest point, where vasa recta penetrate- so these are exposed. LARGE AMOUNT OF BLOOD hemorrhoids- SMALL amount of blood that covers the stool, and mucous, perianal itching, and mild fecal leakage.

Question 309

tto of colonic diverticulosis bleeding

Answer 309

if slef-limiting: fluids, and transfusion of products as needed if persistent: colonoscopy for cauterization or angiographic embolization

Question 310

RF and presentation of photoaging

Answer 310

UV lights, cirgarrete, genetics ``` deep wrinkles leathery skin variable pigmentation of skin telangiectasias brown spots ACTINIC KERATOSIS ```

Question 311

RF and presentation of photoaging

Answer 311

UV lights, cirgarrete, genetics ``` deep wrinkles leathery skin variable pigmentation of skin telangiectasias brown spots ```

Question 312

What is erythrasma and what is the cause

Answer 312

infection of skin that occurs in intertriginous areas Red patches Corynebacterium minutissimum Wood lamps: coral red/pink fluorescence

Question 313

tto of photoaging

Answer 313

Tretinoin - all trans retinoic acid decreases wrinkles, mottled hyperpigmentation and roughness of facial skin reduces actinic keratosis

Question 314

who qualifies for home health care services

Answer 314

it has to meet criteria for "homebound" - use of supportive device ( crutch, can, wheelchair, walker) - ability to leave home only with assistance - medical contraindication to leave home non-skilled care such as bathing, grooming- if person is not able to do ADLs skilled-medication adherence, OT, PT , wound care

Question 315

who qualifies for home health care services

Answer 315

it has to meet criteria for "homebound" - use of supportive device ( crutch, can, wheelchair, walker) - ability to leave home only with assistance - medical contraindication to leave home

Question 316

Patient on warfarin with intracranial hemorrhage who needs reversal of warfarin. What are the options?

Answer 316

Warfarin reversal 1. Prothrombin complex concentrates: contains vit K dependent factors and reverses warfarin < 10 minutes 2. Vit K: takes 12-24 hrs, but maintains reversal. It does not come with clotting factors so these are replaced concomitantly

Question 317

Patient on warfarin with intracranial hemorrhage who needs reversal of warfarin. What are the options?

Answer 317

Warfarin reversal 1. Prothrombin complex concentrates: contains vit K dependent factors and reverses warfarin < 10 minutes 2. Vit K : takes 12-24 hrs, but maintains reversal. It does not come with clotting factors so these are replaced concomittantly

Question 318

reversal of dabigatran

Answer 318

idarucizumab, a monoclonal antibody

Question 319

indicaitions and SE of ephedra

Answer 319

weight loss SE:cardiovascular risk HTN, MI , Stroke

Question 320

Normal Weber and Rinne tests findings

Answer 320

Rinne: AC>BC in both ears | Weber : midline

Question 321

Weber and Rinne tests findings in conductive hearing loss

Answer 321

Rinne: BC>AC in affected ear, AC>BC in UNaffected ear Weber: lateralizes to AFFECTED ear

Question 322

Weber and Rinne tests findings in sensorineural hearing loss

Answer 322

Rinne: AC>BC in both ears Weber: lateralizes to UNAFFECTED ear

Question 323

Weber and Rinne tests findings in mixed hearing loss

Answer 323

Rinne: BC>AC in affected ear, AC>BC in UNaffected ear Weber: lateralizes to UNAFFECTED ear

Question 324

patient with sudden sensorineural hearing loss, no PE findings. Next step

Answer 324

Urgent referral to ENT MRI and formal audiogram likely plus steroids!-ideally within 24 hrs causes: may include viral infection, microvascular events, autoimmune process, tumor

Question 325

When do you use aural irrigation( ear)

Answer 325

to remove cerumen

Question 326

Labs in SIADH

Answer 326

Hyponatremia Serum osmolality <275 (hypotonic) Urine osmolality >100 Urine Na > 40

Question 327

tto fo SIADH

Answer 327

fluid restrictuon+/- salt tablets | hypertonic saline for severe hyponatremia

Question 328

Stimuli for SIADH

Answer 328

Osmotic: if serum osmolarity> 185 Non osmotic: Nausea, pain, physical emotional stress, hypotension, hypovolemia, hypoglycemia seen in POP

Question 329

siadh can be caused after surgery

Answer 329

due to nausea, pain, hypovolemia those are stimuli for ADH secretion

Question 330

pregnancy, painless vaginal bleeding after 20 weeks

Answer 330

placenta previa

Question 331

RF for placenta previa

Answer 331

prior placenta previa multiple gestations prior cesarea tobacco

Question 332

RF for placenta previa

Answer 332

prior placenta previa multiple gestations prior cesarea

Question 333

placenta previa is an absolute contraindication for vaginal delivery, needs cesarea

Answer 333

true

Question 334

bleeding can cause fibronectin test a false positive

Answer 334

true, and is indicated only in < 34 weeks to assess for preterm delivery

Question 335

presentation of amniotic fluid embolism

Answer 335

hypoxia, hypotension, DIC ,coma or seizures during labor or immediately postpartum RF: Cesarea, placenta previa, abruptio placenta

Question 336

tto of amniotic fluid embolism

Answer 336

supportive

Question 337

patient with bone metastasis due to prostate cancer, on high dose narcotic but persistent pain. Next state

Answer 337

external beam radiation therapy

Question 338

patient with obstructive urolithiasis causing infection and hemodynamic instabilitity, next step

Answer 338

percutaneous nephrostomy or retrograde urethral stent

Question 339

tto of alcohol withdrawal

Answer 339

benzodiazepines

Question 340

presentation of urethral diverticulum

Answer 340

dysuria, dispareunia, postvoid dribbling, anterior vaginal wall mass. - can cause multiple UTI - touching diverticulum leads to bloody, purulent discharge in urethra - can have hematuria

Question 341

causes of urethral diverticulum

Answer 341

``` multiple UTIs pelvic trauma ( vaginal delivery) or surgery ```

Question 342

Evaluation of urethral diverticulum

Answer 342

urinalysis and culture | TOCONFIRM: MRI of pelvis or TVUS

Question 343

tto of urethral diverticulum

Answer 343

manual decompression, needle aspiration, or surgery

Question 344

positive Q tip test

Answer 344

used to diagnose urethral hypermobility in stress urinary incontinenece > 30 degrees angle of movement

Question 345

suppurative otitis media -what is it

Answer 345

acute otitis media + tympanic membrane perforation fluid in middle ear infected by nasopharynx bacteria infection causes increased pressure RUPTURE OF TYMPANIC MEMBRANE IS MORE COMMON WITH INFECTIONS BY S.PYOGENES

Question 346

definition of serous otitis media

Answer 346

when there is effusion (fluid) in the middle ear canal without inflammation or infection-- typically follows episodes of suppurative otitis media

Question 347

drugs that cause photosensitivity

Answer 347

SHAT for photo Sulfonamides Hydroclorothiazide Amiodarone Tetracyclins

Question 348

natural history and tto of infantile hemangioma

Answer 348

0-1year grow age 1-9 regress tto: observations topical propanolol for ulcerative or cosmetic areas( face) , or airway, or vision areas

Question 349

Most important factors in matching recipient and donor of kidney transplant

Answer 349

HLA and ABO compatibility ** living donors have better outcomes than deceased

Question 350

labs in hemolysis

Answer 350

normocytic anemia with increased reticulocyte count indirect hyperbilirrubinemia low haptoglobulin high LDH

Question 351

in which condition do you see bite cells and chystocytes

Answer 351

G6PD | Also heinz bodies - denatured Hb

Question 352

Dx of G6PD

Answer 352

LOW G6PD- but given that it can be a false positive repeat test 1-2 weeks after infection, or removal of drug

Question 353

triggers for G6PD

Answer 353

fava beans, sulfa drugs(TMP-SMX)

Question 354

gentics of G6PD

Answer 354

X linked disorder

Question 355

hematochezia +hemodynamic instability, think of .....

Answer 355

upper GI bleeding Do first IV fluids and then an esophagodiodenoscopy if EGD fails to identify source, then colonoscopy should be performed

Question 356

NF2 vs. NF1 presentation

Answer 356

NF1: hyperpigmented areas, can have unilateral acoustic neuromas, cutanepus neurofibromas, axillary freckling, lisch nodules, optic glioma, pheochromocytomas NF2: hypopigmented, BILATERAL acoustic neuromas (aka schwannomas) , issues with balance, juvenile cataracts, meningioma, ependymoma

Question 357

Spetic aboption tto

Answer 357

dilation and curettage + antibiotics occurs when retained products of conception become infected by ascending vaginal flora in the setting of prolonged bleeding or recent instrumentation

Question 358

Constitutional growth delay

Answer 358

``` short stature normal growth velocity delayed bone age delayed secondary characteristics family hx of late bloomers ```

Question 359

Patient with constitutional growth delay concerned with his image, next step

Answer 359

although it is normal, is important to explore psychologic issues in these patients in a solo-interview

Question 360

Definition of polycythemia vera

Answer 360

Hct >=65% or Hb> 22

Question 361

polycythemia vera in newborn, next step?

Answer 361

if it was taken in the heel prick, then collect a peripheral venous blood

Question 362

complications of polycythemia vera

Answer 362

hyperbilirrubinemia, hypoglycemia, hyperviscosity, hypoperfusion, tissue hypoxia

Question 363

Pt with polycythemia vera that develops letharfy, poor oral intake, hypotonia, APNEA, and no focal neuro exam

Answer 363

think of hyperviscosity fluids and tto for hyperglycemia PARTIAL EXCAHNGE TRANSFUSION ( removing blood from baby and infusing NS)

Question 364

Routine initial prenatal labs

Answer 364

``` Hb/Hct, MCV Rh, antibody screen HIV, RPR/VDRL, HbAgs Varicella and rubella immunity Pap smear Chlamydia Urinalysis and culture ```

Question 365

prenatal labs 24-28

Answer 365

hb/hcto antibody screen in Rh- 50 g 1 hrGOT

Question 366

prenatal labs 35-37

Answer 366

GBS

Question 367

Prsentation of gestational thrombocytopenia

Answer 367

``` 70-150000 Asymptomatic No prior history of thrombocytopenia 2nd and 3rd trimester No associated fetal thrombocytopenia Resolution after delivery ```

Question 368

Contraindications for epidural

Answer 368

thrombocytopenia < 70,000 or rapidly progressing droplet count ** CI due to the risk of spinal epidural hematoma

Question 369

Does a minor < 18 is able to do kidney donation

Answer 369

No! ``` Contraindications: < 18 lack of mental ability to make a decision uNCONTROLLED HTN, HIV infection, DM Active or partially treated Cancer acute infection substance abuse suspected coercion ```

Question 370

treatment of dactylitis in sickle cell

Answer 370

often isthe first sign in kids 6m-4 y Oral NSAIDs and oral opiates( oxy) if fails- IV opiates ***Cold compresses can trigger vasocclusive crisis

Question 371

Untreated depression is associated with increased morbidity and mortality from cardiovascular disease

Answer 371

SSRIs are safe in cardiovascular disease

Question 372

tto for nightmares in PTSD

Answer 372

Prazosin

Question 373

tto PTSD

Answer 373

trauma focused cognitive therapy Antidepressants (SSRIs, SNRIs0 Prazosin for nightmares

Question 374

Pre-septal vs. orbital Septal

Answer 374

orbital: painful eyemov, ophtalmoplegia , proptosis

Question 375

MC predisposing factor to orbital cellulitis

Answer 375

sinusitis - S. PNEUMONIA, S.aureus

Question 376

MC Pre-septal vs. orbital Septal

Answer 376

preseptal: S.aureus, S. pyogenes Orbital: S.aureus, S.pneumonia

Question 377

tto orbital cellulitis

Answer 377

inhosp abc management ( if abscess: drain) Ceftriaxone or Amp-Sulba ( May add Vanco if suspicion of MRSA) cover for all potential causes of sinusitis: S.pneumonia, nontypable-H.influenza, S.aureus

Question 378

tto acute paronychia

Answer 378

warm soaks in aluminum acetate,1% acetate mupirocin If abscess drain

Question 379

tto PMS

Answer 379

SSRIs

Question 380

PMS is assocaited to which condition

Answer 380

Depression/mood disorders

Question 381

first line contraceptive in adolescents

Answer 381

IUDs or Contraceptive implants (99%) IUDs: - Copper - 10 years - Progrstine- 5 years- for patients with dysmenorrhea or heavy bleeding Contraceptive implant - subdermal implant every 5 years

Question 382

Order of efficacy of contraceptives ( highest to lowest)

Answer 382

IUD/Implant (99%)>Injection(95%)>Pills, patch, ring (91%) > condom (80%)> withdrawal 75% ** injection is every 3 months

Question 383

Patient 57 years with HTN not controlled by 2 meds, what should you consider

Answer 383

refractory HTN, Secondary cause: Renovascular HTN Do MR angiography of renal arteries

Question 384

Presentation of renovascular HTN

Answer 384

``` Refractory HTN to 2 meds has associated atherovascular disease ( carotid bruit, decreased pulses) Abdominal bruit iNCREASED CREATININE NILATERAL KIDNEY ATROPHY ```

Question 385

How do you confirm dx of Renovascular HTN

Answer 385

MR angiography of renal arteries

Question 386

difference between adjustment disorder and acute distress disorder

Answer 386

adjustment disorder does NOT have intrusive recollections ( nightmares, flashbacks, distressing memories)

Question 387

Why do people often request euthanasia

Answer 387

loss of autonomy and control loss of dignity loss of ability to engage in pleasurable activities

Question 388

Diaper rash: contact dermatitis vs fungal

Answer 388

contact dermatitis: spares creases and skin folds petrolatum or zinc oxide Candida: involves creases, and has satelite lesions nystatin, clortrimazole

Question 389

presentation of tinea capitis

Answer 389

hair loss eczema, pruritus, scaly can have cervical LAD

Question 390

Dx and tto of tinea capitis

Answer 390

KOH examination ORAL GRISEOFULVIN OR TERBINAFINE! NOT TOPICAL!!

Question 391

TTO of bacterial conjunctivitis

Answer 391

no lenses: - Topical erythromycin - Topical Polymixin- trimetropin drops - Azithromycin drops Lenses: ciprodex bacterial conjunctivits is usually self-limited but Abcs are prescribed to shorten ss duration and decrease contagious.

Question 392

Cause of bacterial conjunctivitis

Answer 392

S.pneumonia, S.aureus, H.influenza, Moraxella catarrhalis

Question 393

complication of bacterial conjunctivitis in person with lenses

Answer 393

keratitis-inflammation of the cornea

Question 394

What is endophtalmitis and how does it occur

Answer 394

infection of vitreus | result from trauma/surgeryor hematogenous spread

Question 395

if suspecte keratitis, next step

Answer 395

urgent referral to ophtalmo

Question 396

SE of tamoxifen

Answer 396

endometrial hyperplasia | uterine sarcoma

Question 397

``` abnormal/postmenopausal bleeding pelvic pressure/pain increased urine frequency uterine mass ascites( fluid in posterior cul-de-sac) ```

Answer 397

uterine sarcoma

Question 398

tto of uterinesarcoma

Answer 398

hysterectomy

Question 399

dx of uterine sarcoma

Answer 399

US but needs biopsy, as is impossible to differentiate from leiomyoma

Question 400

RF for uterine sarcoma

Answer 400

tamoxifefn | pelvic radiation

Question 401

nicotine addiction tto

Answer 401

nicotine patches/gums behavioral therapy **bupropion is good for patients who want to decrease weight gain, but CI in seizure disorder and eating disorder Varenicline is superior to nicotine replacement and bupropion but has cardiovascular effects

Question 402

varenicline

Answer 402

partial nicotine receptor agonist

Question 403

Role of anti TNF alpha( Infliximab) in RA

Answer 403

Helps with anemia of chronic disease

Question 404

structures in Kiesselbachs plexus

Answer 404

anterior nose sphenopalatine artery, greater artery, anterior ethmoid, and superior labial arteries

Question 405

Patient with nose bleeding that doesnt stop with pressure

Answer 405

oxymetazoline applied with a cotton pledget or squirt bottle recommend nasal saline, humidifier-

Question 406

Indications for HPV vaccine

Answer 406

Girls and women 11-26( but may be given up to 45y) Men 11-21 ( up to 26 for men who have sex with men) 11-26: immunocompromised NOT INDICATED IN pregnant women recommended time for first dose is 11-12, but can be given as early as 9

Question 407

At what ages do you give 2 vs 3 doses of HPV vaccine

Answer 407

< 15 only 2 doses- studies suggest that early they produce a higher immune response >=15 3 doses

Question 408

Dx of chronic prostatitis

Answer 408

urinalysis and culture before and after prostate massage > 20 leukocytes > 10 fold increase from pre to post

Question 409

presentation of chronic prostatitis

Answer 409

``` > 3 months dysuria pain in genitoruinary region pain with ejaculation prostate exam is generally normal but can have hypertrophy, edema. ```

Question 410

if suspecting chronic prostatitis and urinalysis show 20 leukos but culture negative. DX?

Answer 410

chronic prostatitis /chronic pelvic pain syndrome if culture is negative

Question 411

pain when bladder is full and improves with voiding

Answer 411

interstitial cystitis

Question 412

chronic prostatitis /chronic pelvic pain syndrome

Answer 412

meds for hypertrophy prostate ( alpha blockers) terazosin, tamsulosin antibiotics psychotherapy

Question 413

neutropenic patient, had Central venous access for TPN, and day 4 develops eye pain, light sensitivity, eye exam shows several large, off white lesions with irregular borders, hazy vitreous. Dx?

Answer 413

Candida endophtalmtitis

Question 414

Infection by MAC- presentation

Answer 414

pulmonary or disseminated disease | fever, night sweats,weight loss

Question 415

tto of candida endophtalmitis

Answer 415

vitrectomy and amphotericin B (4-6 weeks) *Ketoconazole doesnt reach vitreous

Question 416

Management of cystic lesions in pancreas

Answer 416

Endoscopic US with aspiration

Question 417

patient with fluoxetine for depression, states that mood has improved but is experiencing insomnia and jitteriness, next step?

Answer 417

Another SSRI- escitalopram Fluoxetin has activating ss

Question 418

Management of preterm labor <32 weeks

Answer 418

magnesium bethamethasone tocolytic Penicillin if GBS + or unknown

Question 419

Management of preterm labor <34 weeks

Answer 419

bethamethasone tocolytic (nifedipine) Penicillin if GBS +or unknown

Question 420

Management of preterm labor > 34 weeks

Answer 420

bethamethasone | Penicillin if GBS +or unknown

Question 421

Emergency contraceptions

Answer 421

Copper IUD- 0-5 Days (CI: infection, severe uterine cavity disortion, wilson disease, complicated organ failure). > 99% ULIPRISTAL (antiprogestin)0-5 days ( no CI) 98-99% Levonogestrel 0-72 -59-95% Oral contraceptives 0-72h - (47-89%)

Question 422

tto rosacea

Answer 422

Topical brimodinida If papulopustular TOPICAL metronidazole , azoleic acid oral mtz is sometimes used for worse cases

Question 423

Complications of rosacea

Answer 423

ocular-- chalazion

Question 424

MMR Administration ages and CI

Answer 424

1 AND 4 anaphylaxis to prior MMR vaccine, neomyicin, or gelatin Immunodef or pregnancy SE: Rash, fever, LAD

Question 425

ocd TTO

Answer 425

Exposure and response prevention therapy | SSRIs

Question 426

Menieres triad

Answer 426

episodeic vertigo unilateral hearing loss vertigo

Question 427

Patient in postpartum with dyspnea, pulmonary edeam hypertension, and end organ damage ( hyperreflexia, increased creatinine)

Answer 427

pre-eclampsia | can go in the postpartum period up to 12 weeks

Question 428

tto of postpartum pre-eclampsia

Answer 428

magnesium for seizure prophylaxis and BP control | if pulmonary edema: LMNO

Question 429

Elderly 60 yo who quit smoking will have decrease in all cause mortality and cardiovascular events in 5 years

Answer 429

true reduced risk of osteoporosis in 10 years

Question 430

Treatment of hyperK with ECG changes

Answer 430

calcium gluconate or calcium chloride

Question 431

EKG changes in HyperK

Answer 431

- Peaked T waves - prolongation of PR and QRS - disappearance of P waves - presence of sine wave

Question 432

tetanus prophylaxis and wounds

Answer 432

say it

Question 433

calcium concentration decreases by 0.8 with every 1 decrease in albumin

Answer 433

true

Question 434

corrected formula for calcium and albumin

Answer 434

Total calcium + 0.8(4- albumin)

Question 435

Most frequent cause/trigger of asthma

Answer 435

house dust mites

Question 436

management of ectopic pregnancy

Answer 436

if unstable: surgery stable : TVUS if diagnostic methrotexate if non diagnostic ( LIKELY NOT VISIBLE) BhCG< 1500: repeat in 2 days BhCG > 1500: repeat in 2 days and also do TVUS

Question 437

DEFICIENCY IN PORPHIRIA CUTANEA TARFA

Answer 437

uroporphyrinogen decarboxylase

Question 438

porphyria cutanea tarda presentation

Answer 438

painLESS blisters skin fragility facial hypertrichosis and hyperpigmentation Dx: elevation urine uroporphyrins

Question 439

porphyria cutanea tarda tto

Answer 439

Avoid exposures (alcohol, estrogen, primidone, other hepatotoxins) Sunscreen use Iron removal by phlebotomy – first line reduces hepatic iron stores – produces remission if phlebotomy not available, deferoxamine Hydroxychloroquine increases excretion of uroporphyrin

Question 440

medical futility but family insists in making a procedure

Answer 440

hospital ethics committee

Question 441

Medicare, who does it cover

Answer 441

65 and older permanent disability ESRD Neurodegenerativ diseases

Question 442

Part A, B, C,D medicare

Answer 442

Part A- Inhospital ( hospital, nursing facility, hospice) Part B -Outpatient services ( including hospital observation status) Part C -Medicare advantage - allows private health insurance to provide medicare advantages Part D- Prescription drugs.

Question 443

Patient with unilateral LAD, that says that has it since mono infection 8-12 weeks ago. you palpate unilateral cervical LAD

Answer 443

Refer for surgical biopsy, is abnormal that he has unilateral and persistence. Assess for lymphoma

Question 444

2 antibodies in pernicious anemia

Answer 444

anti parietal and anti IF, always start testing with IF - if pernicious anemia low B12 and low cobalamin

Question 445

recommended test for pernicious anemia

Answer 445

anti IF antibodies

Question 446

what would you see with endoscopy in pernicious anemia

Answer 446

loss of rugae in the fundus-- AUTOIMMUNE METAPLASTIC ATROPHIC GASTRITIS Glandular atrophy, intestinal metaplasia and inflammation mainly affects fundus and body

Question 447

Once one spontaneous abortion (< 20 weeks) there is risk of another one

Answer 447

yes, | other RF include substance abuse and maternal age

Question 448

Suspect thalassemia, next step

Answer 448

electrophoresis electrophoresis is normal in Alpha is abnormal in B tahlassemia, due to increased A2

Question 449

Partners of pregnant women with thalassemia should also be tested to determine risk for baby

Answer 449

true

Question 450

nadir of physiologic anemia in pregnancy

Answer 450

late 2 to early 3rd trimester

Question 451

suspect perforated ulcer, next step

Answer 451

abdomen x ray if stable

Question 452

management of peptic ulcer

Answer 452

is surgery but in preparation give always ANTIBIOTICS FIRST AND IV PPI

Question 453

Ogilvie's syndrome

Answer 453

acute colonic pseudo-obstruction | dilation of the cecum and the right colon in abscence of mechanical obstruction

Question 454

How CKD causes hyperparathyroidism

Answer 454

CKD-leads to decrease vit D ( no conversion from 25 to 1,25) which leads to decrease Ca absorption in the intestine CKD- causes phosphorus retention- leads to low Ca DUE TO Binding Phos-Ca low Ca leads to high PTH.

Question 455

Indications for parathyroidectomy in tertiary hyperPTH ( ckd scenario)

Answer 455

1. Persistently elevated ca(>10.5), phosphorus and PTH 2. Soft tissue calcification, or vascular calcification with necrosis 3. intractable bone pain or pruritus

Question 456

SE of glucocorticoids at high doses

Answer 456

poor sleep restlessness loss of memory -- sobretodo a higher doses

Question 457

tto of hypocalcemia due to binding to citrate in transfusion

Answer 457

same as any hypocalcemia IV calcium gluconate or calcium chloride

Question 458

initial tto of chronically malnourished children, hemodynamicall stabl

Answer 458

oral rehydration is preferred, and if not try NG IV hydration should be tried to be avoided due to the risk of volume overload and heart failure If unstable: give a 20 cc/kg over 30-60min

Question 459

SSRIs treats both depression and associated insomnia

Answer 459

true

Question 460

Management of ADPKD

Answer 460

ACE inhibitors preferred for HTN Control RF for CV and CKD If ESDR, Dialysis **only the patients who have a history in the family of intracranial bleeding or personal should undergo MRI

Question 461

Mom recently diagnosed with ADPKD, is concerned about her son, next step?

Answer 461

Patients >= 18 with a family hx of ADPKD should be screened with renal US with prior counseling.

Question 462

if rhabdomyolysis is suspected CK is better than myoglobulin

Answer 462

true

Question 463

If patient hemodynamically stable with rhabdo comes and there is association with exercise, next step

Answer 463

repeat urinalysis in 1 week

Question 464

If a peaitnet refuses a treatment and he is at high risk , assess their mental capacity, even if they look ok

Answer 464

true

Question 465

neck mass that moves with swallowing

Answer 465

thyroglossal duct cyst - -sometimes it can become aparent after a respiratory illness - protrussion of the tongue can also move it

Question 466

if patient has thyroglossal duct cyst , next step prior to definitive tto?

Answer 466

US thyroid to identify ectopic thyroid tissue | - because if resection may contribute to hypothyroidism

Question 467

definitie tto of thyroglossal duct cyst

Answer 467

surgical ressection of cyst, associated tract, and central portion of the hyoid.

Question 468

All antidepressants can induce hypomania, and then should be discontinued before de-escalation to mania

Answer 468

patient with depression, treated with fluoxetine and at the follow-up appt shows signs of mania. DISCONTINUE FLUOXETINE If the ss persist after discontinueation then think about adding lithium but not initially.

Question 469

Patient with mania already in lithium having sexual behaviors, aggressiveness, psychotic ss next step

Answer 469

add an antipsychotic

Question 470

patient with sciatica tto

Answer 470

NSAIDs trial, no need to do imaging first * * MRI only if neuro deficits and thinking of cauda equina, epidural abscess * * Xray only if suspecting vertebral metastasis or compression fracture

Question 471

Renal stenosis should be considered in pts with resistant hypertension, flash pulmonary edema, and progressive loss of renal function

Answer 471

true

Question 472

suspect nephrolithiais in pregnant women, next step

Answer 472

renal and pelvic US Most nephrolithiasis in pregnancy occur in second and third trimester - is often supportive and monitor for pain - if obstructive -then surgery is required

Question 473

Benefits of breastfeeding in infants

Answer 473

- decreased infection (GI, Respiratory NEC, OMA) | - decreased risk of Ca

Question 474

Rh incompatibility disorder is only possible in an Rh negative mom and Rh positive dad

Answer 474

true! | Even if the baby is negatove and mom is positive there is no risk

Question 475

how to idfferentiate iron def anemia vs. thalassemia

Answer 475

Mentzer index MCV/RBC > 13 IRON DEF ANEMIA | If < 13 thalassemia

Question 476

trstogenic effect of valproate

Answer 476

spina bifida

Question 477

pt with hallucinations, lauekopenia and edema and pain in wrists,

Answer 477

SLE

Question 478

thin white wrinkled skin in vuvlar, vaginal area. Excoriations, dysuria, painful defecatiosn. dx and tto

Answer 478

vulvar lichen sclerosus and topical steroids

Question 479

are antibiotics indicated for ulcers?

Answer 479

no, unless there are signs of infection/cellulitis. oTHERWISE, TTO IS DEBRIDEMENTE.

Question 480

RF Pre-eclampsia

Answer 480

nulliparity and advanced age

Question 481

Management of pre-eclampsia

Answer 481

no severe features: devlivery at >=37 severe features : delivery at >=34 but always hidralazine and magnesium first! ``` severe features: >160/110 visual ss pulmonary edema increased creatinine/increased transaminases thrombocytopenia ```

Question 482

management for negative symptoms ( apathy, withdrawan, flat affect) in schizophrenia?

Answer 482

social skills training, with psycotherapy

Question 483

management of renal stones

Answer 483

< 5mm: generally pass spontaneously stones + urosepsis, Acute renal failure and complete obstruction: urology >= 10 mm urology <10: hydration, pain control, alpha blockers(tamsulosin)strain urine and d/c If uncontrolled pain, or no passage of stone in 4-6 weeks referral to urology

Question 484

Causes of elevated AFP (>2.5MoM)

Answer 484

Open neural defects (open spina bifida, anencephaly) Ventral wall defects (omphalocele) Multiple gestation A normal AFP does not exclude neural tube defect, as closed spina bifida can have it

Question 485

Causes of decreased AFP

Answer 485

Aneuploidies 18-21

Question 486

If a patient has high AFP , next step

Answer 486

obstretic US

Question 487

if suspecting sickle cell disease , next step

Answer 487

Hb electrophoresis ( high HbS, and HbA low)

Question 488

Acute and maintenance management in sickle cell

Answer 488

Acute: hydration analgesia, +/- transfusion Maintenance:Pneumococcal vaccine, Penicillin until they are 5 years old, Folic acid supplementation, hydroxyurea

Question 489

suspect ovarian torsion, next step

Answer 489

pelvic US with Doppler

Question 490

Poor prognostic factors in CLL

Answer 490

Thrombocytoenia, organomegaly, LAD, anemia,

Question 491

Patient with polycythemia, next step

Answer 491

EPO level Polycythemia + high EPO: polycythemia due to chronic hypoxia (lung disease), or hormone producing neoplasma ( renal cell carcinoma) Polycythemia + low EPO: chronic myeloproliferative disorder

Question 492

algorithm of breast mass

Answer 492

if < 30 UD +/-mammography: if cyst then FNA if, compelx cyst/amass image guided core biopsy if>= 30 mammography- if suspicion of malignancy core biopsy

Question 493

Management of cleft lip with or without palate

Answer 493

common teratogen es alcohol repair is done 10s: 10 lbs of weight 10 weeks( 3 months) 10 Hb

Question 494

recurrence risk of cleft lip on subsequent pregnancies

Answer 494

50%

Question 495

Van der Woude syndrome

Answer 495

AD form of cleft lip palate

Question 496

The major problem that leads to difficulties finding crossmatched blood in patients with a history of multiple transfusions is alloantibodies.

Answer 496

true

Question 497

evaluation of nipple discharge- algorithm

Answer 497

if bilateral: evaluate for pregnancy/galactorrhea if unilateral < 30 : US +/- mammogram >30 : mammogram + US

Question 498

MCC of pathologic nipple discharge

Answer 498

intraductal papilloma tumor

Question 499

What is the first thing that increases upon initiation of iron in iron deficiency

Answer 499

increase reticulocytes by 1-2 weeks after a month Hct, and Hg by 1 Ferrous sulfate should be maintained for 2-3 months after hb normalization to replenish iron stores

Question 500

high ALP what does it mean

Answer 500

marker of bone turnover and biliary disease In the setting of vit D deficiency it is more likely to be due to increased bone turnover

Question 501

Reasons of risk of DM in renal cancer transplant

Answer 501

1. Immunosuppresive therapy - glucocorticoids decrease insulin sensitivity 2. Improved renal function : transplanted kideny causes increased insulin secretionnd is capable of increasing gluconeogenesis.

Question 502

Rf of risk of DM in renal cancer transplant

Answer 502

increased age > 45 increased BMI> 30 Family Hx of diabetes

Question 503

treatment of allergic contact dermatitis

Answer 503

high potency steroids ( betamethasone, triamcinolone, fluocinonide) tacrolimus (calcineurin inhibitors) can be used in areas where steroids are not recommended like the face

Question 504

Patients have the right to refuse genetic information unless it involves a treatable condition for the child.

Answer 504

Patient with Huntington's disease (fatal) who refuses to know. and has childrens.

Question 505

Indications for intrapartum GBS prophylaxis

Answer 505

1. GBS bacteriuria or GBS UTI in current pregnancy despite tto 2. GBS positive rectovaginal culture in current pregnancy 3. GBS unknown PLUS either: < 37 weeks gestation Intrapartum fever ROM >=18 4. If prior infant had GBS infection * * IV penicillin at least 4 hours prior to delivery * no utility of performing a GBS swab intrapartum as results wont be back prior to delivery

Question 506

Does Cesarean delivery decreases risk of neonatal GBS?

Answer 506

NO!

Question 507

Neonatal complications of tobacco during pregnancy

Answer 507

DAOS Diabetes Asthma Obesity Sudden Infant Death Syndrome

Question 508

Obstetric complications of tobacco during pregnancy

Answer 508

``` spontaneous abortion fetal demise IUGR Preterm ROM Placenta previa, abruptio placenta Pre-eclampsia, low birth weight ```

Question 509

there is no data of buproprionand varenicicline in pregnant women

Answer 509

true

Question 510

persistent, intrussive, recurrent thoughts ( ie. to kill the children, but doesnt want to)

Answer 510

OCD - this is different from psychosis

Question 511

tto of OCD

Answer 511

SSRIs, cognitive behavioral therapy * OCD typically starts in adolescence but could have been

Question 512

Duration of brief psychotic disorder

Answer 512

< 1 month

Question 513

Long-acting injectable antipsychotics how often are they administered?

Answer 513

2-4 weeks

Question 514

Absolute contraindications to OCPs

Answer 514

``` Migraine with aura HEAVY smokers ( >=15 cigarettes in > 35 yo) HTN >=160/100 heart disease, DM, stroke thromboembolic disease, antiphospholipid Breast Cancer Cirrhosis and liver Ca Mayor surgery with prolonged immobilization Use < 3 weeks postpartum ```

Question 515

Actinic keratosis increases the risk of which cancer?

Answer 515

Squamous cell carcinoma Any actinic keratosis lesions should be removed or destroyed Individual lesions- liquid nitrogen cryosurgery, surgical excision or curettage Multiple lesions: Field therapy 5 fluoracil, topical diclofenac, imiquimod)

Question 516

Basal vs. squamous cell carcinoma

Answer 516

basal: MC cancer. upper face ( nose, upper lip) pearly nodule umbilicated with telangiectasis " Palidasing nuclei) Mohs surgery ``` Squamous cell carcinoma: MC cancer in immunosupressed, transplanted , prior scars,burns. lower lip, hands, ears. "Keratin pearls" Actinic keratosis is precursor Keratoacanthoma ``` both assocaited with sun exposure

Question 517

Diagnostic evaluation of suspected lung cancer

Answer 517

CT head, chest and abdomen THen a biopsy should be done If patient only have lung/mediastinal lymph nodes involvement - biopsy that area If multiple metastasis: look if supraclavicular or escalene Lymph nodes are involved, if not biopsy the distal site of metastasis (ie. liver, bone)

Question 518

Associated conditions to skin tags

Answer 518

Insulin resistance Pregnancy Chron's disease (Perianal) metabolic syndrome

Question 519

Associated conditions to acanthosis nigricans

Answer 519

Insulin resistance | GI malignancy

Question 520

Associated conditions to severe seborrheic dermatitis

Answer 520

HIV | Parkinson

Question 521

oral vit K is as effective as IV vitK in lowering the INR in 24 hours.

Answer 521

true since IV VitK has risk of anaphylaxis oral route is preferred

Question 522

maNAGEMENT OF SUPRATHERAPEUTIC inr

Answer 522

If no or minimal bleeding: INR < 5- Hold Warfarin for 1-2 days, or decrease the dose INR 5-9- Hold warfarin and resume when INR is therapeutic. Give low dose (1-2.5) vit K if increased risk of bleeding INR> 9 - Hold warfarin and administer high dose 2.5-5 mg of vit K all above are ORAL VIT K if bleeding: Hold warfarin and administer IV 10 mg vit K, or FFP, Or recombinant VIIa, or prothrombin complex concentrate

Question 523

Motherwort uses and CI

Answer 523

anxiety, menses regulation, cardiovascular conditions. (tachycardia, hypertension) CI in pregnancy - miscarriages Otherwise- is safe and there are no interactions with other meds

Question 524

Patients with pancoast tumor can develop spinal metastasis and this is an urgency as to preserve neurologic function.

Answer 524

true

Question 525

Complications of pancreatic pseudocysts

Answer 525

``` mass effect biliary and pancreatic obstuction fistula to other organs and even vessels causing pseudoaneurysms GI hemorrhage infection ```

Question 526

management of pseudocyst

Answer 526

often supportive unless symptomatic /sings of infection where drainage may be required.

Question 527

what organism is most commonly cultured from corneal foreign bodies

Answer 527

s.aureus

Question 528

laNGUAGE DELAY IN ANY CHILD WARRANTS AUDIOLOGY EVALUATION

Answer 528

TRUE

Question 529

breach of privacy of patients- what to do next?

Answer 529

provider must notify through a WRITTEN report what was shared and who received that information , and what actions are being done to prevent that

Question 530

tto for plantar warts

Answer 530

salicylic acid - requires frequent use and may take up to 2-3 weeks to improve , and. tto should be continued for 1-2 weeks after soak in warm water 10-20 min the foot. Then salicylic acid and cover it with tape, then 48 hrs-72 hrs, then remove patch alternative: liquid nitrogen **topical imiquimod doesnt help

Question 531

good prognostic factors in schizophrenia

Answer 531

``` later-onset female acute onset with precipitant predominantly positive symptoms(delusions, hallucinations) no family history short duration of active ss ```

Question 532

poor prognostic factors schizophrenia

Answer 532

``` onset in childhood, adolescence male gradual onset , no precipitant predoninantly negative ss family hx long duration of untreated psychosis ```

Question 533

age to start Pap Smear, despite prior vaccines or sexual activity

Answer 533

21 yo until 65 Routine HPV testing is not recommended in < 30

Question 534

Recommended vaccines during pregnancy

Answer 534

``` DTAP ( if pt has not vaccinated before- >=28 weeks as it provides passive immunization to baby)recommended inactivated Influenza( recommended at any trimester) Rho GAM ```

Question 535

ci VACCINES IN PREGNANCY

Answer 535

MMR, Varicella, HPV, Live attenuated influenza

Question 536

Cause and tto of malignant otitis media

Answer 536

pseudomona | IV ciprofloxacin - can be converted to oral upon good inflammatory markers, but therapy 6-8 weeks

Question 537

tto of poison ivy contact dermatitis

Answer 537

supportive, topical corticosteroids oralsteroids if seere or involvement face or genitalia *antihistamines are not effective

Question 538

when is biopsy indicated in actinic keratosis

Answer 538

``` unclear dx > 1cm diameter indurated painful ulceration growing rapidly fail to respond to adequate tto ```

Question 539

which vaccines require asking about egg allergy

Answer 539

influenza and yellow fever influenza: if anaphylaxis to egg give influenza in the medical setting. The only contraindication for influenza is allergy to the vaccine itself

Question 540

inactivated influenza is preferred rather than life attenuated whi is no longer given

Answer 540

true

Question 541

MOA BUPROPRION

Answer 541

ne, dopamine reuptake inhibitor does not cause weight gainor sexual side effets

Question 542

MOA Mirtazapin and SE

Answer 542

NaSSA Noradrenergic and serotoninergic increased appetite, weight gain, sedation

Question 543

Definition of antidepressant treatment resistant

Answer 543

failure to 2 adequate trials of antidepressant Strategies: 1. Augmentation - either adding a second generation antipsychotic - adding another antidepressant of different mechanism 2. Switch to alternative monotherapy non-responders: switch partial responders: augmentation

Question 544

Inactivated intramuscular influenza is recommended, life attenuated influenza vaccine is not as effective

Answer 544

true

Question 545

Indications of IVC filer

Answer 545

``` contraindications of anticoagulation: recent surgery hemorrhagic stroke bleeding diathesis active bleeding ```

Question 546

Acute complicationsof IVC filter

Answer 546

- guidewire entrapment within the filter | - Post procedural complications: acute insertion site thrombosis, hematoma, AV fistula

Question 547

Long term complications of IVC

Answer 547

Recurrent DVTs IVC prevents progression of the thrombus to pulmonary embolism but does not prevent future DVTs or treats the underlying thromboembolic disease IVC does not affect overall mortality

Question 548

squamous cell carcinoma in head and neck, that is not operable. What is the alternative

Answer 548

Combined radiotherapy and chemotherapy - increases 5 year survival

Question 549

Valproate in pregnancy- if pregnant already do not change. If planning to get pregnant it should be trialed off 6 months prior to pregnancy

Answer 549

always give high dose folic acid ( with any AED) | and offer alpha fetoprotein screening.

Question 550

Patient on antiepileptic drug, CI for breastfeeding?

Answer 550

no

Question 551

Sunburn tto

Answer 551

``` mild-moderate: supportive- cool compresses, calamine lotion, aloe vera nsaidas Severe: hospitalization fluid wound care ```

Question 552

Requirements prior to initiating isotretinoin

Answer 552

2 negative pregnancy tests | and commit to at least 2 contraceptive methods.

Question 553

treatment of melasma

Answer 553

FIRST MINIMIZE SUN EXPOSURE- Sunscreen Then things to lighten skin- azaleic acid, retinoid creams

Question 554

RF for otitis media in children

Answer 554

abscence of breastfeeding daycare attendance use of pacifier SECOND HAND SMOKE- alters cilia and mucosa, affecting clearance of fluids and microbes-predisposing to infection

Question 555

What is the most common pain pattern in rotator cuff tendinitis, impingement, d frozen shoulder?

Answer 555

lateral shoulder pain aggravated by movements requiring abduction and external rotationof the shoulder

Question 556

sudden vision loss, painless, cherry spot on fundoscopy

Answer 556

central retinal artery obstruction

Question 557

subacute sudden vision loss, painless,retinal hemorrhages, and edema optic disc ( blood and thunfer)

Answer 557

central retinal vein obstruction

Question 558

Acne treatment

Answer 558

Comedonal : Topical retinoids, salicylic acid, azelaic acid, Inflammatory: Mild: topical retinoids + benzoylperoxidase Moderate: topical antibiotics ( erythromycin, clinda) Severe: oral antibiotics Nodular(cystic) topical retinoids+ benzoyl peroxidase + oral antibiotics isotretinoin topical retinoid therapy: adapalene, tretinoin, tazarotene

Question 559

Acne treatment in pregnant

Answer 559

topical erythro, clinda, and azaleic acid are safe rest should be avoided

Question 560

middle ear effusion , persistent (> 3months), and uncompanied by signs of infection in an adult-

Answer 560

think about nasopharyngeal carcinoma - decreased hearing and ear fullness - classic triad not seen often- neck mass, nasal obstruction with epistaxis, unilateral persistent middle ear effusion

Question 561

durable power of attorney of healthcare takes preponderance over surrogates

Answer 561

normally prder of surrogate. is: wife, oldest childrent, parents, adult sibling, nearest living relative.

Question 562

RF for adenocarcinomacolon

Answer 562

family history popylopsis syndromes IBD African american ALCOHOL 2-3 drinks/day, and > 4 high risk! Tobacco in long term users (> 30 years using) obesity

Question 563

protective factors for adenocarcinoma of colon

Answer 563

high fiber, regular NSAIDs use, hormone replacement, regular exercise.

Question 564

conversion to cephalic position of fetus- timing

Answer 564

37 or more weeks,

Question 565

Contraindications to external cephalic version

Answer 565

active herpes, placenta previa, multiple gestations, IUGR

Question 566

protective factors aganst suicide

Answer 566

connection to family, pregnancy, parenthood, religion

Question 567

diaper rash that involves inguinal folds and have satellite lesions

Answer 567

candida

Question 568

diaper rash that does not involve inguinal folds, tto

Answer 568

contact dermatitis, zinc oxide paste/petrolatum low potency steroid can be used if not improving high potency isnot advice as it can be absorbed and cause adrenal insufficiency

Question 569

risks of woman havind sex with woman

Answer 569

``` bacterial vaginosis depression, anxiety intimate partner violence cervical ( 2/2 lower vaccination rates/screening), ovarian, breast Ca Obesity DM, Cardiovascular disease ```

Question 570

Nail pitting is a common associated finding to alopecia areata

Answer 570

true

Question 571

Raw vulvar pain >=3 months, positive Qtip test (pain with touching vulva), pain with labial separation. dx and tto

Answer 571

Dx: vuvlodynia tto: behavior modification, pelvic floor PT, cognitive behavioral therapy patients often have associated depression, fibromyalgia, irritable bowel syndrome

Question 572

MCC of abnormal uterine bleeding after menarche

Answer 572

anovulation endometrium builds up under the influence of estrogen ; however with no ovulation, there is no progesterone to slough the endometrium. But then menstrual like bleeding happensdue to estrogen breaktrhough bleeding- severe bleeding, passing clots.

Question 573

treatment for abnormal uterine bleeding due to anovulation

Answer 573

OCPs with high estrogen- high estrogen promotes hemostasis through further proliferation of disorder endometrium and estabilization of bleeding sites

Question 574

causes of abnormal uterine bleeding in non pregnant women, structural and non structural

Answer 574

Structural (PALM): Polyp, Adenomyosis, Leyomioma, malignancy/hyperplasia Non structural: COEIN: coagulopathy, ovulatory dysfunction, Endometrial (infection, inflammation), Iatropgenic(anticoagulatns, Not yet classified

Question 575

small , densely pigmented lesion with irregular borders in the choroid on the eye exam. no ss. Dx and tto?

Answer 575

ocular melanoma - If < 10mm diameter, and < 3 mm in thickness and asymptomatic-- observe for 3 months - if symptomatic and large: RADIOTHERAPY Enucleation is only considered if the tumor is really large, has extrascleral involvement and causes sevre pain

Question 576

There is increased risk of death in patients with dementia who take antipsychotics

Answer 576

true both 1st and 2nd generation due to increased cardiac events, as well as complications such. asstroke, pneumoniafalls,

Question 577

treatment of anal abscess | -when should antibiotics be prescribed?

Answer 577

incision and drainage | - antibiotics should be prescribed in pts with DM, immunosuppressed, extensive cellulitis, valvular heart disease

Question 578

complication of anal abscess

Answer 578

fistula in 50% of cases | -often require surgical repair

Question 579

Suspecting bone metastasis from prostate Ca, next step?

Answer 579

is an osteoblastic lesions ( prostate, small cell lung, Hodgkin) Do: Radionulide bone scan If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

Question 580

Assessment of bone metastasis from osteoblastic lesions

Answer 580

( prostate, small cell lung, Hodgkin) Do: Radionulide bone scan If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

Question 581

Assessment of bone metastasis from osteolyticlesions

Answer 581

myeloma, non small cell, non Hodgkin Do X ray and PET/CT If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

Question 582

Assessment of bone metastasis from primaily bothh osteolytic and osteoblastic lesions lesions

Answer 582

breast PET/CT MRI If positive consider doing CT or MRI to assess cortical integrity and risk of fractures

Question 583

Pospartum blues vs depression

Answer 583

blues peaks by day 5 and resolves by 2 weeks | depression: persist by 2 weeks.

Question 584

bupropion id not considered a first choice for depression in pregnant bacause there is no safety data on that and breastfeeding

Answer 584

true first line: sertraline and paroxetine

Question 585

first choice for depression in pregnancy

Answer 585

first line: sertraline and paroxetine

Question 586

Pain reatment for sickle cell anemia

Answer 586

morphine within 30 minutes of hospital arrival outpatient: oxy

Question 587

All patients with Sickle cell disease who are febrile need blood cultures and anitbiotics- due to risk of encapsulated given asplenia

Answer 587

true

Question 588

Codeine is contraindicated in < 12 years

Answer 588

unpredictable metaboslims

Question 589

Diagnostic criteria for acute chest syndrome in sickle cell disease

Answer 589

new infiltraate in chest x ray PLUS AT LEAST 1 OF THE FOLLOWING:' - Increased work of breathing, tachypnea, wheezing - Fever >101.3 - hypoxemia - est pain

Question 590

tto of acute chest syndrome in sickle cell

Answer 590

ceftriaxone plus azithromycin ( s.pneumonia, and mycoplasma coverage) IV fluids Pain control

Question 591

Causes of of acute chest syndrome in children

Answer 591

infection. sthma exacerbation and PE

Question 592

When does G6PD deficiency presents in neonate

Answer 592

usually day 2-3 | anemia and indirect hyperbilirrubinemia

Question 593

biliary atresia presents with

Answer 593

jaundice ,DIRECT BILIRRUBIN ( It is conjugated)

Question 594

treatment of any pelvic organ prolapse

Answer 594

pessary placement and ssurgical repair

Question 595

complications of laser removal of tattoos

Answer 595

scar marks and hypo or hyper pigmentation laser removal involves use of lasers of different wavelenghts, breaks up pigment into smaller particles that can be processed by macrophages

Question 596

MC techniques t for tattoo removal

Answer 596

dermabrasion - removes superficial dermis, pigment leaks out and laser removal -use of la- sers of different wavelenghts, breaks up pigment into smaller particles that can be processed by macrophages

Question 597

MCC of osteomyelitis in helathy children and tto

Answer 597

S.aureus If MRSA prevalence is low;: naficillin, or oxacillin or cefazolin If MRSA prevalence is high:Clinda OR Vanco

Question 598

MCC of osteomyelitis in sickle cell children and tto

Answer 598

Salmonella S.aureus Ceftriaxone (gram negative cover) plus either: If MRSA prevalence is low;: naficillin, or oxacillin or cefazolin If MRSA prevalence is high:Clinda OR Vanco

Question 599

Patient with wasp sting, has hypoxia, bronnchospasm , skin lesions. Next step?

Answer 599

IM epinephrine. This are signs of anaphylaxis- presentation is variable and hypotension can be delayed or absent. After this send them to allergist for venom immunotherapy as it reduces the risk of future anaphylaxis from 60 to 5%.

Question 600

Why IV epinephrine is not often used in anaphylaxis , and IM is preferred?

Answer 600

IV is associated with increased risk for dosing errors and side effects (arrhythmias), its often reserved for refractory hypotension or bronchospasm

Question 601

Management of hip fractures

Answer 601

call immediately ortho they will define if surgery or open reduction with internal fixation is needed Patients who are stable and ambulatory and get surgery WITHIN 48 HOURS have lower mortality and decreased risk of pressure ulcers nd pneumonia. Non operative management reserved for nonambulatory, dementia or are medically unstable

Question 602

Treating friends should generally be limited o emergency situationswhen no other care is available.

Answer 602

true

Question 603

tto of multinodular goiterretrosternal that is compressing the trachea

Answer 603

surgery removal

Question 604

Early physical signs of compartment syndrome

Answer 604

tightness of the area muscle weakness pain with passive stretching of the muscles

Question 605

Lofgren syndrome

Answer 605

acute clinical presentation of sarcoidosis: | fever, erythema nodosum, bilateral hilar lymphadenopathy

Question 606

Eye manifestations of sarcoidosis

Answer 606

Anterior/posterio uveitis ( photophobia) | Sicca

Question 607

Sarcoidosis can cause parotid gland swelling ?

Answer 607

yes

Question 608

Presentation of anterior uveitis

Answer 608

infalmmation of the iris and ciliary body ``` erythema at the limbus constricted pupil photosensitivity blurred vision moderate eye pain ```

Question 609

Treatment for squamous cell carcinoma skin

Answer 609

surgery but if patient refuses: cryotherapy, electrosurgery, RADIOTHERAPY

Question 610

iNDICATIONS OF braf kINASE INHIBITORS ( Vemurafenib)

Answer 610

in melanoma, can increase survival.

Question 611

Treatment of allergic rhinitis

Answer 611

``` avoidance of triggers intranasal corticosteroids (fluticasone) ```

Question 612

Pneumonia is a common precipitant of SIADH although mechanism is not understood. tto?

Answer 612

fluid restriction +/- salt tablets

Question 613

common precipitants of SIADH

Answer 613

``` CNS ( stroke, hemorrhage, trauma) Medications ( Carbamazepine, SSRIs, NSAIDs) Lung disease ( Pneumonia) Small cell carcinoma Pain and Nausea ```

Question 614

tto postpartum endometritis

Answer 614

clindamycin + gentamicin treatment is continued until the patient is afebrile for at least 24 hours gentamicin covers gram negative and S.aureus

Question 615

RF of postpartum endometritis

Answer 615

``` Cesarean delivery (THE MOST ) Instrumental vaginal delivery Chorioamnionitis GBS colonization Prolonged rupture of membranes ```

Question 616

Criteria for schizoaffective disorder

Answer 616

1. Major depression or manic episode concurrent with schizophrenia ss 2. hx of hallucinations/delusions >=2 weeks IN THE ABSCENCE of major depressive disorder 3. More predominant mood disorder 4. Not cause by substance. ordrugs

Question 617

schizoaffective disorder vs. major depressive or bipolar disorder with psychotic ss

Answer 617

the second one has always mood ss with psychotic ss at the same time. schizoaffective: 1. Major depression or manic episode concurrent with schizophrenia ss 2. hx of hallucinations/delusions >=2 weeks IN THE ABSCENCE of major depressive disorder 3. More predominant mood disorder 4. Not cause by substance. ordrugs

Question 618

Maternal complications of adolescent pregnancy ( <19 yo)

Answer 618

``` Hydatiform mole pre-eclampsia Anemia Post partum depression Operational vaginal delivery ```

Question 619

Fetal complications of adolescent pregnancy ( <19 yo)

Answer 619

``` Gastroschisis Omphalocele Preterm labor ( inadequate nutrition and immature physiology) Low birth weight Perinatal death ```

Question 620

RF for breech presentation

Answer 620

placenta previa multiple gestations polyhydramnios advanced maternal age

Question 621

RF GDM

Answer 621

``` Fx history diabetes prior pregnancy with diaebtes obesity multiple gestation maernal age >25 ```

Question 622

tto of herpes zoster

Answer 622

oral valacyclovir for 7 days oral acyclovir requires dosing 5 times a day, while valacyclovir is 3

Question 623

Varicella zoster postexposure prophylaxis

Answer 623

If immune ( had it, or received varicella vaccine x2): nothing if not immune: varicella vaccine within 5 days of exposure if not immune and pregnant or immunocompromised: varicella zoster Ig

Question 624

management of post herpetic neuralgia ( > 4 months after rash onset)

Answer 624

TCAs are the first line p but should be used with caution in elderly. Gabapentin , TCAs, pregabalin if despite all these may try opioids

Question 625

Types of pains after VZV and how. totreat

Answer 625

Acute pain < 30 days: NSAIDsanalgesics Subacute pain > 30 days , less than 4 months: NSAIDs analgesics Postherpetic neuralgia: > 4 months : TCAs, gabapentin, pregabalin

Question 626

Allergic vs non-allergic rhinitis

Answer 626

allergic: watery rhinorrhea, sneezing, watery eyes, early onset identifiable trigger, bluish or pale mucosa tto: avoid trigger, intranasal steroid( fluticasone) non-allergic: age> 20, nasal obstruction, rhinorrhea, postnasal drip. no trigger identified. worsen with seaseon mucosa normal or boggy and erythematous tto intransal steroid(fluticasone), , intranasal antihistamine (azelastine)

Question 627

Viral conjunctivitis is contagious?

Answer 627

Yes, it is contagious until eye discharge resolves

Question 628

Why do patients with poor glycemic control have blurry vision

Answer 628

swelling of optic lens due to osmotic changes- improving glycemic control can improve that

Question 629

Radiation induced cardiotoxicity can cause calcified valves, dyastolic dysfunction , MI,conduction defects

Answer 629

true

Question 630

anthracycline toxicity

Answer 630

dilated cardiomyopathy (decreased ejection fraction) but no valvular changes

Question 631

Patient with bipolar on lithium with suicide risk, what to do with lithium?

Answer 631

Continue lithium- it was been shown that it decreases risk of suicide.

Question 632

Causes of oligohydramnios (amniotic fluid index < 5)

Answer 632

``` Pre-eclampsia Abruptio placenta uteroplacental insufficiency renal anomalies NSAIDs ```

Question 633

Causes of polyhydramnios (amniotic fluid index >=45)

Answer 633

``` anencephaly multiple gestations esophageal/duodenal atresia Congenital infection DIABETES MELLITUS ```

Question 634

TTP PRESENTATION

Answer 634

``` Pregnancy is assocaited with ADAMTs13 deficiency that becomes more pronounced with increased gestation age. rENAL FAILURE Neurologic manifestations Fever adbominal pain, nausea petequial rash ``` hemolytic anemia thrombocytopenia

Question 635

tto of thrombotic thrombocytopenic purpura

Answer 635

plasma exchange

Question 636

acute fatty liver of pregnancy

Answer 636

occurs in 3rd trimester , nausea, emesis, elevated transaminases

Question 637

Surgical management of renal cell carcinoma

Answer 637

1. If extends through the capsule but not the Gerota's facia: Radical nephrectomy - also with invesion of major vessels, adrenal mass 2. If confined to the capsule: partial nehrectomy If huge: debulking If metastasis: chemtherapy and imunotherapy

Question 638

Patient with bilateral galactorrhea that labs are normal, and mammogram sand US are negative. Next step

Answer 638

reassurance and observation

Question 639

teenager with isolated proteinuria

Answer 639

orthostatic proteinuria a higher than normal protein during the day ( while they are up) but normal at night Dx with 24 hour split urine collection

Question 640

tto and prognosis of orthostatic proteinuriain adolescence

Answer 640

no intervention needed will resolve by its woen and DOES NOT PREDICT DEVELOPMENT OF FUTURE GLOMERULONEPHRITIS

Question 641

Why women who want to donate kidney should ideally be out of childbearing period?

Answer 641

``` it has consequences: fetal loss pre-eclampsia Gestational Diabetes Gestational hypertension ``` This is not an absolute CI, but people need to know

Question 642

RCTs are efficacy trials by desing and are not powered to assess adverse evffects, especially if rare.

Answer 642

True , follow-up times are often short.

Question 643

The best test for screening has to have the highest sensitivity.

Answer 643

true

Question 644

Formula for SMR and what does SMR of 1.75 menas

Answer 644

SMR: Observed number of deaths/expected umber ofdeaths 1.75 indicates that the observed number of deaths among the miners is 1.75 times (75%) higher than would be expected if the miners had the same death rate as the general population.

Question 645

Effect modification results when an external variable has an effect on one of the risk factors on disease status. Stratification helps identify this effect modification and separate measures for outcome should be reported for each level of the effect modififer

Answer 645

true. Example: effect of erythropoyetin on survival in ESRD, controlled by age, sex, duration of disease. among patients with Diabetes, epo use was associated with higher survival rates while patients without diabetes no association.

Question 646

Definition of maternal mortality rate

Answer 646

maternal deaths/live births

Question 647

crude mortality rate

Answer 647

number of deaths/total population size

Question 648

cause specific mortality rate

Answer 648

number of deaths from a particular disease by the total population size

Question 649

case fatality rate

Answer 649

deaths from specific disease/people with the disease

Question 650

Attack rate

Answer 650

number of patients with disease / total population at risk

Question 651

Crude birth date

Answer 651

live births/total population

Question 652

relationshop between plasma homocysteine level and folic acid intake , the correlation coefficient is -0.8. how much variability in plasma homocyteine levels is explained by folic acid intake?

Answer 652

0.8x0.8: 0.64 or 64% that is the coefficient of determination

Question 653

tto of seborrheic dermatitis

Answer 653

topic antifungals ( selenium sulfate, or ketoconazole shampoos) topical glucocorticoids topical calcineurin inhibitor( Pimerolimus)

Question 654

Cause of seborrheic dermatitis

Answer 654

Malassezia

Question 655

prognosis of seborrheic dermatitis

Answer 655

often a chronic relapsing condition, should be applied every 1-2 weeks to prevent recurrence

Question 656

steps for root cause analysis

Answer 656

1. collect data 2. Create causal factor flow chart 3. Determine root cause 4. Recommend change andimplement strategia 5. Measure success of change

Question 657

how does hydatiform mole forms?

Answer 657

one empty egg and 2 sperms, or 1 sperm that replicates its content

Question 658

management of hydatiform mole?

Answer 658

suction and curettage + OCPS then weekly bHCG until undetected then weekly bHCG until 6 months without being detected If at some point it becomes detected (Raising or plateauing)-- then Dx of gestational trophoblastic neoplasia If after 6 months remained undetected they can try pregnancy, the risk of neoplasia is low after 6 months.

Question 659

Patient with hydatiform mole resection with raising bHCG , Dx and next step?

Answer 659

gestational trophoblastic neoplasia Do Pelvic US and Chest X ray

Question 660

PCP mode of action

Answer 660

NMDA receptor antagonist

Question 661

PCP intoxication presentation

Answer 661

aggressive, agitated, combative, bizarre-- lasts for 8 hours HTN, Tachycardia, NYSTAGMUS (horizontal, vertical, rotatory)

Question 662

First thing to do in patient with PCP intoxication who is aggresive

Answer 662

BZD then physical constraint if pt does nto redirect verbally In mild cases of intoxications-low stimulation environment.

Question 663

molluscum contagiosum virus type and transmission

Answer 663

enveloped DNA poxvirus skin to skin contact, sexual transmission Can be associated to other genital infections or with HIV so ALWAYS TEST FOR hiv ( particularly if they have lesions in the face)

Question 664

tto. ofmolluscum contagiosum

Answer 664

self limited 6-9 months. Cryotherapy topical podopylotoxin curretage

Question 665

Risk factos for vulvar cancer?

Answer 665

``` Tobacco Vulvar lichen sclerosis Vulvar/cervical intraepithelial neoplasia Prior Cervical Ca immunodeficiency ``` ** presents as a plaque ( can be pigmented) - needs biopsy!

Question 666

presetnation of vulvar cancer

Answer 666

raised pigmented plaque in the vulva dyspareunia can have or not abnormal bleeding vulvar pruritus 2 main causes: HPV persisten infection and chronic infkammation

Question 667

tto vulvar cancer

Answer 667

surgical resection and possible chemoradiation

Question 668

presentation of presbycusis

Answer 668

elderly sensorineural hearing loss, affects HIGH FREQUENCY sounds. are not able to hear in noisy, distracting environment.

Question 669

recurrent sinusitis can be caused by second hand smoke

Answer 669

true- cigarrettend air pollution damage the cilia. Other causes in healthy subjects: - inadequately treated sinusitis - anatomic abnormalities in nasal septum or palate - allergic rhinitis

Question 670

Kartagener syndrome patophysiology and presentation

Answer 670

AR dynein arm affecting cilia chronic sinusitis, bronchiectasis, situs inversus, infertility, conductive hearing loss, Increased risk of ectopic pregnancy in females

Question 671

screening test for Kartagener

Answer 671

nasal nitric oxide test | is reduced in kartagener

Question 672

Why can hypocalcemia occur in the setting of a recent surgery?

Answer 672

Two mechanissms: 1. Volume expansion and hypoalbuminemia 2. Transfusions: Blood products have citrate to anticoagulate the blood. Citrate chelates with Calcium and causes hypocalcemia

Question 673

With which electrolyte disturbance would you see increased deep tendon reflexes?

Answer 673

HypoCalcemia. -also have Chvostek, Trousseau, muscle cramps, convulsions. Hypomagnesemia can also mimic hypoCa, but is often seen with heavy alcohol use, diuretics, and prolonged NG tube suction /diarrhea

Question 674

Presentation of HyperMg

Answer 674

rare but can cause decreased tendon reflexes a more severe form would cause: loss of reflexes, muscle paralysis, flaccid quadriplegia, decreased respiration

Question 675

short and long term complications of female circumcision

Answer 675

short: hemorrhage and infection | long term: genital pain, scarring, infection, infertility, difficulty with coitus and vaginal delivery

Question 676

7 yo with malodorous vaginal discharge and vaginal spotting? Dx? TTO?

Answer 676

Vaginal foreign body Warm irrigation and vaginoscopy under sedation MC object is toilett paper, but toys too

Question 677

Gestational trophoblastic neoplasia ( i.e choriocarcinoma) can occur in hydatiform moles but also in a normal pregnancy likely due to high maternal age. can be even after abortion, ectopic pregnancy

Answer 677

true, after normal pregnancy would present with persistent vaginal spotting, pelvic pain and pressure, high bHCG, and can have metastasis to lungs, vaginal, CNS, liver

Question 678

Evaluation of Gestational trophoblastic neoplasia ( i.e choriocarcinoma)

Answer 678

Pelvic US Chest X ray thryoid, hepatic and renal function tests

Question 679

tto of Gestational trophoblastic neoplasia ( i.e choriocarcinoma)

Answer 679

chemotherapy | hysterectomy

Question 680

how to differentiate an aplastic crisis and splenic sequestration in sickle cell disease

Answer 680

aplastic crisis: arrest in erythropoiesis due to parvovirus- so decreased reticulocyte count (<1%) and resultant acute, severe anemia. tto: blood transfusion in the meantime splenic sequestration : splenic vasooclusion--rapidly enlarging spleen. severe anemia but HIGH reticulocytes

Question 681

presetnation of acute chest syndrome in sickle cell

Answer 681

fever, chest pain, new pulmonary infiltrate in chest X ray

Question 682

Complications of sickle cell anemia:

Answer 682

aplastic crisis ( parvovirus) arrest of erythropoyesis, decreased reticulocytes and severe anemia Autosplenectomy: high risk of infection by encapsulated Splenic crisis: hepatomegaly, increased reticulocytes, severe anemia Salmonella osteomyelitis Sickling in renal medulla ( decreased PO2)- Renal papullary necrosis0

Question 683

Prevention of pre-eclampsia recurrence

Answer 683

``` low dose aspirin in the second trimester, at 12 weeks, for patients with high risk: renal disease DM HTN Prior pre-eclampsia ```

Question 684

When does pre-eclampsia occur?

Answer 684

>20 weeks caused by abnormal increase in platelet aggregation and vasoconstruction

Question 685

Do prenatal vitamins contain folic acid?

Answer 685

Yes 0.4 mg But consider an increased dose 4 mg in patients with prior neural tube defect kids, or taking CBZ or valproate

Question 686

Which patients are at higher risk of pre-eclampsia recurrence?

Answer 686

renal disease DM HTN Prior pre-eclampsia

Question 687

newborn with webbed neck posteriorly rotated ears, high arched palate, and edema ( lymphedema)

Answer 687

turner - NONDISJUNCTION , 45,X

Question 688

long term outcoms of turner syndrome

Answer 688

need screening for thyroid and celiac given increased risk of autoimmune diseases are at increased risk of learning disabilities BUTIN GENERAL EXHIBIT NORMAL INTELLIGENCE

Question 689

Fragile X syndrome- associated with autism Rett syndrome- developmental regression, microcephaly , epilepsy, stereotyped hand and movements Trisomies 13 and 18-associated with epilepsy

Answer 689

true

Question 690

Patient with child with turner, worried about risk of recurrence in next child?

Answer 690

Random error so risk does not increase with maternal age or subsequent pregnancies. Recurrence risk is same as general population

Question 691

treatment of tinea pedis

Answer 691

mild- respond well to topical terbinafine 1-2 weeks but if more severe or with onycomycosis ORAL terbinafine is preferred.

Question 692

pregnant women that arrives for bleeding. At exam has aa mass that is concerning for cervical cancer and bleeds to touch. Next step?

Answer 692

punch biopsy

Question 693

characteristics of alcoholic ketoacidosis

Answer 693

anion gap acidosis, increased osmolal gap, ketonemia or ketonuria, with variable levels of glucose in diabetic ketoacidosis glucose is often> 250

Question 694

tto of alcoholic ketoacidosis

Answer 694

Dextrose normal saline, and thiamine Dextrose will lead to increased insulin secretion which will lead ketone metabolism to bicarb

Question 695

Most frequent complication of transurehtral resection of the prostate

Answer 695

retrograde ejaculation

Question 696

tto of hidradenitis suppurative

Answer 696

all pts: weight loss, stop smoking Hurley classification: Mild: topical clinda intralesional corticosteroids for flares Moderates( nodules, sinus tracts) : oral tetracycline ( doxy) Severe: Infliximab, or surgical resection

Question 697

RF for hidradenitis suppurative

Answer 697

Family history of HS obesity smokers mechanical stress in the skin ( friction, manipulation)

Question 698

patient who told another doctor that her PCP makes her undress to do breast exam, next step

Answer 698

talk to physician and if suspicion notify to the board

Question 699

Causes of anemia in ESRD

Answer 699

Mainly due to decreased erythropoietin production in kineys. Other causes: iron deficiency, hyperparathyroidism ( increased resistance to erythropoietin), folate def, systemic inflammation, aluminum toxicity iron def from frequent blood draws, GI blood loss(common in ESDR), or dyalisis

Question 700

When is erythropoietin recommended in ESRD

Answer 700

with Hb < 10 and a target of 10-11.5 | Patients with transferring saturation =< 30%and ferritin =< 500require iron supplementation, preferable IV than oral

Question 701

Management of undescended testes

Answer 701

by 6 months if not descended sent for orchipexy, as decent is less likely to occur after this age. without surgery complications are: inguinal hernias, testicular torsion, subfertility and testicular cancer after orchopexy: there is still higher risk for cancer compared to the general population.

Question 702

Indications for endometrial biopsy

Answer 702

Age>=45 with suspected anovulatory bleeding Age < 45 with risk factors for unopposed estrogen( obestiy, PCOS), Failed medical managementr persistent abnormal bleeding

Question 703

tto for anovulatory bleeding in the transition to menopause, once it has been ruled out endometrial hyperplasia

Answer 703

cyclic progestin therapy low dose OCPs levonogestrel

Question 704

RF for endometrial hyperplasia

Answer 704

obestiy, age > 45, anovulation, DM

Question 705

Pathogenesis and clinical presentation of neuroblastoma

Answer 705

neural crest origin, involves the adrenal medulla and sympathic chain mean age < 2 years abdominal mass ( depending of size can cause constipation, obstruction) opsoclonus myoclonus syndrome periorbital ecchymosis ( orbital metastasis) Spinal cord compression ( dumbell tumor) can cause HTN, flushing, sweating

Question 706

Dx of neuroblastoma

Answer 706

elevated catecholamines metabolites samll round blue cells on histology N-myc gene amplification

Question 707

MC extracranial tumor of the childhood

Answer 707

neuroblastoma

Question 708

Wilms tumpr

Answer 708

RENAL tumor age < 5with unilateral, , PAINFUL, hematuria HTN WAGR

Question 709

Multiple drugs are a major cause of adverse drug reactions in the elderly.

Answer 709

true

Question 710

Caput vs. cephalohematoma vs. subgaleal

Answer 710

Caput is a scalp swelling that crosses sutures lines subgaleal: between scalp and periostium and rapid expansion is dangerious due to hypovolemic shock ( happens with vacuum forceps) - monitor in the ICU for volume replacement and evaluation of coagulation studies cephalohematoma: below periostium, does not cross suture , may lead to hyperbilirrubinemia secondary to red bloodcell breakdown -- less commonly these can calcify or ossify leading to skull malformation.

Question 711

Presentation of psoriatic arthritis

Answer 711

morning stiffness thatis relieved by physical activity- distal interphalanges, axial ( sacroilitis) nail pitting skin change sin the fingers ( erythema in phalanges)

Question 712

tto of psoriatic arthritis

Answer 712

patients with plaque psoriasis without arthritis: topical glucocorticoids or vit D derivatives (calcipotriene) But if arthritis: methotrexate

Question 713

Most common organisms causing otitis externa

Answer 713

S. aureus, pseudomonas

Question 714

tto of otitis externa

Answer 714

mild: topical acetic acid moderate/sever ( pain, pruritus, occlusion due to edema): topical antibiotics (polymixin B neomycin, colistin/neomycin, ciprodex) malignant otitis externa: IV cipro +/- debridement

Question 715

tto of otitis externa

Answer 715

mild: topical acetic acid, Domeboro solution x 7-10 days moderate/sever ( pain, pruritus, occlusion due to edema): topical antibiotics (polymixin B neomycin, colistin/neomycin, ciprodex) malignant otitis externa: IV cipro +/- debridement

Question 716

infectious outbreak causing hemorrhagic diarrhea. type of study needed to assess relation between exposure to one restaurant and breakout?

Answer 716

Case control | allows for quick localization of the source of outbreak

Question 717

Etiology of acute epididimytis

Answer 717

< 35 years: sexually transmitted ( Chlamydia, Gonorrhea) | > 35 years: bladder outlet obstruction ( Coliform bacteria)

Question 718

Unilateral testicular pain, mainly posterior, swelling, and that improves with elevation of testis?

Answer 718

Epididymtis

Question 719

Unilateral testicular pain, mainly posterior, swelling, and that improves with elevation of testis. Next step?

Answer 719

Likely epididymitis Urinalysis/culture NAAT for gonorrhea and chlamydia and antibiotic Ceftriaxone and Doxy if gonorrhea cannot be rule out

Question 720

Acute prostatitis vs. Chronic prostatisit presentation and tto

Answer 720

Acute: fever, chills, malaise, pelvic pain, urgency, tender prostate tto: TMP-smx OR Cipro for 4-6 weeks Chronic: dysuria and increased frequency, recurrent UTI tto Cipro Culture of midstream sample to dx

Question 721

Causes of viral orchitis

Answer 721

mumps ( aseptic meningitis, parotitis) rubella parvovirus

Question 722

tto of keratosis pilaris

Answer 722

urea cream, salycilic acid cream -can become pruritic in cold and dry weather

Question 723

suspect renovascular

Answer 723

abdominal dupplex doppler ultrasonography or CT/MRI angiography due to risk of contrast induced nephropathy the 1st one is recommended in patients with renal insufficiency

Question 724

pelvic organ prolapse treatment

Answer 724

weight loss pelvi floor exercises ( Kegel exercises)-- not helpful in advanced pelvic prolapse PESSARY placement ( severe cases, or poor surgical patients- with cardiovascular/pulmonary comorbidities) Surgery

Question 725

RF factor Dupuytren contracture

Answer 725

``` DM male age> 50 family history SMOKING, ALCOHOL USE Northern Europe ```

Question 726

Dupuytren contracture what is it?

Answer 726

Fibrosis of the Palmar Facia - usually 3,4,5th | Discrete nodules along the flexor

Question 727

tto of Dupuytren contracture

Answer 727

mild: modification of hand tools persistentor progressive disease: needle aponeurotomy or intralesional steroids Surgery: for advance disease or contractures.

Question 728

Constant urine leakage nocturia, weak urinary stream, decreased perineal sensation and large postvoid residue (> 150mL)

Answer 728

Overflow incontinence

Question 729

antihistamines can worsen overflow incontinence

Answer 729

rue

Question 730

Dating a former patient is unethical?

Answer 730

yes, current or former is always unethical if psychiatric patients. if other normal patients only current

Question 731

Definition of infertility

Answer 731

>=12 months. For women > 35 years, >=6 months

Question 732

First step in evaluation of infertility

Answer 732

semen analysis

Question 733

Common drugs that cause urinary incontinence

Answer 733

alpha adrenergic antagonists ( relax urethra) Anticholinergic, opiates Ca channel blockers diuretics

Question 734

First line treatment of alcohol disorder-wanting to spot

Answer 734

Naltrexone- mu opioid receptor antagonist ( reduces cravings, heavy drinking days, and increase sobriety days) CI in pts taking opioids or with liver failure Acamprosate glutamate modulator

Question 735

When do you use naltrexone vs. disulfiram in alcoholic pts

Answer 735

naltreoxine: patient who wants to stop drinking, decreases cravings, and increase sobriety days disulfiram: is in patients ALREADY ABSTINENT-INHIBITS aldehyde dehydrogenase

Question 736

pathophysiology of familial hypocalciuric hypercalcemia

Answer 736

AD inactivating mutations of Ca sensing receptor Normally high concentrations of Ca suppress PTH, but here higher than the high normal are needed 1st step measure PTH which is high, Calcium excretion NORMAL FINDINGS AT EXAM

Question 737

Antihypertensive recommended in patients on lithium

Answer 737

Amlodipine

Question 738

Which antihypertensives are NOT recommended in a patient on lithium?

Answer 738

Thiazides, NSAIDs except aspirin ACEs, ARBs, Tetracycline and MTZ they increase lithium levels

Question 739

antihypertensive that decreases lithium levels

Answer 739

K sparing diuretics

Question 740

6 medical contraindications for pregnancy

Answer 740

``` prior peripartum cardiomyopathy LVEF< 40 Severe HTN ( Eisenmenger sx) HG NYHA Class III-IV Severe obstructive cardiac lesions unstable aortic dilation ```

Question 741

What contraceptive are recommended in patients with eisenmenger syndrome?

Answer 741

hysteroscopic sterilization or subdermal progestin implant estrogen containing contraceptives are contraindicated due to risk of thromboembolism

Question 742

patient with recurrent rash in different parts of the body have been occuring for the last 6 months, recurs every 2-3 weeks last up to 24 hours and disappear. Next step?

Answer 742

``` Chronic urticaria ( > 6 weeks) No ned of further evaluation ``` ``` Triggers: 80-90% idiopathic Physical stimuli ( cold, skin pressure) NSAIDs Stress systemic disorders ``` 40% associated with angioedema.

Question 743

tto for chronic urticaria

Answer 743

second generation antihistamine: daily cetirizine, loratadine Refractory patients can try H1 blocker( hydroxyzine), montelukast ( leukotriene receptor antagonist), H2 blocker(ranitidine)

Question 744

long term prognosis of chronic urticaria

Answer 744

most patients will have spontaneous resolution within 2-5 years 30-50% show remission in the first year 70% at 5 year

Question 745

Patients with presbycusis often withdrawn from social life and exhibit isolation. Do not confuse with depression ( > 5/9), and there should be other signs such as seeing tv more close.

Answer 745

true

Question 746

treatment of bacterial vaginosis in pregnant and non pregnant

Answer 746

same! Clindamycin MTZ is contraindicated in the first trimester

Question 747

Why should we treat bacterial vaginosis during pregnancy

Answer 747

``` symptomatic relief plus avoid complications: preterm birth preterm prom chorioamnionitis postpartum endometritis ```

Question 748

initial treatment of squamous cell carcinoma limited to a vocal cord and no metastasis

Answer 748

radiotherapy first, laser excision, or partial vocal cordectomy if tumor is in the comisure of vocal cords-partial or hemilaryngotomy

Question 749

how long should a patient be treated for a DVT

Answer 749

If DVT had a cause- for at least 3 months up to a maximum of 6 months If DVT is idiopathic for at least 6 months, and at that point reassess if its needed more long term anticoagulation

Question 750

tto of condiloma acuminata

Answer 750

chemical: if lesion is inside: trichloroacetic acid if lesion is outside: podophylin ( is contraindicated. inpregnancy) immunotherapy: cidofovir and surgical excision

Question 751

When do kids realize about death

Answer 751

Preschool childrenbelieve death is temporary or reversible > 7 years: understand that death is final

Question 752

Treatment of slipped capital femoral epiphysis

Answer 752

Non-weight bearing | Surgical pinning

Question 753

Dx of slipped capital femoral epiphysis

Answer 753

posteriorly displacedfemoral head on X ray

Question 754

RF for slipped capital femoral epiphysis

Answer 754

Obesity and adolescence

Question 755

Complications slipped capital femoral epiphysis

Answer 755

Avascular necrosis Osteoarthritis

Question 756

timing of adjustement disorder

Answer 756

onset within 3 months of trigger

Question 757

When do you consider antibiotic prophylaxis for UTI?

Answer 757

when there have been more than 2 UTIs in 6 months or more than 3 in a year Can be continuous for several years or only after intercourse Cipro, TMP-SMX, nitrofurantoin

Question 758

RF for Cerebral venous sinus thrombosis

Answer 758

``` pregnancy OCPs Malignancy Infection Head trauma ```

Question 759

tto Cerebral venous sinus thrombosis for everyone even in pregnancy

Answer 759

low molecular weight heparin | although there can be some hemorrhage on imaging it is considered safe and the standard of care

Question 760

How do you monitor antracycline toxicity ( doxorubicin)

Answer 760

Radioncleide ventriculography-- queantifies ejection fraction. performed at baseline prior to initiating chemo, and then prior to subsequent cycles Anthracyclin CI if LEVF is < 30 and a dose should be modified if < 50%.

Question 761

Severe seborrheic dermatitis is asscoaited with which conditions

Answer 761

HIV, Parkinson

Question 762

3 main risk factors for prostate cancer

Answer 762

age, race, , family history

Question 763

the best way to reduce pop pulmonary complications

Answer 763

stop smoking at least 8 weeks before the surgery less importnat: pulmonary toilet, spirometry, minimal narcotic administration

Question 764

MC cause of POP fever in the first 24 hours

Answer 764

atelectasis

Question 765

If a patient has COPD as either very young or non smoker, what is the etiology

Answer 765

alpha 1 antitrypsin deficiency

Question 766

children of smoking parents are more likely to develop...

Answer 766

asthma , URI, otitis media there is also risk for lung Ca and risk increases iwth exposure

Question 767

"salty tastin baby", rectal prolapse, meconium ileum, failure to thrive

Answer 767

cystic fibrosis cor pulmonale pancreatic insuff infertility

Question 768

RF COPDS

Answer 768

Smoke cigarrete, secondhand smole, pccupational dust and chemical exposure, advancing age, Socioeconomic status

Question 769

Dx of COPD

Answer 769

Spirometry FEV1/FVC >0.7

Question 770

copd EXACERBATION TTO

Answer 770

``` Albuterol (short acting b agonist) Ipratropium ( short acting cholinergic) Prednsione Antibitoics if increased dyspnea, increased sputum O2 ```

Question 771

do not prescribe b blockers for asthma or COPD, WHY

Answer 771

they block the beta receptors that are needed to open airways

Question 772

In asthma, LABA Sshould never be prescribed as monotherapy due to increased risk of death.

Answer 772

true

Question 773

tto sarcoidosis

Answer 773

prednisone

Question 774

Leriche syndrome

Answer 774

PAD, Erectile dysufunction, absent or diminished femoral pulses

Question 775

Ankle Brachial index normal

Answer 775

SBP of dorsalis pedis or posterior tibial artery /SBP brachial artery normal: 0.91- 1.3 <0.9 PAD >1.3- Suggests calcified or uncompressible veins

Question 776

mullerian agenesis waht is it

Answer 776

congenital abscence of proximal 2/3 of vagina with no uterus

Question 777

single greates risk factor for breast Ca in males

Answer 777

BRCA mutation and having Klinefelter syndrome

Question 778

Scombroid poisoning

Answer 778

histidine to histamine flushing, throbbing head, palpitations, abdominal cramps, diarrhea, oral burning devleops 10-30 min after ingestion and is self limited-can also have wheezinghypotnesion,

Question 779

Pufferfish poisoning

Answer 779

``` neuro ss ( perioral tingling, incoordination , tingling 0 ```

Question 780

Persons who need post exposure prophylaxis to N. meningitidis

Answer 780

Household members Roomates Child care center workers Person directly exposed to respiratory or oral ( intubatio, kissing, mouth to mouth Person sitting next to infected person > 8 hrs

Question 781

Postexposure prophylaxis for N. Meningitidis

Answer 781

Rifampin 600 mg BID x 2 days (preferred, but do not give to women with OCPs) cipro 500 mg single oral dose Ceftriaxone250 mg dose

Question 782

presence of orbital fat in eyelid laceration, indicates that the most likely affected structure is

Answer 782

septum injury and levator muscle

Question 783

treatment of tinea versicolor- Malassezia in fection

Answer 783

topical antifungals- topical ketoconazole, terbinafine, clotrimazole)

Question 784

patient with multiple episodes of emesis, x ray with multiple air levels in the small intestine, and some gas in distal colon. Dx? and management?

Answer 784

Partial small bowel obstruction - initially can be managed with observation and supportive treatment - If patient does not improve in the next 12-24 hours then consult surgery

Question 785

What is the best prognostic factor in patients with HIV who have primary CNS lymphoma

Answer 785

increase in CD4 count and decrease in viral load. The degree of immunosupresion seems to be the major determinant in the prognosis of CNS lymphoma.

Question 786

if a patient wants to pursue alllife measures in tto and physician considers its futile, next step?

Answer 786

respect patients desire. With the exception of treatments taht are really futile

Question 787

pregnant women with contractions, at arrival isnoticed to have condiloma acuminata. Next step?

Answer 787

expectant vaginal delivery. Cesarea does not decrease the risk of vertical transmission. cesarea is only indicated if the lesions are large and may obstruct the birth canal.

Question 788

anti Parkinson drugs can cause hallucinations/psychosis due to increased dopamine. If patient is on multiple meds try to reduce the dose of the less potent med

Answer 788

true

Question 789

Patient who underwent FNA for cyst that yielded a greenish aspirate, and after that the cyst and ss resolved. Next step

Answer 789

Repeat US in 4-6 weeks. Because if its recurrent/peristent a biopsy is needed as well as additional imaging

Question 790

Patient had a lobular carcinoma in situ identified by needle biopsy, next step

Answer 790

proceed with excisional biopsy as it has risk to progress to ductal carcinoma or invasive cancer.

Question 791

screening for lung Ca

Answer 791

55-80 years , yearly with low dose CT scan patients with >=30 years smoking or current smoker or quit within the last 15 years.

Question 792

small cell cancer, location and associated with what paraneoplastic syndrome

Answer 792

center, smoking, paraneoplastic syndromes most aggressive, oat cell Klutchitsky cell ACTH-Cushing SIADH Lambert EAton paraneoplastic myelitis, encephalitis, subacute combined denegernation chemotherapy+/- radiation

Question 793

Types of non-small cell cancer

Answer 793

adenocarcinoma ( peripheral, non smoker, clubbing, arthropathy) squamous cell carcinoma( central, hilar mass, necrotic, cavitation, hypercalcemia, smoking) large cell carcinoma(peripheral, ginecomastia, galactorrhea, secretes bhcg) bronchial carcinoid.

Question 794

prior to starting varenicline , patient should be assessed for

Answer 794

psychiatric ss, it had a black box warning and is CI in current unstable neuropsychiatric status or recent suicidal ideation. buproprion is an alternative but is contraindicated in seizures.

Question 795

treatment of heat stroke

Answer 795

augmentative evaporing cooling- wet sheet and fans. ideally decrease 0.2C/min It is caused because the pt does not sweat enough to lower the temperature of the body.

Question 796

pregnant women with right adnexal mass concernign for ovarian tumor. next step?

Answer 796

surgical resection in the early second trimester and if pathology condfirms tumor that needs chemo then chemo during second and third trimester ** there is no role for tumor markers during pregnancy because the hormines may indicate other things ( ie. high AFP- neural tube defect instead of what is in the tumor)

Question 797

RF for ovarian cancer

Answer 797

``` Age >=50 Early menarche/late menopause genetic mutations ( BRCA1,2) Endometriosis Infertily Hormone replacement therapy ```

Question 798

Protective factors for ovarian cancer

Answer 798

multiparity, OCPS | breastfeeding

Question 799

pelvic organ prolapse can cause erosions in vagina or cervix that may present as abnormal vaginal bleeding ( postcoital, postvoid)

Answer 799

true tto is pessary surgery and vaginal estrogen. tohelp heal erosions

Question 800

RF for Pelvic organ prolapse

Answer 800

increased age high multiparity obesity history of operative vaginal delivery

Question 801

patient with psychosis. onmarihuana

Answer 801

before diagnosing the patient with any psychiatric disorder, make sure that he is off any drug. high potency marihuana has been associated with paranoia, depersonalization, hallucinations

Question 802

RF fo cervical insufficency

Answer 802

``` CUCO Collagen defects uterine abnormalities ( bicornuate or septate) Cervical conization obstetric injury ```

Question 803

Dx of cervical insufficeincy

Answer 803

>=2 spontanous second trimester losses or current painlessadvanced cervical dilation at < 24 weeks.

Question 804

pregnant patient with cervical insufficiency with prolapsing amniotic membranes, prognosis?

Answer 804

very poor! prolapsing amniotic membranes causes prolong expo to. vaginal flora-high risk of amniotic fluid, preterm membrane rupture, abruptio prolapsing amniotic membrane is a relative contraindication for cerclaje

Question 805

when do prophylactic cerclage is done

Answer 805

12-14 weeks

Question 806

tto of hyperviscosity syndrome ( nasal, oral bleeding, blurry vision, ehadache) in MM

Answer 806

plasmapheresi s

Question 807

treatment and complications of impetigo

Answer 807

if localized: topical mupirocin if generalized: orall cephalexin complications: postrep glomerulonephritis

Question 808

cause of inguinal hernia

Answer 808

failed obliteration of the processus vaginalis.

Question 809

prior to initiating TMP SMX for cystitis, always do a pregnancy test!!

Answer 809

true

Question 810

treamtne of uncomplicated cystitis in non pregnant and pregnant

Answer 810

nonpregnant: nITROFURANTOIN FOR 5 DAYS TMP/SMX for 3 days Fosfomycin for a single dose pregnant: nitrofurantoin amoxicillin, amoxi clavulanate, fosfomycin, cephalexin

Question 811

Acute cystitis is a common cause of hematura

Answer 811

true

Question 812

pathophysiology of immune thrombocytopenia

Answer 812

Anti GPIIB/iiiA antibodies- slenic macrophages eat the platelets. idiopathic or secondary to viral infection , HIV, HCV, SLE, CLL, drug reactions.

Question 813

side effects of combined hormonal contraceptives ( pills, patch, ring)

Answer 813

breakthrough bleeding, breast tenderness, nausea

Question 814

SE of depot medroxyrprogesterone acetate( injection)

Answer 814

``` irregular bleeding initially amenorrhea reversible bone loss delayed return to fertility +/- weigh gain ```

Question 815

SE of copper IUD

Answer 815

DYSMENORRHEA heavy menstruation

Question 816

SE of depot medroxyrprogesterone acetate( injection)

Answer 816

``` irregular bleeding initially amenorrhea reversible bone loss NOT ASSOCIATED WITH INCREASED RISK OF FUTURE OSTEOPOROSIS delayed return to fertility +/- weigh gain ```

Question 817

TTO OF ONYCOMYCOSIS

Answer 817

TFirst line: ORAL terbinafine, itraconazole | Second line: griseofulvin fluconazole

Question 818

TTO OF ONYCOMYCOSIS

Answer 818

TFirst line: ORAL terbinafine, itraconazole Second line: griseofulvin fluconazole Infection of the skin requires 6 weeks of tto, and of the nail 12 weeks.

Question 819

tto actinic keratosis

Answer 819

Tto: field therapy with 5 fluoracil cream for up to 6 weeks Other treatments: imiquimod cream, topical diclofenac. Liquid nitrogen cryosurgery ors urgical excision can be done for individual lesions. But is impractical when there are many.

Question 820

how long antidepressants aregiven for in a patient that has already started to feel good?

Answer 820

6 months following acute response Patients with recurrent episodes of major depression, chronic episodes (>=2 years), family history or severe episodes should be considered to be at maintenance, usually 1-3 years.

Question 821

patient with erythrocytosis, that has hematuria. and is a smoker. next step

Answer 821

CT abdomen to assess for Renal cell carcinoma | - renal cell carcinoma can cause erythrocytosis.

Question 822

tto of renal cell carcinoma

Answer 822

nephrectomy

Question 823

complications of ovarian stimulation syndrome

Answer 823

``` hemoconcentration respiratory distress renal failure DIC hypotension thrombosis ```

Question 824

patient withdepression on SSRIs that comes at the 2 month follow-up complaining of erectile dysfunction, next step?

Answer 824

switch to another class - bupropion or mirtazapine SSRI Erectile dysfunction: decreased libido, anorgasmia, delayed ejaculation,

Question 825

antibodies for autoimmune hepatitis

Answer 825

ANA and ASMA autoimmune hepatitis: mild elevation of transaminases. normal ALP, Anti mitochondrial antibodies are for primary biliary cirrhosis ( high ALP, normal transaminases

Question 826

transient PSA elevation causes and what to do

Answer 826

``` Urinary retention Infection instrumentation digital prostate exam recent ejaculation ``` repeat PSA levels in 4-6 weeks

Question 827

Sexually active women < 25 should be screened for cHLAMYDIA with NAAT

Answer 827

TRUE, if NAAT positive then screening for other STIs, including HIV should be done.

Question 828

treatment of gonococcal conjunctivitis (2-5) and chlamydia (5-14)

Answer 828

1 dose of IM Ceftriaxone or Cefotax chlamydia: oral eitrho

Question 829

After HIT 2 what is the management of short term and long term coagulation therapy

Answer 829

stop all heparin products and give argatroban, bivalirudin. Given that these are not oral, warfarin is more for long term only started once platelets >= 150,000 as rapidly dropping protein Clevels cause prothrombotic state

Question 830

CML tto

Answer 830

Imatinib, tyrosine kinase

Question 831

tto of ischemic priapism ( > 4 hours of erection)vs non-ischemic

Answer 831

paspiration of the cavernous corpora followed by irrigation with saline phenyelphrine (alpha agonist) non-ischemic( high flow priapism) - angiographic embolization

Question 832

which is the one single item screening fo alcohol abuse?

Answer 832

how many times in the past have you had more than 5 drinks?

Question 833

when they ask about the net clinical benefit of a medication you consider both the option that harm and the beneficial one.

Answer 833

true

Question 834

ITT approaach goal

Answer 834

preserve randomization, avoid effect of crossover and dropout

Question 835

colon cancer screening in average risk vs. high risk pts

Answer 835

colonoscopy every 10 years in average risk high risk: 10 years before the age of relative and repeat every 3-5 years

Question 836

Dx OF SUPERIOR VENA CAVA SYMDROME

Answer 836

CT neck and chest

Question 837

Acute fatty liver of pregnancy

Answer 837

third trimester, presents with nausea, emesis, and elevation of transaminases ( 300-500s)

Question 838

hellp

Answer 838

elevated transaminases thrombocytopenia ( < 100,000) proteinuria

Question 839

fatigue, bruising, MAHA, normal coag studies, fever. Dx

Answer 839

TTP

Question 840

Anemia in pregnancy

Answer 840

< 11 in 1st and 3rd | < 10.5 in second

Question 841

Iron deficiency anemia is associated with increased risk of preterm delivery, cesarean delivery, and increased transfusion.

Answer 841

true

Question 842

TTO of TTP

Answer 842

pLASMAPHERESIS-- remove antubodies agains metalloproteinase , Glucocorticoids, rituximab