question

"Sawtooth" P waves

answer

Classic ECG finding in atrial flutter.

question

Angina is new, is worsening, or occurs at rest

answer

Definition of unstable angina.

question

ACEI

answer

Antihypertensive for a diabetic patient with proteinuria.

question

Hypotension, distant heart sounds, and JVD

answer

Beck's triad for cardiac tamponade.

question

β-blockers, digoxin, calcium channel blockers

answer

Drugs that slow AV node transmission.

question

Niacin

answer

Hypercholesterolemia treatment that → flushing and pruritus.

question

Anticoagulation, rate control, cardioversion

answer

Treatment for atrial fibrillation.

question

Immediate cardioversion

answer

Treatment for ventricular fibrillation.

question

Dressler's syndrome: fever, pericarditis, ↑ ESR

answer

Autoimmune complication occurring 2-4 weeks post-MI.

question

Treat existing heart failure and replace the tricuspid valve

answer

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

question

Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

answer

Diagnostic test for hypertrophic cardiomyopathy.

question

Pulsus paradoxus (seen in cardiac tamponade)

answer

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

question

Low-voltage, diffuse ST-segment elevation

answer

Classic ECG findings in pericarditis.

question

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

answer

Definition of hypertension.

question

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

answer

Eight surgically correctable causes of hypertension.

question

Abdominal ultrasound and CT

answer

Evaluation of a pulsatile abdominal mass and bruit.

question

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

answer

Indications for surgical repair of abdominal aortic aneurysm.

question

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

answer

Treatment for acute coronary syndrome.

question

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

answer

What is the metabolic syndrome?

question

Exercise stress treadmill with ECG

answer

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

question

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

answer

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

question

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

answer

Signs of active ischemia during stress testing.

question

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

answer

ECG findings suggesting MI.

question

Prinzmetal's angina

answer

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

question

CHF, shock, and altered mental status

answer

Common symptoms associated with silent MIs.

question

V/Q scan

answer

The diagnostic test for pulmonary embolism.

question

Protamine

answer

An agent that reverses the effects of heparin.

question

PT

answer

The coagulation parameter affected by warfarin.

question

Hypertrophic cardiomyopathy

answer

A young patient with a family history of sudden death collapses and dies while exercising.

question

Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after

answer

Endocarditis prophylaxis regimens.

question

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia

answer

The 6 P's of ischemia due to peripheral vascular disease.

question

Stasis, hypercoagulability, endothelial damage

answer

Virchow's triad.

question

OCPs

answer

The most common cause of hypertension in young women.

question

Excessive EtOH

answer

The most common cause of hypertension in young men.

question

Seborrheic keratosis

answer

"Stuck-on" appearance.

question

Psoriasis

answer

Red plaques with silvery-white scales and sharp margins.

question

Basal cell carcinoma

answer

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

question

Impetigo

answer

Honey-crusted lesions.

question

Cellulitis

answer

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

question

Pemphigus vulgaris

answer

+ Nikolsky's sign.

question

Bullous pemphigoid

answer

- Nikolsky's sign.

question

Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

answer

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

question

Varicella zoster

answer

Dermatomal distribution.

question

Lichen planus

answer

Flat-topped papules.

question

Erythema multiforme

answer

Iris-like target lesions.

question

Contact dermatitis

answer

A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

question

Pityriasis rosea

answer

Presents with a herald patch, Christmas-tree pattern.

question

Alopecia areata (autoimmune process)

answer

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

question

Pityriasis versicolor

answer

Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance.

question

Asymmetry, border irregularity, color variation, large diameter

answer

Four characteristics of a nevus suggestive of melanoma.

question

Actinic keratosis

answer

Premalignant lesion from sun exposure that can → squamous cell carcinoma.

question

Lesions of 1° varicella

answer

"Dewdrop on a rose petal."

question

Seborrheic dermatitis. Treat with antifungals

answer

"Cradle cap."

question

Acne vulgaris

answer

Associated with Propionibacterium acnes and changes in androgen levels.

question

Herpes simplex

answer

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

question

Lichen sclerosus

answer

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

question

Squamous cell carcinoma

answer

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

question

Hashimoto's thyroiditis

answer

The most common cause of hypothyroidism.

question

High TSH, low T4, antimicrosomal antibodies

answer

Lab findings in Hashimoto's thyroiditis.

question

Graves' disease

answer

Exophthalmos, pretibial myxedema, and ↓ TSH.

question

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

answer

The most common cause of Cushing's syndrome.

question

Hypoparathyroidism

answer

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

question

Signs and symptoms of hypercalcemia

answer

"Stones, bones, groans, psychiatric overtones."

question

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

answer

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

question

Pheochromocytoma

answer

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

question

α-antagonists (phentolamine and phenoxybenzamine)

answer

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

question

Nephrogenic diabetes insipidus (DI)

answer

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

question

Administration of DDAVP ↓ serum osmolality and free water restriction

answer

Treatment of central DI.

question

SIADH due to stress

answer

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

question

Metformin

answer

An antidiabetic agent associated with lactic acidosis.

question

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

answer

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

question

< 7.0

answer

Goal hemoglobin A1c for a patient with DM.

question

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

answer

Treatment of DKA.

question

They can mask symptoms of hypoglycemia

answer

Why are β-blockers contraindicated in diabetics?

question

Observational bias

answer

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

question

Lead-time bias

answer

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

question

Confounding variable

answer

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

question

Sensitivity

answer

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

question

Out

answer

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

question

Highly sensitive for TB

answer

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?

question

Higher prevalence

answer

Chronic diseases such as SLE—higher prevalence or incidence?

question

Higher incidence

answer

Epidemics such as influenza—higher prevalence or incidence?

question

Prevalence

answer

Cross-sectional survey—incidence or prevalence?

question

Incidence and prevalence

answer

Cohort study—incidence or prevalence?

question

Neither

answer

Case-control study—incidence or prevalence?

question

High reliability, low validity

answer

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

question

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

answer

Difference between a cohort and a case-control study.

question

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

answer

Attributable risk?

question

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

answer

Relative risk?

question

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

answer

Odds ratio?

question

1 ÷ (rate in untreated group − rate in treated group)

answer

Number needed to treat?

question

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

answer

In which patients do you initiate colorectal cancer screening early?

question

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

answer

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

question

68%, 95.5%, 99.7%

answer

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

question

Number of live births per 1000 population

answer

Birth rate?

question

Number of live births per 1000 women 15-44 years of age

answer

Fertility rate?

question

Number of deaths per 1000 population

answer

Mortality rate?

question

Number of deaths from birth to 28 days per 1000 live births

answer

Neonatal mortality?

question

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

answer

Postnatal mortality?

question

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

answer

Infant mortality?

question

Number of deaths from 20 weeks' gestation to birth per 1000 total births

answer

Fetal mortality?

question

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

answer

Perinatal mortality?

question

Number of deaths during pregnancy to 90 days postpartum per 100,000 live births

answer

Maternal mortality?

question

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

answer

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

question

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

answer

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?

question

Conflict of interest

answer

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

question

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

answer

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

question

False. Withdrawing and withholding life are the same from an ethical standpoint

answer

True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.

question

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

answer

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

question

Treat immediately. Consent is implied in emergency situations

answer

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

question

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

answer

Conditions in which confidentiality must be overridden.

question

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

answer

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

question

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

answer

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

question

A patient's family cannot require that a doctor withhold information from the patient

answer

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

question

Emergent laparotomy to repair perforated viscus, likely stomach

answer

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

question

Diverticulosis

answer

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

question

HIDA scan

answer

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

question

Acute pancreatitis

answer

Sentinel loop on AXR.

question

Fat, female, fertile, forty, flatulent

answer

Risk factors for cholelithiasis.

question

Murphy's sign, seen in acute cholecystitis

answer

Inspiratory arrest during palpation of the RUQ.

question

Campylobacter

answer

Identify key organisms causing diarrhea: ■ Most common organism

question

Clostridium difficile

answer

Identify key organisms causing diarrhea: ■ Recent antibiotic use

question

Giardia

answer

Identify key organisms causing diarrhea: ■ Camping

question

ETEC

answer

Identify key organisms causing diarrhea: ■ Traveler's diarrhea

question

S. aureus

answer

Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise

question

E. coli O157:H7

answer

Identify key organisms causing diarrhea: ■ Uncooked hamburgers

question

Bacillus cereus

answer

Identify key organisms causing diarrhea: ■ Fried rice

question

Salmonella

answer

Identify key organisms causing diarrhea: ■ Poultry/eggs

question

Vibrio, HAV

answer

Identify key organisms causing diarrhea: ■ Raw seafood

question

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

answer

Identify key organisms causing diarrhea: ■ AIDS

question

Yersinia

answer

Identify key organisms causing diarrhea: ■ Pseudoappendicitis

question

Crohn's disease

answer

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

question

Ulcerative colitis

answer

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

question

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

answer

Extraintestinal manifestations of IBD.

question

5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations

answer

Medical treatment for IBD.

question

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

answer

Difference between Mallory-Weiss and Boerhaave tears.

question

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

answer

Charcot's triad.

question

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

answer

Reynolds' pentad.

question

↓ protein intake, lactulose, neomycin

answer

Medical treatment for hepatic encephalopathy.

question

Establish the ABCs

answer

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

question

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

answer

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

question

HBV immunoglobulin

answer

Post-HBV exposure treatment.

question

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

answer

Classic causes of drug-induced hepatitis.

question

Biliary tract obstruction

answer

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

question

Femoral hernia

answer

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

question

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

answer

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?

question

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

answer

Four causes of microcytic anemia.

question

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

answer

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

question

Sulfonamides, antimalarial drugs, fava beans

answer

Precipitants of hemolytic crisis in patients with G6PD deficiency.

question

Factor V Leiden mutation

answer

The most common inherited cause of hypercoagulability.

question

Hereditary spherocytosis

answer

The most common inherited hemolytic anemia.

question

Osmotic fragility test

answer

Diagnostic test for hereditary spherocytosis.

question

Diamond-Blackfan anemia

answer

Pure RBC aplasia.

question

Fanconi's anemia

answer

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

question

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

answer

Medications and viruses that → aplastic anemia.

question

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

answer

How to distinguish polycythemia vera from 2° polycythemia.

question

Pentad of TTP—"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

answer

Thrombotic thrombocytopenic purpura (TTP) pentad?

question

Anemia, thrombocytopenia, and acute renal failure

answer

HUS triad?

question

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

answer

Treatment for TTP.

question

Usually resolves spontaneously; may require IVIG and/or corticosteroids

answer

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

question

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

answer

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

question

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

answer

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

question

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

answer

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?

question

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

answer

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

question

Hodgkin's lymphoma

answer

Reed-Sternberg cells

question

Non-Hodgkin's lymphoma

answer

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

question

Anemia of chronic disease

answer

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

question

Iron deficiency anemia

answer

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

question

Chronic lymphocytic leukemia (CLL)

answer

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

question

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

answer

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

question

Acute myelogenous leukemia (AML)

answer

Auer rods on blood smear.

question

M3

answer

AML subtype associated with DIC.

question

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

answer

Electrolyte changes in tumor lysis syndrome.

question

Retinoic acid

answer

Treatment for AML M3.

question

CML

answer

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

question

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy

answer

Heinz bodies?

question

Glanzmann's thrombasthenia

answer

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

question

Parvovirus B19

answer

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

question

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

answer

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

question

Iron overload; use deferoxamine

answer

A significant cause of morbidity in thalassemia patients. Treatment?

question

Infection, cancer, and autoimmune disease

answer

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

question

Fever, pharyngeal erythema, tonsillar exudate, lack of cough

answer

Four signs and symptoms of streptococcal pharyngitis.

question

Postinfectious glomerulonephritis

answer

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

question

Encapsulated organisms--pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella

answer

Asplenic patients are particularly susceptible to these organisms.

question

105 bacteria/mL

answer

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

question

Pregnant women. Treat this group aggressively because of potential complications

answer

Which healthy population is susceptible to UTIs?

question

Coccidioidomycosis. Amphotericin B

answer

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

question

1° syphilis

answer

Nonpainful chancre.

question

Rubella

answer

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

question

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

answer

Meningitis in neonates. Causes? Treatment?

question

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

answer

Meningitis in infants. Causes? Treatment?

question

Check for ↑ ICP; look for papilledema

answer

What should always be done prior to LP?

question

Bacterial meningitis

answer

CSF findings: ■ Low glucose, PMN predominance

question

Aseptic (viral) meningitis

answer

CSF findings: ■ Normal glucose, lymphocytic predominance

question

Subarachnoid hemorrhage (SAH)

answer

CSF findings: ■ Numerous RBCs in serial CSF samples

question

MS

answer

CSF findings: ■ ↑ gamma globulins

question

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

answer

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

question

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

answer

Findings in 3° syphilis.

question

Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis

answer

Characteristics of 2° Lyme disease.

question

Mycoplasma

answer

Cold agglutinins.

question

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

answer

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

question

≤ 200 for PCP (with TMP); ≤ 50-100 for MAI (with clarithromycin/azithromycin)

answer

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

question

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

answer

Risk factors for pyelonephritis.

question

7-10 days

answer

Neutropenic nadir postchemotherapy.

question

Lesion of 1° Lyme disease

answer

Erythema migrans.

question

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

answer

Classic physical findings for endocarditis.

question

Parvovirus B19

answer

Aplastic crisis in sickle cell disease.

question

Taenia solium (cysticercosis)

answer

Ring-enhancing brain lesion on CT with seizures

question

Actinomyces israelii

answer

Name the organism: ■ Branching rods in oral infection.

question

Haemophilus ducreyi

answer

Name the organism: ■ Painful chancroid.

question

Pasteurella multocida

answer

Name the organism: ■ Dog or cat bite.

question

Sporothrix schenckii

answer

Name the organism: ■ Gardener.

question

Toxoplasma gondii

answer

Name the organism: ■ Pregnant women with pets.

question

Neisseria meningitidis

answer

Name the organism: ■ Meningitis in adults.

question

Streptococcus pneumoniae

answer

Name the organism: ■ Meningitis in elderly.

question

Klebsiella

answer

Name the organism: ■ Alcoholic with pneumonia.

question

Klebsiella

answer

Name the organism: ■ "Currant jelly" sputum.

question

Pseudomonas

answer

Name the organism: ■ Infection in burn victims.

question

Pseudomonas

answer

Name the organism: ■ Osteomyelitis from foot wound puncture.

question

Salmonella

answer

Name the organism: ■ Osteomyelitis in a sickle cell patient.

question

Legionella pneumonia

answer

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?

question

Lyme disease, Ixodes tick, doxycycline

answer

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?

question

S. aureus or S. epidermidis.

answer

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

question

All-compartment fasciotomy for suspected compartment syndrome

answer

A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?

question

Spinal stenosis

answer

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

question

MCP and PIP joints; DIP joints are spared

answer

Joints in the hand affected in rheumatoid arthritis.

question

Osteoarthritis

answer

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

question

Osteogenesis imperfecta

answer

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

question

Suspect ankylosing spondylitis. Check HLA-B27

answer

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

question

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

answer

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

question

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

answer

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

question

Pseudogout

answer

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

question

Polymyalgia rheumatica

answer

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

question

Osgood-Schlatter disease

answer

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

question

Distal radius (Colles' fracture)

answer

Bone is fractured in fall on outstretched hand.

question

Avascular necrosis

answer

Complication of scaphoid fracture.

question

Wrist drop, loss of thumb abduction

answer

Signs suggesting radial nerve damage with humeral fracture.

question

Duchenne muscular dystrophy

answer

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

question

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

answer

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

question

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

answer

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

question

Multiple myeloma

answer

The most common 1° malignant tumor of bone.

question

Cluster headache

answer

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

question

β-blockers, Ca2+ channel blockers, TCAs

answer

Prophylactic treatment for migraine.

question

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

answer

The most common pituitary tumor. Treatment?

question

Broca's aphasia. Frontal lobe, left MCA distribution

answer

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

question

Trauma; the second most common is berry aneurysm

answer

The most common cause of SAH.

question

Subdural hematoma—bridging veins torn

answer

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

question

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

answer

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

question

Elevated ICP, RBCs, xanthochromia

answer

CSF findings with SAH.

question

Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count)

answer

Albuminocytologic dissociation.

question

Normal

answer

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

question

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

answer

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

question

Absence seizures

answer

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

question

Headache

answer

The most frequent presentation of intracranial neoplasm.

question

Infection, febrile seizures, trauma, idiopathic

answer

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

question

Trauma, alcohol withdrawal, brain tumor

answer

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

question

IV benzodiazepine

answer

First-line medication for status epilepticus.

question

Wernicke's encephalopathy due to a deficiency of thiamine

answer

Confusion, confabulation, ophthalmoplegia, ataxia.

question

Seventy percent if the stenosis is symptomatic

answer

What % lesion is an indication for carotid endarterectomy?

question

Alzheimer's and multi-infarct

answer

The most common causes of dementia.

question

ALS

answer

Combined UMN and LMN disorder.

question

Parkinson's disease

answer

Rigidity and stiffness with resting tremor and masked facies.

question

Levodopa/carbidopa

answer

The mainstay of Parkinson's therapy.

question

IVIG or plasmapheresis

answer

Treatment for Guillain-Barré syndrome.

question

Huntington's disease

answer

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

question

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

answer

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

question

Neurofibromatosis 1

answer

Café-au-lait spots on skin.

question

Klüver-Bucy syndrome (amygdala)

answer

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

question

Edrophonium

answer

Administer to a symptomatic patient to diagnose myasthenia gravis.

question

Placental abruption and placenta previa

answer

1° causes of third-trimester bleeding.

question

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

answer

Classic ultrasound and gross appearance of complete hydatidiform mole.

question

46,XX

answer

Chromosomal pattern of a complete mole.

question

Partial mole

answer

Molar pregnancy containing fetal tissue.

question

Continuous, painful vaginal bleeding

answer

Symptoms of placental abruption.

question

Self-limited, painless vaginal bleeding

answer

Symptoms of placenta previa.

question

Never

answer

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

question

Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides

answer

Antibiotics with teratogenic effects.

question

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

answer

Shortest AP diameter of the pelvis.

question

Betamethasone or dexamethasone × 48 hours

answer

Medication given to accelerate fetal lung maturity.

question

Uterine atony

answer

The most common cause of postpartum hemorrhage.

question

Uterine massage; if that fails, give oxytocin

answer

Treatment for postpartum hemorrhage.

question

IV penicillin or ampicillin

answer

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

question

Sheehan's syndrome (postpartum pituitary necrosis)

answer

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

question

Inevitable abortion

answer

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

question

Threatened abortion

answer

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

question

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

answer

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

question

Menometrorrhagia

answer

Term for heavy bleeding during and between menstrual periods.

question

Asherman's syndrome

answer

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

question

Weight loss and OCPs

answer

Therapy for polycystic ovarian syndrome.

question

Clomiphene citrate

answer

Medication used to induce ovulation.

question

Endometrial biopsy

answer

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

question

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

answer

Indications for medical treatment of ectopic pregnancy.

question

OCPs, danazol, GnRH agonists

answer

Medical options for endometriosis.

question

"Chocolate cysts," powder burns

answer

Laparoscopic findings in endometriosis.

question

Ampulla of the oviduct

answer

The most common location for an ectopic pregnancy.

question

Ultrasound

answer

How to diagnose and follow a leiomyoma.

question

Regresses after menopause

answer

Natural history of a leiomyoma.

question

Trichomonas vaginitis

answer

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

question

Oral or topical metronidazole

answer

Treatment for bacterial vaginosis.

question

Intraductal papilloma

answer

The most common cause of bloody nipple discharge.

question

OCP and barrier contraception

answer

Contraceptive methods that protect against PID.

question

Endometrial or estrogen receptor- breast cancer

answer

Unopposed estrogen is contraindicated in which cancers?

question

Consider Fitz-Hugh-Curtis syndrome

answer

A patient presents with recent PID with RUQ pain.

question

Paget's disease

answer

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

question

CA-125 and transvaginal ultrasound

answer

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

question

Kegel exercises, estrogen, pessaries for stress incontinence

answer

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

question

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

answer

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

question

↑ serum FSH

answer

Lab values suggestive of menopause.

question

Endometriosis

answer

The most common cause of female infertility.

question

Colposcopy and endocervical curettage

answer

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

question

Lobular carcinoma in situ

answer

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

question

Neuroblastoma

answer

Nontender abdominal mass associated with elevated VMA and HVA.

question

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

answer

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

question

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

answer

Not contraindications to vaccination.

question

Ophthalmologic exam, CT, and MRI

answer

Tests to rule out shaken baby syndrome.

question

CF or Hirschsprung's disease

answer

A neonate has meconium ileus.

question

Duodenal atresia

answer

Bilious emesis within hours after the first feeding.

question

Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

answer

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

question

Selective IgA deficiency

answer

The most common 1° immunodeficiency.

question

Febrile seizures (roseola infantum)

answer

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

question

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

answer

Acute-phase treatment for Kawasaki disease.

question

Phototherapy (mild) or exchange transfusion (severe)

answer

Treatment for mild and severe unconjugated hyperbilirubinemia.

question

Reye's syndrome

answer

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

question

Suspect retinoblastoma

answer

A child has loss of red light reflex. Diagnosis?

question

HBV, DTaP, Hib, IPV, PCV

answer

Vaccinations at a six-month well-child visit.

question

Precocious puberty

answer

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

question

RSV bronchiolitis

answer

Infection of small airways with epidemics in winter and spring.

question

Surfactant deficiency

answer

Cause of neonatal RDS.

question

Chronic granulomatous disease

answer

What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.

question

Wiskott-Aldrich syndrome

answer

What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.

question

Bruton's X-linked agammaglobulinemia

answer

What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.

question

Intussusception

answer

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

question

Coarctation of the aorta

answer

A congenital heart disease that cause 2° hypertension.

question

Amoxicillin × 10 days

answer

First-line treatment for otitis media.

question

Parainfluenza virus type 1

answer

The most common pathogen causing croup.

question

Kwashiorkor (protein malnutrition)

answer

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

question

Lesch-Nyhan syndrome (purine salvage problem with

answer

Defect in an X-linked syndrome with mental retardation,

question

HGPRTase deficiency)

answer

gout, self-mutilation, and choreoathetosis.

question

Patent ductus arteriosus (PDA)

answer

A newborn female has continuous "machinery murmur."

question

SSRIs

answer

First-line pharmacotherapy for depression.

question

MAOIs

answer

Antidepressants associated with hypertensive crisis.

question

Patient on dopamine antagonist

answer

Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.

question

Conversion disorder

answer

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

question

Displacement

answer

Name the defense mechanism: ■ A mother who is angry at her husband yells at her child.

question

Reaction formation

answer

Name the defense mechanism: ■ A pedophile enters a monastery.

question

Isolation

answer

Name the defense mechanism: ■ A woman calmly describes a grisly murder.

question

Regression

answer

Name the defense mechanism: ■ A hospitalized 10-year-old begins to wet his bed.

question

Neuroleptic malignant syndrome

answer

Life-threatening muscle rigidity, fever, and rhabdomyolysis.

question

Anorexia

answer

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

question

Panic disorder

answer

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

question

Agranulocytosis

answer

The most serious side effect of clozapine.

question

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

answer

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

question

Weight gain, type 2 DM, QT prolongation

answer

Key side effects of atypical antipsychotics.

question

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

answer

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

question

Neuroleptics

answer

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

question

Conduct disorder

answer

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

question

Rett's disorder

answer

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

question

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

answer

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

question

Malingering

answer

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

question

Factitious disorder (Munchausen syndrome)

answer

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

question

Substance abuse

answer

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

question

Phencyclidine hydrochloride (PCP) intoxication

answer

A violent patient has vertical and horizontal nystagmus.

question

Depersonalization disorder

answer

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

question

Frotteurism (a paraphilia)

answer

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

question

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

answer

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

question

Dissociative fugue

answer

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

question

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

answer

Risk factors for DVT.

question

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

answer

Criteria for exudative effusion.

question

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

answer

Causes of exudative effusion.

question

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

answer

Causes of transudative effusion.

question

Fatigue and impending respiratory failure

answer

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

question

Sarcoidosis

answer

Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.

question

Obstructive pulmonary disease (e.g., asthma)

answer

PFT showing ↓ FEV1/FVC.

question

Restrictive pulmonary disease

answer

PFT showing ↑ FEV1/FVC.

question

Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

answer

Honeycomb pattern on CXR. Diagnosis? Treatment?

question

Radiation

answer

Treatment for SVC syndrome.

question

Inhaled β-agonists and inhaled corticosteroids

answer

Treatment for mild, persistent asthma.

question

Hypoxia and hypocarbia

answer

Acid-base disorder in pulmonary embolism.

question

Squamous cell carcinoma

answer

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

question

Small cell lung cancer (SCLC)

answer

Lung cancer associated with SIADH.

question

SCLC

answer

Lung cancer highly related to cigarette exposure.

question

Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

answer

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

question

Immediate needle thoracostomy

answer

Treatment of tension pneumothorax.

question

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

answer

Characteristics favoring carcinoma in an isolated pulmonary nodule.

question

ARDS

answer

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.

question

Mycobacterium tuberculosis

answer

↑ risk of what infection with silicosis?

question

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

answer

Causes of hypoxemia.

question

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

answer

Classic CXR findings for pulmonary edema.

question

Type I (distal) RTA

answer

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

question

Type II (proximal) RTA

answer

RTA associated with abnormal HCO3 − and rickets.

question

Type IV (distal) RTA

answer

RTA associated with aldosterone defect.

question

Hypernatremia

answer

"Doughy skin."

question

Cirrhosis, CHF, nephritic syndrome

answer

Differential of hypervolemic hyponatremia.

question

Hypocalcemia

answer

Chvostek's and Trousseau's signs.

question

Malignancy and hyperparathyroidism

answer

The most common causes of hypercalcemia.

question

Hypokalemia

answer

T-wave flattening and U waves.

question

Hyperkalemia

answer

Peaked T waves and widened QRS.

question

IV hydration and loop diuretics (furosemide)

answer

First-line treatment for moderate hypercalcemia.

question

Prerenal

answer

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

question

Nephrolithiasis

answer

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

question

Calcium oxalate

answer

The most common type of nephrolithiasis.

question

Cerebral berry aneurysms (AD PCKD)

answer

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

question

Nephritic syndrome

answer

Hematuria, hypertension, and oliguria.

question

Nephrotic syndrome

answer

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.

question

Membranous glomerulonephritis

answer

The most common form of nephritic syndrome.

question

IgA nephropathy (Berger's disease)

answer

The most common form of glomerulonephritis.

question

Alport's syndrome

answer

Glomerulonephritis with deafness.

question

Wegener's granulomatosis and Goodpasture's syndrome

answer

Glomerulonephritis with hemoptysis.

question

Glomerulonephritis/nephritic syndrome

answer

Presence of red cell casts in urine sediment.

question

Allergic interstitial nephritis

answer

Eosinophils in urine sediment.

question

Nephrotic syndrome

answer

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

question

Uremic syndrome seen in patients with renal failure

answer

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

question

Wait, surgical resection, radiation and/or androgen suppression

answer

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

question

DI

answer

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

question

Fluid restriction, demeclocycline

answer

Treatment of SIADH?

question

Renal cell carcinoma (RCC)

answer

Hematuria, flank pain, and palpable flank mass.

question

Choriocarcinoma

answer

Testicular cancer associated with β-hCG, AFP.

question

Seminoma—a type of germ cell tumor

answer

The most common type of testicular cancer.

question

Transitional cell carcinoma

answer

The most common histology of bladder cancer.

question

Central pontine myelinolysis

answer

Complication of overly rapid correction of hyponatremia.

question

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

answer

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

question

Respiratory alkalosis

answer

Acid-base disturbance commonly seen in pregnant women.

question

DM, SLE, and amyloidosis

answer

Three systemic diseases → nephrotic syndrome.

question

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

answer

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

question

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

answer

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

question

Antipsychotics (neuroleptic malignant syndrome)

answer

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

question

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

answer

Side effects of corticosteroids.

question

Benzodiazepines

answer

Treatment for DTs.

question

N-acetylcysteine

answer

Treatment for acetaminophen overdose.

question

Naloxone

answer

Treatment for opioid overdose.

question

Flumazenil

answer

Treatment for benzodiazepine overdose.

question

Dantrolene or bromocriptine

answer

Treatment for neuroleptic malignant syndrome.

question

Nitroprusside

answer

Treatment for malignant hypertension.

question

Rate control, rhythm conversion, and anticoagulation

answer

Treatment of AF.

question

Rate control with carotid massasge or other vagal stimulation

answer

Treatment of supraventricular tachycardia (SVT).

question

INH, penicillamine, hydralazine, procainamide

answer

Causes of drug-induced SLE.

question

B12 deficiency

answer

Macrocytic, megaloblastic anemia with neurologic symptoms.

question

Folate deficiency

answer

Macrocytic, megaloblastic anemia without neurologic symptoms.

question

Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

answer

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

question

Bladder rupture or urethral injury

answer

Blood in the urethral meatus or high-riding prostate.

question

Retrograde cystourethrogram

answer

Test to rule out urethral injury.

question

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

answer

Radiographic evidence of aortic disruption or dissection.

question

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

answer

Radiographic indications for surgery in patients with acute abdomen.

question

Pseudomonas

answer

The most common organism in burn-related infections.

question

Parkland formula

answer

Method of calculating fluid repletion in burn patients.

question

50 cc/hour

answer

Acceptable urine output in a trauma patient.

question

30 cc/hour

answer

Acceptable urine output in a stable patient.

question

Third-degree heart block

answer

Cannon "a" waves.

question

Hypotension and bradycardia

answer

Signs of neurogenic shock.

question

Hypertension, bradycardia, and abnormal respirations

answer

Signs of ↑ ICP (Cushing's triad).

question

Hypovolemic shock

answer

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

question

Cardiogenic shock

answer

↓ CO, ↑ PCWP, ↑ PVR.

question

Septic or anaphylactic shock

answer

↑ CO, ↓ PCWP, ↓ PVR.

question

Fluids and antibiotics

answer

Treatment of septic shock.

question

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

answer

Treatment of cardiogenic shock.

question

Identify cause; fluid and blood repletion

answer

Treatment of hypovolemic shock.

question

Diphenhydramine or epinephrine 1:1000

answer

Treatment of anaphylactic shock.

question

Continuous positive airway pressure

answer

Supportive treatment for ARDS.

question

A patient with chest trauma who was previously stable suddenly dies

answer

Signs of air embolism.

question

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

answer

Trauma series.

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