question

Classic ECG finding in atrial flutter.

answer

"Sawtooth" P waves

question

Definition of unstable angina.

answer

Angina is new, is worsening, or occurs at rest.

question

Antihypertensive for a diabetic patient with proteinuria.

answer

ACEI.

question

Beck's triad for cardiac tamponade.

answer

Hypotension, distant heart sounds, and JVD.

question

Drugs that slow heart rate

answer

β-blockers, digoxin, calcium channel blockers, amiodarone

question

Hypercholesterolemia treatment that leads to flushing and pruritus.

answer

Niacin.

question

Murmur—hypertrophic obstructive cardiomyopathy (HOCM).

answer

Systolic ejection murmur heard along the lateral sternal border that ↑ with Valsalva maneuver and standing.

question

Murmur—aortic insufficiency.

answer

Diastolic, decrescendo, high-pitched, blowing murmur that is best heard sitting up; ↑ with ↓ preload (handgrip maneuver).

question

Murmur—aortic stenosis.

answer

Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ preload (squatting maneuver).

question

Murmur—mitral regurgitation.

answer

Holosystolic murmur that radiates to the axillae or carotids. Increases with increased after load (handgrip)

question

Murmur—mitral stenosis.

answer

Diastolic, mid- to late, low-pitched murmur preceded by opening snap.

question

Treatment for atrial fibrillation and atrial flutter.

answer

If unstable, cardiovert. If stable or chronic, rate control with calcium channel blockers or β-blockers.

question

Treatment for ventricular fibrillation.

answer

Immediate cardioversion.

question

Dressler's syndrome

answer

Autoimmune complication occurring 2-4 weeks post-MI with fever, pericarditis, increased ESR

question

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

answer

Treat existing heart failure and replace the tricuspid valve.

question

Diagnostic test for hypertrophic cardiomyopathy.

answer

Echocardiogram (showing thickened left ventricular wall and outflow obstruction).

question

A fall in systolic BP of > 10 mmHg with inspiration.

answer

Pulsus paradoxus (seen in cardiac tamponade).

question

Classic ECG findings in pericarditis.

answer

Low-voltage, diffuse ST-segment elevation.

question

Definition of hypertension.

answer

BP > 140/90 on three separate occasions two weeks apart.

question

Eight surgically correctable causes of hypertension.

answer

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.

question

Evaluation of a pulsatile abdominal mass and bruit.

answer

Abdominal ultrasound and CT.

question

Indications for surgical repair of abdominal aortic aneurysm.

answer

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured.

question

Treatment for acute coronary syndrome.

answer

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin.

question

What is metabolic syndrome?

answer

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.

question

Appropriate diagnostic test? ■ A 50-year-old man with angina can exercise to 85% of maximum predicted heart rate. ■

answer

Exercise stress treadmill with ECG.

question

Appropriate diagnostic test? A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

answer

Pharmacologic stress test (e.g., dobutamine echo).

question

Target LDL in a patient with diabetes.

answer

< 70.

question

Signs of active ischemia during stress testing.

answer

Angina, ST-segment changes on ECG, or ↓ BP.

question

ECG findings suggesting MI.

answer

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves.

question

Coronary territories in MI.

answer

Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal).

question

Young patient with angina at rest and ST segment elevation with normal cardiac enzymes

answer

Prinzmental Angina

question

Common Symptoms associated with silent MIs

answer

CHF, shock, AMS

question

Diagnostic Test for Pulmonary Embolism

answer

Spiral CT with contrast

question

Protamine

answer

Reverses the effects of heparin

question

Prothrombin Time

answer

Coagulation parameter affected by warfarin

question

Young patient with a family history of sudden death collapses and dies while exercising

answer

HCOM

question

Endocarditis prophylaxis for oral surgery

answer

Amoxacillin (certain situations)

question

Endocarditis prophylaxis for GI or GU procedures

answer

not recommended

question

Virchows triad

answer

Hypercoagulability, Endothelial damage, venous stasis

question

Most common cause of hypertension in young women

answer

OCPs

question

Most common cause of hypertension in young men

answer

Excessive EtOH

question

Figure 3 sign

answer

Aortic Coarctation

question

Water bottle shaped heart

answer

Pericardial effusion

question

Associated with Propionibacterium acnes and changes in androgen levels.

answer

Acne vulgaris.

question

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

answer

Herpes simplex.

question

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

answer

Lichen sclerosus.

question

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

answer

Squamous cell carcinoma.

question

The most common cause of hypothyroidism.

answer

Hashimoto's thyroiditis.

question

Stuck on appearance

answer

Seborrheic keratosis

question

Red plaques with silvery white scales and sharp margins

answer

Psoriasis

question

Honey crusted lesions

answer

Impetigo

question

A febrile patient with a history of diabetes presents with red swollen painful lower extremity

answer

cellulitis

question

+ Nikolsky's sign

answer

Pemphigus Vulgaris

question

- Nikolsky's sign

answer

Bullous Pemphagoid

question

55 year old obese patient presents with dirty velvety patches on the back of the neck

answer

Acanthosis nigricans . Check fasting blood glucose to rule out diabetes

question

Dermatomal distribution

answer

Varicella Zoster

question

Flat topped papules

answer

Lichen Planus

question

Iris-like target lesions

answer

Erythema Multiforme

question

Lesion characteristically occurring in a linear pattern in areas where skin comes in contact with clothing or jewelry

answer

Contact Dermatitis

question

Presents with herald patch- christmas tree pattern

answer

Pityriasis rosea

question

Pinkish scaling flat lesions on chest and back, KOH prep has spaghetti and meatballs appearance

answer

Tinea (Pityriasis) Versicolor

question

Four characteristics of a nevus suggestive of melanoma

answer

Asymmetry, Border irregularity, color variation, large diameter

question

Premalignant lesion from sun exposure that can lead to squamous cell carcinoma

answer

Actinic Keratosis

question

Dewdrops on a rose petal

answer

Lesions of primary Varicella

question

Cradle cap

answer

Seborrheic dermatitis, treat conservatively with bathing and moisturizing agents

question

Lab findings in Hashimoto's thyroiditis.

answer

High TSH, low T4, antimicrosomal antibodies.

question

Exophthalmos, pretibial myxedema, and ↓ TSH.

answer

Graves' disease.

question

The most common cause of Cushing's syndrome.

answer

Iatrogenic corticosteroid administration. The second most common cause is Cushing's disease.

question

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

answer

Hypoparathyroidism.

question

"Stones, bones, groans, psychiatric overtones."

answer

Signs and symptoms of hypercalcemia.

question

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis.

answer

1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia).

question

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

answer

Pheochromocytoma.

question

Should α- or β-antagonists be used first in treating pheochromocytoma?

answer

α-antagonists (phentolamine and phenoxybenzamine).

question

A patient with a history of lithium use presents with copious amounts of dilute urine.

answer

Nephrogenic diabetes insipidus (DI).

question

Treatment of central DI.

answer

Administration of DDAVP ↓ serum osmolality and free water restriction.

question

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

answer

SIADH due to stress.

question

An antidiabetic agent associated with lactic acidosis.

answer

Metformin.

question

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

answer

1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids.

question

Goal HbA1c for a patient with DM.

answer

< 7.0.

question

Treatment of DKA.

answer

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+).

question

Why are β-blockers contraindicated in diabetics?

answer

They can mask symptoms of hypoglycemia.

question

Bias introduced into a study when a clinician is aware of the patient's treatment type.

answer

Observational bias.

question

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

answer

Lead-time bias.

question

If you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.

answer

Confounding variable.

question

The number of true positives divided by the number of patients with the disease is _____.

answer

Sensitivity.

question

Sensitive tests have few false negatives and are used to rule _____ a disease.

answer

Out.

question

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a PPD. Highly sensitive or specific?

answer

Highly sensitive for TB.

question

Chronic diseases such as SLE—higher prevalence or incidence?

answer

Higher prevalence.

question

Epidemics such as influenza—higher prevalence or incidence?

answer

Higher incidence.

question

Cross-sectional survey—incidence or prevalence?

answer

Prevalence.

question

Cohort study—incidence or prevalence?

answer

Incidence and prevalence.

question

Case-control study—incidence or prevalence?

answer

Neither.

question

Describe a test that consistently gives identical results, but the results are wrong.

answer

High reliability, low validity.

question

Difference between a cohort and a case-control study.

answer

Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR.

question

Attributable risk?

answer

The incidence rate (IR) of a disease in exposed - the IR of a disease in unexposed.

question

Relative risk?

answer

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed.

question

Odds ratio?

answer

The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed.

question

Number needed to treat?

answer

1 ÷ (rate in untreated group - rate in treated group).

question

In which patients do you initiate colorectal cancer screening early?

answer

Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer.

question

The most common cancer in men and the most common cause of death from cancer in men.

answer

Prostate cancer is the most common cancer in men, but lung cancer causes more deaths.

question

The percentage of cases within one SD of the mean? Two SDs? Three SDs?

answer

68%, 95.4%, 99.7%.

question

Birth rate?

answer

Number of live births per 1000 population in one year.

question

Fertility rate?

answer

Number of live births per 1000 females (15-44 years of age) in one year.

question

Mortality rate?

answer

Number of deaths per 1000 population in one year.

question

Neonatal mortality rate?

answer

Number of deaths from birth to 28 days per 1000 live births in one year.

question

Postnatal mortality rate?

answer

Number of deaths from 28 days to one year per 1000 live births in one year.

question

Infant mortality rate?

answer

Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality) in one year.

question

Fetal mortality rate?

answer

Number of deaths from 20 weeks' gestation to birth per 1000 total births in one year.

question

Perinatal mortality rate?

answer

Number of deaths from 20 weeks' gestation to one month of life per 1000 total births in one year.

question

Maternal mortality rate?

answer

Number of deaths during pregnancy to 90 days postpartum per 100,000 live births in one year.

question

True or false: Once patients sign a statement giving consent, they must continue treatment.

answer

False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity.

question

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Is parental consent required?

answer

No. Parental consent is not necessary for the medical treatment of pregnant minors.

question

A doctor refers a patient for an MRI at a facility he/she owns.

answer

Conflict of interest.

question

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

answer

The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs).

question

True or false: Withdrawing a nonbeneficial treatment is ethically similar to withholding a nonindicated one.

answer

True.

question

When can a physician refuse to continue treating a patient on the grounds of futility?

answer

When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care.

question

An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.

answer

Treat immediately. Consent is implied in emergency situations.

question

Conditions in which confidentiality must be overridden.

answer

Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse.

question

Involuntary commitment or isolation for medical treatment may be undertaken for what reason?

answer

When treatment noncompliance represents a serious danger to public health (e.g., active TB).

question

A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.

answer

Treat because the disease represents an immediate threat to the child's life. Then seek a court order.

question

A son asks that his mother not be told about her recently discovered cancer.

answer

A physician can withhold information from the patient only in the rare case of therapeutic privilege or if the patient requests not to be told. A patient's family cannot require the physician to withhold information from the patient.

question

A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?

answer

Emergent laparotomy to repair perforated viscus.

question

The most likely cause of acute lower GI bleed in patients > 40 years of age.

answer

Diverticulosis.

question

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

answer

HIDA scan.

question

Risk factors for cholelithiasis.

answer

Fat, female, fertile, forty, flatulent.

question

Inspiratory arrest during palpation of the RUQ.

answer

Murphy's sign, seen in acute cholecystitis.

question

The most common cause of SBO in patients with no history of abdominal surgery.

answer

Hernia.

question

The most common cause of SBO in patients with a history of abdominal surgery.

answer

Adhesions.

question

Identify key organisms causing diarrhea: ■ Most common organism ■

answer

Campylobacter

question

diarrhea from Recent antibiotic use ■

answer

Clostridium difficile

question

Diarrhea from camping

answer

Giardia

question

Traveler's diarrhea

answer

ETEC

question

Diarrhea from church picnics/ mayonnaise

answer

S. aureus

question

Diarrhea uncooked hamburgers

answer

E. Coli O157:H7- HUS

question

Diarrhea fried rice

answer

Baccilus cereus

question

Diarrhea poultry/eggs

answer

Salmonella

question

Diarrhea raw seafood

answer

Vibrio, HAV

question

Diarrhea AIDS

answer

Isospora, Cryptosporidium, Mycobacterium avium complex

question

Diarrhea from Pseudoappendicitis

answer

Yersinia

question

A 25-year-old Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

answer

Crohn's disease

question

Inflammatory disease of the colon with ↑ risk of colon cancer.

answer

Ulcerative colitis (greater risk than Crohn's).

question

Extraintestinal manifestations of IBD.

answer

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis.

question

Medical treatment for IBD.

answer

5-ASA agents and steroids during acute exacerbations.

question

Difference between Mallory-Weiss and Boerhaave tears.

answer

Mallory-Weiss—superficial tear in the esophageal mucosa; Boerhaave—full-thickness esophageal rupture.

question

Charcot's triad.

answer

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis.

question

Reynolds' pentad.

answer

Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis.

question

Medical treatment for hepatic encephalopathy.

answer

↓ protein intake, lactulose, rifaximin.

question

First step in the management of a patient with an acute GI bleed.

answer

Establish the ABCs.

question

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

answer

Hemolytic-uremic syndrome (HUS) due to E. coli O157: H7.

question

Post-HBV exposure treatment.

answer

HBV immunoglobulin.

question

Classic causes of drug-induced hepatitis.

answer

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.

question

A 40-year-old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

answer

Biliary tract obstruction.

question

Hernia with highest risk of incarceration—indirect, direct, or femoral?

answer

Femoral hernia.

question

A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

answer

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and "tincture of time."

question

Four causes of microcytic anemia.

answer

TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia.

question

An elderly man with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

answer

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer.

question

Precipitants of hemolytic crisis in patients with G6PD deficiency.

answer

Sulfonamides, antimalarial drugs, fava beans.

question

The most common inherited cause of hypercoagulability.

answer

Factor V Leiden mutation.

question

The most common inherited bleeding disorder.

answer

von Willebrand's disease.

question

The most common inherited hemolytic anemia.

answer

Hereditary spherocytosis.

question

Diagnostic test for hereditary spherocytosis.

answer

Osmotic fragility test.

question

Pure RBC aplasia.

answer

Diamond-Blackfan anemia.

question

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café au lait spots, microcephaly, and pancytopenia.

answer

Fanconi's anemia.

question

Medications and viruses that lead to aplastic anemia.

answer

Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV.

question

How to distinguish polycythemia vera from 2° polycythemia.

answer

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels.

question

Thrombotic thrombocytopenic purpura (TTP) pentad?

answer

"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities.

question

HUS triad?

answer

Anemia, thrombocytopenia, and acute renal failure.

question

Treatment for TTP.

answer

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs.

question

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

answer

Usually resolves spontaneously; may require IVIG and/or corticosteroids.

question

Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.

answer

Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.

question

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

answer

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements.

question

A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?

answer

von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate.

question

A 60-year-old African-American man presents with bone pain. Workup for multiple myeloma might reveal?

answer

Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones.

question

Reed-Sternberg cells.

answer

Hodgkin's lymphoma.

question

A 10-year-old boy presents with fever, weight loss, and night sweats. Exam shows an anterior mediastinal mass. Suspected diagnosis?

answer

Non-Hodgkin's lymphoma.

question

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

answer

Anemia of chronic disease.

question

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

answer

Iron deficiency anemia.

question

An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?

answer

Chronic lymphocytic leukemia (CLL).

question

The lymphoma equivalent of CLL.

answer

Small lymphocytic lymphoma.

question

A late, life-threatening complication of chronic myelogenous leukemia (CML).

answer

Blast crisis (fever, bone pain, splenomegaly, pancytopenia).

question

Auer rods on blood smear.

answer

Acute myelogenous leukemia (AML).

question

AML subtype associated with DIC.

answer

M3.

question

Electrolyte changes in tumor lysis syndrome.

answer

↓ Ca2+, ↑ K+, ↑ phosphate, ↑ uric acid.

question

Treatment for AML M3.

answer

Retinoic acid.

question

A 50-year-old man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

answer

CML.

question

Heinz bodies?

answer

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy.

question

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

answer

Glanzmann's thrombasthenia.

question

Virus associated with aplastic anemia in patients with sickle cell anemia.

answer

Parvovirus B19.

question

A 25-year-old African-American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

answer

O2, analgesia, hydration, and, if severe, transfusion.

question

A significant cause of morbidity in thalassemia patients. Treatment?

answer

Iron overload; use deferoxamine.

question

The three most common causes of fever of unknown origin (FUO).

answer

Infection, cancer, and autoimmune disease.

question

Four signs and symptoms of streptococcal pharyngitis.

answer

Fever, pharyngeal erythema, tonsillar exudate, lack of cough.

question

A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.

answer

Postinfectious glomerulonephritis.

question

Asplenic patients are particularly susceptible to these organisms.

answer

Encapsulated organisms—pneumococcus, meningococcus,Haemophilus influenzae, Klebsiella.

question

The number of bacteria on a clean-catch specimen to diagnose a UTI.

answer

10^5 bacteria/mL.

question

Which healthy population is susceptible to UTIs?

answer

Pregnant women. Treat this group aggressively because of potential complications.

question

A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?

answer

Coccidioidomycosis. Amphotericin B.

question

Nonpainful chancre.

answer

1° syphilis.

question

A "blueberry muffin" rash is characteristic of what congenital infection?

answer

Rubella.

question

Meningitis in neonates. Causes? Treatment?

answer

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin.

question

Meningitis in infants. Causes? Treatment?

answer

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin.

question

What should always be done prior to LP?

answer

Check for ↑ ICP; look for papilledema.

question

CSF: Low glucose, PMN predominance

answer

Bacterial meningitis

question

CSF: Normal glucose, lymphocytic predominance

answer

Aseptic (viral) meningitis

question

CSF: Numerous RBCs in serial CSF samples

answer

Subarachnoid hemorrhage (SAH)

question

CSF: ↑ gamma globulins

answer

MS

question

Initially presents with a pruritic papule with regional lymphadenopathy; evolves into a black eschar after 7-10 days. Treatment?

answer

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.

question

Findings in 3° syphilis.

answer

Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.

question

Characteristics of 2° Lyme disease.

answer

Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis.

question

Cold agglutinins.

answer

Mycoplasma.

question

A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

answer

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension.

question

Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?

answer

≤ 200 for P. jiroveci (with TMP-SMX); ≤ 50-100 for MAI (with clarithromycin/azithromycin).

question

Risk factors for pyelonephritis.

answer

Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.

question

Neutropenic nadir postchemotherapy.

answer

7-10 days.

question

Erythema migrans.

answer

Lesion of 1° Lyme disease.

question

Classic physical findings for endocarditis.

answer

Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots.

question

Aplastic crisis in sickle cell disease.

answer

Parvovirus B19.

question

Ring-enhancing brain lesion on CT with seizures.

answer

Taenia solium (cysticercosis).

question

Branching rods in oral infection

answer

Actinomyces israelii

question

Painful chancroid

answer

Haemophilus ducreyi

question

Dog or cat bite

answer

Pasteurella multocida

question

Gardener

answer

Sporothrix schenckii

question

Pregnant women with pets

answer

Toxoplasma gondii

question

Meningitis in adults

answer

Neisseria meningitidis

question

Meningitis in elderly

answer

Streptococcus pneumoniae

question

Alcoholic with pneumonia

answer

Klebsiella

question

"Currant jelly" sputum

answer

Klebsiella

question

Infection in burn victims

answer

Pseudomonas

question

Osteomyelitis from foot wound puncture

answer

Pseudomonas

question

Osteomyelitis in a sickle cell patient

answer

Salmonella

question

A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

answer

Legionella pneumonia.

question

A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, and how did he get it? Treatment?

answer

Lyme disease, Ixodes tick, doxycycline.

question

A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

answer

S. aureus or S. epidermidis.

question

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

answer

Spinal stenosis.

question

Joints in the hand affected in rheumatoid arthritis.

answer

MCP and PIP joints; DIP joints are spared.

question

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

answer

Osteoarthritis.

question

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

answer

Osteogenesis imperfecta.

question

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

answer

Suspect ankylosing spondylitis. Check HLA-B27.

question

Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?

answer

Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma.

question

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

answer

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid.

question

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

answer

Pseudogout. calcium pyrophosphate

question

An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.

answer

Polymyalgia rheumatica.

question

An active 13-year-old boy has anterior knee pain. Diagnosis?

answer

Osgood-Schlatter disease.

question

Bone is fractured in a fall on an outstretched hand.

answer

Distal radius (Colles' fracture).

question

Complication of scaphoid fracture.

answer

Avascular necrosis.

question

Signs suggesting radial nerve damage with humeral fracture.

answer

Wrist drop, loss of thumb abduction.

question

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

answer

Duchenne muscular dystrophy.

question

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

answer

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction.

question

An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?

answer

Slipped capital femoral epiphysis. AP and frog-leg lateral view.

question

The most common 1° malignant tumor of bone.

answer

Multiple myeloma.

question

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

answer

Cluster headache.

question

Prophylactic treatment for migraine.

answer

Antihypertensives, antidepressants, anticonvulsants.

question

The most common pituitary tumor. Treatment?

answer

Prolactinoma. Dopamine agonists (e.g., bromocriptine).

question

A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?

answer

Broca's aphasia. Frontal lobe, left MCA distribution.

question

The most common cause of SAH.

answer

Trauma; the second most common is berry aneurysm.

question

A crescent-shaped hyperdensity on CT that does not cross the midline.

answer

Subdural hematoma—bridging veins torn.

question

A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely source? Treatment?

answer

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation.

question

CSF findings with SAH.

answer

Elevated ICP, RBCs, xanthochromia.

question

Albuminocytologic dissociation.

answer

Guillain-Barré syndrome (↑ protein in CSF without a significant ↑ in cell count).

question

Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathologic?

answer

Normal.

question

The most common 1° sources of metastases to the brain.

answer

Lung, breast, skin (melanoma), kidney, GI tract.

question

May be seen in children who are accused of inattention in class and confused with ADHD.

answer

Absence seizures.

question

The most frequent presentation of intracranial neoplasm.

answer

Headache.

question

The most common cause of seizures in children (2-10 years).

answer

Infection, febrile seizures, trauma, idiopathic.

question

The most common cause of seizures in young adults (18-35 years).

answer

Trauma, alcohol withdrawal, brain tumor.

question

First-line medication for status epilepticus.

answer

IV benzodiazepine.

question

Confusion, confabulation, ophthalmoplegia, ataxia.

answer

Wernicke's encephalopathy due to a deficiency of thiamine.

question

What % lesion is an indication for carotid endarterectomy?

answer

Seventy percent if the stenosis is symptomatic.

question

The most common causes of dementia.

answer

Alzheimer's and multi-infarct.

question

Combined UMN and LMN disorder.

answer

ALS.

question

Rigidity and stiffness with resting tremor and masked facies.

answer

Parkinson's disease.

question

The mainstay of Parkinson's therapy.

answer

Levodopa/carbidopa.

question

Treatment for Guillain-Barré syndrome.

answer

IVIG or plasmapheresis.

question

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.

answer

Huntington's disease.

question

A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma.

answer

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe.

question

Café au lait spots on skin.

answer

Neurofibromatosis type 1.

question

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

answer

Klüver-Bucy syndrome (amygdala).

question

May be administered to a symptomatic patient to diagnose myasthenia gravis.

answer

Edrophonium.

question

1° causes of third-trimester bleeding.

answer

Placental abruption and placenta previa.

question

Classic ultrasound and gross appearance of complete hydatidiform mole.

answer

Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination.

question

Chromosomal pattern of a complete mole.

answer

46,XX.

question

Molar pregnancy containing fetal tissue.

answer

Partial mole.

question

Symptoms of placental abruption.

answer

Continuous, painful vaginal bleeding.

question

Symptoms of placenta previa.

answer

Self-limited, painless vaginal bleeding.

question

When should a vaginal exam be performed with suspected placenta previa?

answer

Never.

question

Antibiotics with teratogenic effects.

answer

Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.

question

Shortest AP diameter of the pelvis.

answer

Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis.

question

Medication given to accelerate fetal lung maturity.

answer

Betamethasone or dexamethasone × 48 hours.

question

The most common cause of postpartum hemorrhage.

answer

Uterine atony.

question

Treatment for postpartum hemorrhage.

answer

Uterine massage; if that fails, give oxytocin.

question

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

answer

IV penicillin or ampicillin.

question

A patient fails to lactate after an emergency C-section with marked blood loss.

answer

Sheehan's syndrome (postpartum pituitary necrosis).

question

Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.

answer

Inevitable abortion.

question

Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.

answer

Threatened abortion.

question

The first test to perform when a woman presents with amenorrhea.

answer

β-hCG; the most common cause of amenorrhea is pregnancy.

question

Term for heavy bleeding during and between menstrual periods.

answer

Menometrorrhagia.

question

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

answer

Asherman's syndrome.

question

Therapy for polycystic ovarian syndrome.

answer

Weight loss and OCPs.

question

Medication used to induce ovulation.

answer

Clomiphene citrate.

question

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

answer

Endometrial biopsy.

question

Indications for medical treatment of ectopic pregnancy.

answer

Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation.

question

Medical options for endometriosis.

answer

OCPs, danazol, GnRH agonists.

question

Laparoscopic findings in endometriosis.

answer

"Chocolate cysts," powder burns.

question

The most common location for an ectopic pregnancy.

answer

Ampulla of the oviduct.

question

How to diagnose and follow a leiomyoma.

answer

Ultrasound.

question

Natural history of a leiomyoma.

answer

Regresses after menopause.

question

A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.

answer

Trichomonas vaginitis.

question

Treatment for bacterial vaginosis.

answer

Oral or topical metronidazole.

question

The most common cause of bloody nipple discharge.

answer

Intraductal papilloma.

question

Contraceptive methods that protect against PID.

answer

OCPs and barrier contraception.

question

Unopposed estrogen is contraindicated in which cancers?

answer

Endometrial or estrogen receptor- breast cancer.

question

A patient presents with recent PID with RUQ pain.

answer

Consider Fitz-Hugh-Curtis syndrome.

question

Breast malignancy presenting as itching, burning, and erosion of the nipple.

answer

Paget's disease.

question

Annual screening for women with a strong family history of ovarian cancer.

answer

CA-125 and transvaginal ultrasound.

question

A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?

answer

Kegel exercises, estrogen, pessaries for stress incontinence.

question

A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?

answer

Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.

question

Lab values suggestive of menopause.

answer

↑ serum FSH.

question

The most common cause of female infertility.

answer

Endometriosis.

question

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?

answer

Colposcopy and endocervical curettage.

question

Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.

answer

Lobular carcinoma in situ.

question

Nontender abdominal mass associated with elevated VMA and HVA

answer

Neuroblastoma.

question

The most common type of tracheoesophageal fistula (TEF). Diagnosis?

answer

Esophageal atresia with distal TEF (85%). Unable to pass NG tube.

question

Not contraindications to vaccination.

answer

Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity.

question

Tests to rule out shaken baby syndrome.

answer

Ophthalmologic exam, CT, and MRI.

question

A neonate has meconium ileus.

answer

CF or Hirschsprung's disease.

question

Bilious emesis within hours after the first feeding.

answer

Duodenal atresia.

question

A two-month-old baby presents with nonbilious projectile emesis. What are the appropriate steps in management?

answer

Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy.

question

The most common 1° immunodeficiency.

answer

Selective IgA deficiency.

question

An infant has a high fever and onset of rash as fever breaks. What is he at risk for?

answer

Febrile seizures (roseola infantum).

question

A boy has chronic respiratory infections. Nitroblue tetrazolium test is positive

answer

Chronic granulomatous disease

question

A child has eczema, thrombocytopenia, and high levels of IgA

answer

Wiskott-Aldrich syndrome

question

A four-month-old boy has life-threatening Pseudomonas infection

answer

Bruton's X-linked agammaglobulinemia

question

Acute-phase treatment for Kawasaki disease.

answer

High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms.

question

Treatment for mild and severe unconjugated hyperbilirubinemia.

answer

Phototherapy (mild) or exchange transfusion (severe).

question

Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.

answer

Reye's syndrome.

question

A child has loss of red light reflex. Diagnosis?

answer

Suspect retinoblastoma.

question

Vaccinations at a six-month well-child visit.

answer

HBV, DTaP, Hib, IPV, PCV.

question

Tanner stage 3 in a six-year-old girl.

answer

Precocious puberty.

question

Infection of small airways with epidemics in winter and spring.

answer

RSV bronchiolitis.

question

Cause of neonatal RDS.

answer

Surfactant deficiency.

question

A condition associated with red "currant-jelly" stools.

answer

Intussusception.

question

A congenital heart disease that causes 2° hypertension.

answer

Coarctation of the aorta.

question

First-line treatment for otitis media.

answer

Amoxicillin × 10 days.

question

The most common pathogen causing croup.

answer

Parainfluenza virus type 1.

question

A homeless child is small for his age and has peeling skin and a swollen belly.

answer

Kwashiorkor (protein malnutrition).

question

Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.

answer

Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency).

question

A newborn girl has a continuous "machinery murmur."

answer

Patent ductus arteriosus (PDA).

question

First-line pharmacotherapy for depression.

answer

SSRIs.

question

Antidepressants associated with hypertensive crisis.

answer

MAOIs.

question

Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.

answer

Patient on dopamine antagonist.

question

A 17-year-old girl has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.

answer

Conversion disorder.

question

A mother who is angry at her husband yells at her child

answer

Displacement

question

A pedophile enters a monastery.

answer

Reaction formation

question

A woman calmly describes a grisly murder. ■

answer

Isolation

question

A hospitalized 10-year-old begins to wet his bed.

answer

Regression

question

Life-threatening muscle rigidity, fever, and rhabdomyolysis.

answer

Neuroleptic malignant syndrome.

question

Amenorrhea, bradycardia, and abnormal body image in a young female.

answer

Anorexia.

question

A 35-year-old man has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.

answer

Panic disorder.

question

The most serious side effect of clozapine.

answer

Agranulocytosis.

question

A 21-year-old man has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.

answer

Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms).

question

Key side effects of atypical antipsychotics.

answer

Weight gain, type 2 DM, QT prolongation.

question

A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?

answer

Acute dystonia (oculogyric crisis). Treat with benztropine,trihexyphenidyl or diphenhydramine.

question

Medication to avoid in patients with a history of alcohol withdrawal seizures.

answer

Neuroleptics.

question

A 13-year-old boy has a history of theft, vandalism, and violence toward family pets.

answer

Conduct disorder.

question

A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.

answer

Rett's disorder.

question

A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?

answer

Acute mania. Start a mood stabilizer (e.g., lithium).

question

After a minor fender bender, a man wears a neck brace and requests permanent disability.

answer

Malingering.

question

A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C-peptide.

answer

Factitious disorder (Munchausen syndrome).

question

A patient continues to use cocaine after being in jail, losing his job, and not paying child support.

answer

Substance abuse.

question

A violent patient has vertical and horizontal nystagmus.

answer

Phencyclidine hydrochloride (PCP) intoxication.

question

A woman who was abused as a child frequently feels outside of or detached from her body.

answer

Depersonalization disorder.

question

A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.

answer

Frotteurism (a paraphilia).

question

A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?

answer

Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine).

question

A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.

answer

Dissociative fugue.

question

Risk factors for DVT.

answer

Stasis, endothelial injury, and hypercoagulability (Virchow's triad).

question

Criteria for exudative effusion.

answer

Pleural/serum protein > 0.5; pleural/serum LDH > 0.6.

question

Causes of exudative effusion.

answer

Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis.

question

Causes of transudative effusion.

answer

Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy.

question

Normalizing PCO2 in a patient having an asthma exacerbation may indicate?

answer

Fatigue and impending respiratory failure.

question

Dyspnea, lateral hilar lymphadenopathy on CXR, noncaseating granulomas, ↑ ACE, and hypercalcemia.

answer

Sarcoidosis.

question

PFTs showing ↓ FEV1/FVC.

answer

Obstructive pulmonary disease (e.g., asthma).

question

PFTs showing ↑ FEV1/FVC.

answer

Restrictive pulmonary disease.

question

Honeycomb pattern on CXR. Diagnosis? Treatment?

answer

Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.

question

Treatment for SVC syndrome.

answer

Radiation.

question

Treatment for mild, persistent asthma.

answer

Inhaled β-agonists and inhaled corticosteroids.

question

Treatment for COPD exacerbation.

answer

O2, bronchodilators, antibiotics, corticosteroids with taper, smoking cessation.

question

Treatment for chronic COPD.

answer

Smoking cessation, home O2, β-agonists, anticholinergics, systemic or inhaled corticosteroids, flu and pneumococcal vaccines.

question

Acid-base disorder in pulmonary embolism.

answer

Hypoxia and hypocarbia (respiratory alkalosis).

question

Non-small cell lung cancer (NSCLC) associated with hypercalcemia.

answer

Squamous cell carcinoma.

question

Lung cancer associated with SIADH.

answer

Small cell lung cancer (SCLC).

question

Lung cancer highly related to cigarette exposure.

answer

SCLC.

question

A tall white male presents with acute shortness of breath. Diagnosis? Treatment?

answer

Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.

question

Treatment of tension pneumothorax.

answer

Immediate needle thoracostomy.

question

Characteristics favoring carcinoma in an isolated pulmonary nodule.

answer

Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins.

question

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.

answer

ARDS.

question

Sequelae of asbestos exposure.

answer

Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass).

question

↑ risk of what infection with silicosis?

answer

Mycobacterium tuberculosis.

question

Causes of hypoxemia.

answer

Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch.

question

Classic CXR findings for pulmonary edema.

answer

Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing.

question

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.

answer

Type I (distal) RTA.

question

RTA associated with abnormal HCO3- and rickets.

answer

Type II (proximal) RTA.

question

RTA associated with aldosterone defect.

answer

Type IV (distal) RTA.

question

"Doughy" skin

answer

Hypernatremia.

question

Differential of hypervolemic hyponatremia.

answer

Cirrhosis, CHF, nephritic syndrome.

question

Chvostek's and Trousseau's signs.

answer

Hypocalcemia.

question

The most common causes of hypercalcemia.

answer

Malignancy and hyperparathyroidism.

question

T-wave flattening and U waves.

answer

Hypokalemia.

question

Peaked T waves and widened QRS.

answer

Hyperkalemia.

question

First-line treatment for moderate hypercalcemia.

answer

IV hydration and loop diuretics (furosemide).

question

Type of ARF in a patient with FeNa < 1%.

answer

Prerenal.

question

A 49-year-old man presents with acute-onset flank pain and hematuria.

answer

Nephrolithiasis.

question

The most common type of nephrolithiasis.

answer

Calcium oxalate.

question

A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?

answer

Cerebral berry aneurysms (autosomal-dominant PCKD).

question

Hematuria, hypertension, and oliguria.

answer

Nephritic syndrome.

question

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema.

answer

Nephrotic syndrome.

question

The most common form of nephritic syndrome.

answer

Membranous glomerulonephritis.

question

The most common form of glomerulonephritis.

answer

IgA nephropathy (Berger's disease).

question

Glomerulonephritis with deafness.

answer

Alport's syndrome.

question

Glomerulonephritis with hemoptysis.

answer

Wegener's granulomatosis and Goodpasture's syndrome.

question

Presence of red cell casts in urine sediment.

answer

Glomerulonephritis/nephritic syndrome.

question

Eosinophils in urine sediment.

answer

Allergic interstitial nephritis.

question

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).

answer

Nephrotic syndrome.

question

Drowsiness, asterixis, nausea, and a pericardial friction rub.

answer

Uremic syndrome seen in patients with renal failure.

question

A 55-year-old man is diagnosed with prostate cancer. Treatment options?

answer

Wait, surgical resection, radiation and/or androgen suppression.

question

Low urine specific gravity in the presence of high serum osmolality.

answer

Diabetes insipidus.

question

Treatment of SIADH?

answer

Fluid restriction, demeclocycline.

question

Hematuria, flank pain, and palpable flank mass.

answer

Renal cell carcinoma (RCC).

question

Testicular cancer associated with β-hCG, AFP.

answer

Choriocarcinoma.

question

The most common type of testicular cancer.

answer

Seminoma, a type of germ cell tumor.

question

The most common histology of bladder cancer.

answer

Transitional cell carcinoma.

question

Complication of overly rapid correction of hyponatremia.

answer

Central pontine myelinolysis.

question

Salicylate ingestion occurs in what type of acid-base disorder?

answer

Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.

question

Acid-base disturbance commonly seen in pregnant women.

answer

Respiratory alkalosis.

question

Three systemic diseases that lead to nephrotic syndrome.

answer

DM, SLE, and amyloidosis.

question

Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?

answer

RCC or other erythropoietin-producing tumor; evaluate with CT scan.

question

A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?

answer

Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP).

question

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.

answer

Antipsychotics (neuroleptic malignant syndrome).

question

Side effects of corticosteroids.

answer

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies.

question

Treatment for DTs.

answer

Benzodiazepines.

question

Treatment for acetaminophen overdose.

answer

N-acetylcysteine.

question

Treatment for opioid overdose.

answer

Naloxone.

question

Treatment for benzodiazepine overdose.

answer

Flumazenil.

question

Treatment for neuroleptic malignant syndrome and malignant hyperthermia.

answer

Dantrolene.

question

Treatment for malignant hypertension.

answer

Nitroprusside.

question

Treatment of atrial fibrillation.

answer

Rate control, rhythm conversion, and anticoagulation.

question

Treatment of supraventricular tachycardia.

answer

If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine.

question

Causes of drug-induced SLE.

answer

INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine.

question

Macrocytic, megaloblastic anemia with neurologic symptoms.

answer

B12 deficiency.

question

Macrocytic, megaloblastic anemia without neurologic symptoms.

answer

Folate deficiency.

question

A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?

answer

Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant.

question

Blood in the urethral meatus or high-riding prostate.

answer

Bladder rupture or urethral injury.

question

Test to rule out urethral injury.

answer

Retrograde cystourethrogram.

question

Radiographic evidence of aortic disruption or dissection.

answer

Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus.

question

Radiographic indications for surgery in patients with acute abdomen.

answer

Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography).

question

The most common organism in burn-related infections.

answer

Pseudomonas.

question

Method of calculating fluid repletion in burn patients.

answer

Parkland formula.

question

Acceptable urine output in a trauma patient.

answer

50 cc/hr.

question

Acceptable urine output in a stable patient.

answer

30 cc/hr.

question

Cannon "a" waves.

answer

Third-degree heart block.

question

Signs of neurogenic shock.

answer

Hypotension and bradycardia.

question

Signs of ↑ ICP (Cushing's triad).

answer

Hypertension, bradycardia, and abnormal respirations.

question

↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).

answer

Hypovolemic shock.

question

↓ CO, ↑ PCWP, ↑ PVR.

answer

Cardiogenic (or obstructive) shock.

question

↑ CO, ↓ PCWP, ↓ PVR.

answer

Septic or anaphylactic shock.

question

Treatment of septic shock.

answer

Fluids and antibiotics.

question

Treatment of cardiogenic shock.

answer

Identify cause; pressors (e.g., dopamine).

question

Treatment of hypovolemic shock.

answer

Identify cause; fluid and blood repletion.

question

Treatment of anaphylactic shock.

answer

Diphenhydramine or epinephrine 1:1000.

question

Supportive treatment for ARDS.

answer

Continuous positive airway pressure.

question

Signs of air embolism.

answer

A patient with chest trauma who was previously stable suddenly dies.

question

Trauma series.

answer

AP chest, AP/lateral C-spine, AP pelvis.

question

Meningitis AIDS CD4 <100

answer

cryptococcus

question

Meningitis camper/hiker, target rash

answer

Lyme dz

question

Meningitis camper/hiker, rash moves from arms/legs to trunk

answer

Rocky Mt Spotted Fever (Rickettsia)

question

Meningitis pulmonary TB in 85%

answer

Tuberculosis

question

Meningitis none

answer

viral

question

Meningitis adolescent, petechial rash

answer

Neisseria

question

signs of cardiac tamponade

answer

distended neck veins, hypotension, diminished heart sounds ( becks triad), pulsus paradoxus

question

absent breath sounds, dullness to percussion, shock, flat neck veins

answer

massive hemothorax

question

absent breath sounds, tracheal deviation, shock, distended neck veins

answer

tension pneumothorax

question

treatment for blunt or penetrating abdominal trauma in hemodynamically unstable patients

answer

immediate exploratory laparotomy

question

increase ICP in alcoholics or the elderly following head trauma. can be acute or chronic; crescent shape on CT

answer

subdural hematoma

question

head trauma with immediate loss of consciousness followed by a lucid interval and then rapid deterioration. convex shaped on CT

answer

epidural hematoma

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