Medical Case Studies: Various Conditions and Treatments, Exams of World Religions

Download Medical Case Studies: Various Conditions and Treatments and more Exams World Religions in PDF only on Docsity! World Step 2 Question bank Exam Latest with Verified Answers. 1. Where is the classic pain in diverticulitis? (Vs. appendicitis) - Correct answer Left lower quadrant (vs. right lower quadrant) 2. What vitamin is beneficial in treating children with measles? - Correct answer Vitamin A 3. What's a common side effect of dihydropyridine CA-channel blockers (ex: amlodipine)? - Correct answer Peripheral edema via dilation of peripheral blood vessels 4. What receptors does risperidone act on? - Correct answer Atypical antipsychotic - *DA antagonist* that also acts on *serotonin receptors* - risperidone found to ink DA levels more than other antipsychotics 5. What receptors does aripiprazole act on? - Correct answer Partial agonist of DA *D2* receptors (increases DA) 6. What is hydrated disease? - Correct answer Infection with *Echinococcus granulose* from contact with dogs -> can cause unilocular cystic lesion in any organs (liver, lung, muscle, bone), usually multiple lesions -> "eggshell calcification" on CT. TX: albendazole + surgical removal. 7. How do simple liver cysts form? - Correct answer Congenital; fluid secretion by liver epithelium -> dull RUQ pain, abdominal bloating, early satiety 8. What's acute stress disorder? - Correct answer Similar to PTSD - pt. experiences event that threatens serious injury/death, six’s present *< 1 mo.* 9. What are the genetics behind Marfa’s? - Correct answer Autosomal dominant mutation of *fibrillin-1 gene*, up to 30% of cases are sporadic 10. How does the lens dislocation differ between Marfa’s and homocystinuria (cystathionine synthase deficiency)? - Correct answer Marfa’s: lens dislocation upward 11. Homocystinuria: lens dislocation downward 12. How does Ehlers-Dandles syndrome present? - Correct answer Disorder of collagen structure: hypermobile joints, easy bruising, poor wound healing, soft/velvety/hyperplastic skin, ~organ rupture/hemorrhage 13. What murmur is associated with infective endocarditis (ex: IV drug users)? - Correct answer *Tricuspid valve regurgitation* -> holosystolic murmur that increases with inspiration 14. What murmur would you hear with hypertrophic cardiomyopathy? - Correct answer *Systolic ejection murmur (SEM)* that increases when patient stands from a supine position (Dec venous return to the heart, worsens dynamic gradient) 15. Should we screen for bladder cancer? - Correct answer USPSTF recommends against screening for bladder cancer - low incidence, poor PPV of screening tests (UA & cytology, bladder tumor antigen, nuclear matrix protein) 16. What are the most common organisms behind acute bacterial rhino sinusitis? - Correct answer Strep pneumonia (30%), noticeable H flu (30%), & Moraxella catarrhal is (10%) 17. What are some alarming six’s of life-threatening fungal sinusitis? - Correct answer Epistaxis, turbinate destruction, palatal scars, and maxillary cyanosis 18. Definition of chronic sinusitis, and a causal pathogen? - Correct answer Sinus inflammation *> 12 wks.*, can be caused by Staph aurous P a g e 1 | 63 19. What is 1st line pharm TX for bipolar d/o? - Correct answer 1. Atypical antipsychotics (risperidone, aripiprazole, olanzapine) 20. 2. Lithium (excreted thru kidneys! not for ARF) 21. 3. Valerio acid 22. *Combo TX has more rapid onset of action 23. What is Escher? - Correct answer Firm necrotic tissue classically formed on exposed tissue following a burn -> when occurring circumferentially, it can restrict outward expansion of compartment -> compartment syndrome 24. What're the 5 P's of compartment syndrome? - Correct answer Pain (earliest sign, out of proportion to injury), Paresthesia’s (burning or tingling in distribution of affected nerve), Pallor of overlying skin, Uselessness (late finding), & Paralysis (late finding). 25. What does *central cord syndrome* classically look like? - Correct answer Hyperextension injury in an elderly pt. with degenerative changes in cervical spine -> selective damage to central part of anterior spinal cord -> weakness that's more pronounced in upper than lower extremities (motor fibers serving arms are nearer to center of corticospinal tract) 26. What does *posterior cord syndrome* look like? - Correct answer bilateral loss of vibratory & proprioceptive sensation 27. What does *anterior cord syndrome* look like? - Correct answer bilateral spastic motor paresis distal to lesion, usually 2/2 occlusion of vertebral artery 28. Signs of TTP-HUS? - Correct answer Unexplained *hemolytic anemia* and *thrombocytopenia* in a pt. w/*renal failure* and *neuron six’s*, fragmented RBCs suggest microangiopathic hemolytic anemia; idiopathic TTP-HUS thought to be due to deficiency of or autobahn against *ADAMTS-13 (cleaves vows)* -> platelet aggregation 29. TX: plasma exchange (80% mortality if not treated) 30. When is packed RBC transfusion indicated? - Correct answer previously healthy pt.: Hob < 7-8 31. CAD/CHF pt.: Hob < 10 32. What does cryoprecipitate contain? - Correct answer *Fibrinogen* -> to TX low fibrinogen states 33. Why is platelet transfusion contraindicated for TTP-HUS? - Correct answer it can worsen renal failure & neuron six’s (continued consumption of platelets via microthombi) 34. What causes Sinker’s (pharyngoesophageal) diverticulum? - Correct answer Upper esophageal sphincter dysfxn & esophageal dysmotility -> incoordination of contraction results in herniation of mucosa (pulsing mechanism) -> dysphagia & neck mass, asset w/GERD 35. What metabolic abnormality is associated with esophageal web? - Correct answer Iron deficiency 36. TX of Sinker’s diverticulum? - Correct answer Surgical TX: excision + frequently cricopharyngeal myology 37. What's the presentation of milk protein intolerance? - Correct answer Hypersensitivity to cow's milk proteins -> breastfed baby or baby fed cow's milk -> vomiting & bloody diarrhea (*RBCs* and *eosinophil’s* in stool), may be family hex of atopic d/o P a g e 2 | 63 72. How do lacunar strokes occur, and where? - Correct answer Small vessel halitosis (HTN, diabetes are risk factors) -> occlusion of small penetrating arteries, often in the *internal capsule* -> 25% of ischemic strokes -> *pure motor dysfxn* 73. How does Parkinson's tremor differ from essential tremor? - Correct answer Parkinson's tremor: occurs during rest, improves w/activity - often the first sign of Parkinson's. 74. Essential tremor does the opposite (occurs w/activity). 75. What's trihexyphenidyl? - Correct answer Anticholinergic agent, typically used in younger pts. Where tremor is the predominant six of Parkinson's 76. What are some treatments for essential tremor? - Correct answer 1st line: propranolol +/- pyrimidine (AED). 77. 2nd line: BDZ or clozapine. 78. What CV effects does furosemide have? - Correct answer Decreases cardiac preload -> Dec palm capillary P -> relieves palm edema in heart failure. 79. Vasodilation -> further Dec cardiac preload. 80. What do you see in peripheral blood smear for pts.? With *G6PD deficiency*? - Correct answer Bite cells and Heinz bodies 81. What antibodies are involved in autoimmune hemolysis? - Correct answer Anti-RBC membrane Iggy antibodies -> positive *direct Coombs test*, peripheral blood smear with *spherocytosis* (RBCs removed from circulation by spleen) 82. What's the typical presentation of nasopharyngeal carcinoma? - Correct answer usually asymptomatic until ds is advanced. Six’s: recurrent otitis media, recurrent epistaxis, nasal obstruction. 83. What risk factors are associated with undifferentiated nasopharyngeal carcinoma? - Correct answer *EBV* - titer levels may be used to track the progress of therapy for NPC. 84. Also, smoking and chronic nitrosamine consumption (salted fish). 85. Chronic alcohol use is a risk factor for what diseases? - Correct answer Alcoholism, alcoholic cirrhosis, aspiration PNA, Wernicke-Korsakoff syndrome, depression, & liver cancers. 86. What do the diff stages of syphilis look like? - Correct answer Painless chancre -> disseminated skin lesions, condylomata late, & fever -> ascending otitis, tabs dorsal is, psychosis, & tumors (gammas) of skin/bone/liver 87. What cancer is H. pylori gastritis associated with? - Correct answer Gut-associated lymphoid tissue (GALT) lymphoma 88. What's the classic presentation of intraductal papilloma? - Correct answer Intermittent blood discharge from one nipple, premenopausal women, small size (may not detect on U/S), soft consistency, use situated beneath areola 89. How does fibro adenoma usually present? - Correct answer Solitary breast lesion, painless, firm, mobile lump, ~2cm, use in women ages 15-25, benign, no change with menstrual cycle 90. How does ductal carcinoma in situ usually present? - Correct answer Postmenopausal women, use discovered as incidental finding on mammography, six’s include nipple discharge & breast mass, his to dx (ductal epic ban, no penetration of BM) P a g e 5 | 63 91. How does neuroblastoma usually present? - Correct answer Most common extra cranial solid tumor of childhood, ~2yo at dx, from *neural crest cells*, most common site is abdomen (adrenal glands or retroperitoneal ganglia), calcifications & hemorrhages on imaging, up to 70% have metastasis (long bones/skull/bone marrow/liver/lymph nodes/skin) at presentation, elevated serum/urine catecholamine’s & metabolites (*HVA & VMA*) 92. Which tumor arises from metaphors? - Correct answer Wilma' tumor (renal parenchyma) - use presents in early childhood (2-3 you) as asymptomatic bad mass and hematuria 93. What does mesonephros give rise to? - Correct answer Seminal vesicles, epididymis, ejaculatory ducts, & ducts deferens 94. What does paramesonephron give rise to? - Correct answer Fallopian tubes, uterus, & part of the vagina 95. What is Morton neuroma? - Correct answer mechanically induced neuropathic degeneration, commonly occurring in runners. Six’s: numbness, burning of toes, aching, burning in distal forefoot, worsened by walking on hard surfaces. Pecks: pain btw 3rd & 4th toes on plantar surface, clicking sensation (*Mulder sign*) when palpating this space & squeezing metatarsal joints. TX: metatarsal support *bilaterally* via inserts, or surgery if this fails. 96. How does plantar fasciitis usually present? - Correct answer burning pain in the plantar area of foot, worse when walking. Common in runner’s w/repeated micro trauma. Local point tenderness. 97. What is tarsal tunnel syndrome? - Correct answer Compression of tibia nerve as it passes through the ankle, use caused by fox of bones around the ankle. Six’s: burning, numbness, aching of distal planter surface of foot/toes that sometimes radiate up to calf. 98. What is tenosynovitis? - Correct answer Inflammation of the tendon and its synovial sheath. Use seen in hands/wrist joints after a bite or puncture wound. 99. What are some risk factors of postpartum endometritis? - Correct answer Prolonged rupture of membranes (> 24hrs), prolonged labor (>12 hrs.), C/S, use of intrauterine pressure catheters or fetal scalp electrodes. 100. How to treat postpartum endometritis? - Correct answer IV clindamycin + gentamicin (aminoglycoside). 101. *Clindamycin active against anaerobes. Gentamicin active against gram- negatives. 102. What are some risk factors for cervical insufficiency (cervical incompetence)? - Correct answer Prior gym surgery (LEEP procedure, cone biopsy of cervix, etc.), prior OB trauma, multiple gestation, Mullein abnormalities, & hex of preterm birth or 2nd trimester pregnancy loss. 103. What are risk factors for placental abruption? - Correct answer Hex of maternal trauma, chronic HTN, maternal smoking, & hex of external cephalic version. 104. What are risk factors for uterine rupture? - Correct answer Multiparty, advanced maternal age, & previous C/S or myomectomy operations. 105. What are the main risk factors for polyhydramnios? - Correct answer fetal malformations & genetic disorders, maternal diabetes mellitus, multiple gestation, & fetal anemia. P a g e 6 | 63 106. What are the most common risk factors for SGA infants (< 10th %lie)? - Correct answer Impaired placental perfusion, maternal smoking, Ethos/drug abuse, maternal malnutrition, multiple gestations, infections, genetic d/o, & teratogen exposure. 107. What's the gold standard for evaluating for cervical incompetence/insufficiency? - Correct answer Transvaginal U/S to look for funneling of the cervix or shortening 108. How to treat acute dystonia? - Correct answer Antihistamines (diphenhydramine) or anticholinergic (benztropine or trihexyphenidyl) 109. What's akathisia and how to treat it? - Correct answer Subjective feeling of restlessness & inability to sit still - can occur at any time during antipsychotic use. TX: beta-blockers (propranolol). 110. How to treat neuroleptic malignant syndrome? - Correct answer NMS = arises at any time during antipsychotic use = high fever, muscle rigidity, rhabdomyolysis. TX: *dantrolene*. 111. How does IgA deficiency usually present? - Correct answer recurrent sin pulmonary (Strep & H flu) and GI (Giardia) infections. Pts. may form Abs’ against IgA -> anaphylactic transfusion runs. 112. What is associated with Diverge syndrome (thyme aplasia, T cell deficiency)? - Correct answer Fungal & viral infections, hypothec (hypo CA), cleft palate, congenital heart disease. 113. What's lacking in X-linked agammaglobulinemia (Burton’s)? - Correct answer No B cells and any classes of I -> sin pulmonary infections, Pseudomonas 114. What's Weskit-Aldrich syndrome? - Correct answer X-linked combined B & T cell disorder -> recurrent otitis media, eczema, and thrombocytopenia. Infections w/encapsulated organisms. Usually presents at birth with bleeding from circumcision, blood stools, petechial, bruises. Low Gimp but high IgA & I.e. 115. What's wrong in hyper-Gimp syndrome? - Correct answer Elevated Gimp, depressed Iggy/IgA -> Giardia, recurrent sin pulmonary infections, lymphoid hyperplasia. No transfusion run. Less common than IgA deficiency. 116. What's postpericardiotomy syndrome? - Correct answer A pleuropericardial disease that occurs days-moss after cardiac surgery/injury, from inflammation -> reactive pericarditis, pericardial effusion, or even cardiac tamponed. 117. What is "Beck's triad" in cardiac tamponed? - Correct answer 1. Distant heart sounds, 2. Distended jugular veins (scalp veins in infants), 3. Hypotension 118. What's the most common esophageal anomaly? - Correct answer esophageal atresia with a TE fistula -> allows air to enter the stomach -> gastric distention. Also, infant can't swallow -> drooling, regard during feeding. Can also have aspiration PNA, pneumonitis, and atelectasis when gastric fluid ascends esophagus and goes into lungs. 119. How does vascular ring present? - Correct answer Trachea & esophagus completely encircled by aortic arch & its branches -> noisy breathing in first few wks. Of life, esophageal six’s (choking, vomiting, dysphagia) in older infants/children. 120. How does duodenal atresia present? - Correct answer Bilious vomiting that's not associated with the first feeding. Asoka w/*annular pancreas*. On radiology, *double bubble sign*. P a g e 7 | 63 158. What does the flow-volume loop look like in fixed upper airway obstruction (ex: laryngeal edema)? - Correct answer Flow limitation with both inspiration (below x-axis) and expiration (above x-axis). Pretty symmetric about x-axis. 159. What does the flow-volume loop look like in pneumothorax? - Correct answer Dec ventilation of one hemi thorax -> restrictive pattern on flow-volume testing -> overall volume of flow is decreased, while expiratory flow rate may be increased. 160. What does the flow-volume loop look like in pulmonary edema? - Correct answer Small airway obstruction similar to that seen in asthma -> Dec airflow during passive exhalation -> "scooped out" pattern on exhalation. 161. What does the flow-volume loop look like in a panic attack? - Correct answer Normal. 162. How does lithium intoxication present? - Correct answer Tremors, ataxia, altered mental status, n/v, & hypotension. No muscle rigidity as in NMS. 163. When should you suspect tropical spree? - Correct answer Pts. w/chronic diarrhea and hex of living in endemic areas (Puerto Rico, etc.) for >1 mo. Etiology likely infectious. Ds: small intestinal mucosal biopsy -> blunted villi, infiltration of chronic inflammatory cells. 164. How does perforated peptic ulcer disease present? - Correct answer chronic epigastria pain that suddenly worsens and becomes diffuse with a pneumoperitoneum. Gastric secretions released into peritoneal cavity -> peritonitis w/rebound tenderness & guarding. 165. How to treat hyperthyroidism, including Graves'? - Correct answer Radioactive iodine ablative TX. Many pts. Achieve euthyroidism with a single dose of radioactive iodine. 166. Contraindications: pregnancy & *very severe ophthalmopathy*. 167. What are iodinated contrast agents (*iopanoic acid*) used for? - Correct answer Dec the release of thyroid hormone from thyroid gland, Dec peripheral conversion of T4 to T3 -> used to control severe six’s of *thyrotoxicosis* 168. What are ant thyroid drugs (*PTU*) used for? - Correct answer TX of hyperthyroidism during pregnancy and in prep for surgery or radioactive iodine TX - less effective & asset w/more serious side effects than radioactive iodine TX 169. What are the complications of surgery for Graves' hyperthyroidism w/large goiter & coexisting thyroid nodule? - Correct answer recurrent laryngeal nerve paralysis, hypothec, and hypothyroidism. 170. What drugs most commonly cause type 1 hypersensitivity runs? - Correct answer Beta lactam drugs, neuromuscular blocking agents, quinolones, platinum-containing chemo agents, & foreign proteins (ex: chimeric Abs’) 171. What kind of rash sometimes develops in pts.? W/infectious mononucleosis 2/2 EBV, given amoxicillin or other ax’s? - Correct answer Polymorphous, maculopapular rash typically developing after 24 hrs. (Vs. immediately in type 1 hypersensitivity). Unclear mechanism, but rash isn't considered a true drug allergy - somehow due to EBV infection. 172. When would you administer heparin? - Correct answer For MI ((+) cardiac markers or ST elevation) or high suspicion/confirmation of PE P a g e 10 | 63 173. Signs of Kwashiorkor? - Correct answer Protruding belly, edema 174. How does celiac ds usually present? - Correct answer Ban hypersensitivity to gluten -> presents at 12-15 moss with Kwashiorkor-like clinical features, chronic non- bloody diarrhea. Asoka w/dermatitis herpetiformis 175. How is neutropenia defined? - Correct answer Absolute neutrophil count (ANC) < 1500/micro. 176. Inc. susceptibility to infection, ink risk of death esp. when ANC < 500/micro. Most commonly, bacterial infections, esp. gram-positives (but also Pseudomonas). Empiric TX: *ceftazidime, impanel, cefepime, or meropenem*. 177. What ax would you add with prolonged neutropenia, or when neutropenia fever persists despite empiric ax? - Correct answer Add an antifungal agent such as *amphotericin B* 178. How does alveolar consolidation (ex: lobar PNA) present on physical exam? - Correct answer Bronchial breath sounds (full inspiratory & expiratory phases), *dullness to percussion, increased tactile fremitus*, ego phony, & Broncho phony. 179. How does pneumothorax present on physical exam? - Correct answer Air in the pleural space -> hyper resonance to percussion, Dec/absent breath sounds, Dec/absent fremitus, & transmitted voice sounds 180. How does pleural effusion present on physical exam? - Correct answer Fluid in the pleural space -> dullness to percussion (*fluid blocks sound transmission*), Dec breath sounds, Dec tactile fremitus, & Dec transmitted airway sounds. 181. What are diff options for colon cancer screening? - Correct answer fecal occult blood testing, flexible sigmoidoscopy, a combo of the two, colonoscopy, or double- contrast barium enema 182. *Colonoscopy is most sensitive & specific, but also most costly & expertise- dependent 183. How long does it take for troponin T levels to return to normal after an MI? - Correct answer Up to 10 days (even though it's the most sensitive & specific test for MI), vs. CK-MB 184. How is cyclothymic diagnosed? - Correct answer alternating episodes of hypomania and depressive six’s (that don't meet criteria for MDD) over a period of 2 yrs. 185. How to diagnose appendicitis? - Correct answer clinically! Six’s: RLQ pain, n/v, fever, leukocytosis. 186. *Imaging can delay TX! Imaging may be useful in pts. Who have suspected appendicitis with atypical presentation (ex: women of childbearing age). 187. How to manage appendicitis who've had six’s for >5 days? - Correct answer they use have a phlegm on w/abscess that's walled off -> manage conservatively w/IV ax’s, bowel rest, & delayed appendectomy wks. Later. 188. How to manage splenic trauma due to blunt abdominal injury? - Correct answer depends on pt.’s hemodynamic status & response to IVF. 189. Unstable/Unresponsive -> ex lap. 190. Responds to IVF (SBP > 100mmHg) -> bad CT scan -> surgery depending on grade of injury. 191. What is HELLP syndrome in pregnancy? - Correct answer Pre-ex + Hemolysis, Elevated Liver enzymes, & Low Platelet count. Can have RUQ pain 2/2 distention of liver capsule. Normal PT & PTT. P a g e 11 | 63 192. What is idiopathic (immune) thrombocytopenic purport (ITP)? - Correct answer autoimmune destruction of platelets -> bleeding from skin & gums. 193. With HELLP syndrome, when should you NOT deliver? - Correct answer for pregnancies <34wks GA (fetal lung immaturity) with fetal well-being ascertained & mother stabilized. In this case, consider TX with dexamethasone, and delivery when fetus reaches 34 wks. Or lungs become mature. 194. How would you diagnose rheumatic fever using the Jones criteria? - Correct answer Ds = preceding group A Strep infection + 2 major criteria or 1 major and 2 minor criteria. 195. Major criteria: migratory polyarthritis, caritas, subcutaneous nodules, erythema marinate, Sydenham chorea. 196. Minor criteria: arthralgia, fever, elevated acute phase reactants (CRP, ESR), prolonged PR interval on EKG. 197. How to diagnose juvenile rheumatoid arthritis? - Correct answer Arthritis present for >6 wks. Can have systemic six’s like rash, but rash wouldn't be migratory (vs. rheumatic fever). 198. How does eosinophilia PNA usually present? - Correct answer Gradual six onset. Asthma-like six’s for several days - diffuse wheezes, fine inspiratory crackles suggestive of bronchial & interstitial involvement. Peripheral eosinophilia. 199. How does leukocytoclastic vacuities usually present? - Correct answer prominent cutaneous manifestations. Six’s of possibly palm infiltrates & pleural effusions are slow to evolve. 200. What kind of neuron disorder is asset with congenital heart disease (esp. R->L shunts)? - Correct answer these kids are at ink risk for developing *brain abscesses* 201. What are some risk factors for developing a brain abscess? - Correct answer congenital heart ds, head trauma, infections of jaw/mouth, and infections of face/scalp, meningitis, & cranial instrumentation. 202. Management of a par pneumonic effusion? - Correct answer Use caused by PNA. May be sterile initially and resolve with ax, but sometimes pt. will persist in having fever, pleurisy chest pain, & dyspnea. CT scan -> aspiration of fluid -> protein content, gram stain, cell count, cytology (r/o cancer), glucose levels, *pH* (< 7.2 almost always indicates *empyema* -> needs chest tube). *Glucose < 60mg/dl* also needs a chest tube. 203. *Total protein may be elevated in almost all exudative effusions (ex: neoplasm, TB, infection). 204. What are some early six’s of Alzheimer's dementia? - Correct answer Visuospatial deficits (getting lost in own neighborhood), anterograde memory problems, cognitive impairment, & language difficulties (word finding). 205. What are some late six’s of Alzheimer's dementia? - Correct answer Personality/Behavior changes (apathy, agitation), neuropsych changes (hallucinations, change in alertness), no cognitive neuron deficits (myoclonus, seizures), urinary incontinence, & apraxia (difficulty using a comb). 206. Ds of Alzheimer's? - Correct answer Clinical dx: MMSE, neuropsych testing, criteria (2+ cognitive deficits, worsening memory or other cognitive fan, onset >60yo, no other cause). P a g e 12 | 63 241. What's the complete workup for multiple myeloma? - Correct answer CBC w/diff/morphology, serum electrolytes, kidney/liver screening, skeletal survey, serum electrophoresis, & bone marrow biopsy. 242. What are complications of multiple myeloma? - Correct answer renal failure, hyper CA, & hyper viscosity syndrome. 243. What would a bone marrow biopsy in essential thrombocytosis show? - Correct answer Increased marrow cellularity with megakaryocytic hyperplasia. Megakaryocytes are the precursors to platelets. 244. What would the bone marrow of aplastic anemia show? - Correct answer Hypo plastic fat-filled marrow w/no abnormal cells. (No cells at all, including RBCs.) 245. What would the bone marrow of myelofibrotic disorders show? - Correct answer Hypo cellular & fibrotic bone marrow. 246. How to prevent/treat post herpetic neuralgia after shingles? - Correct answer Tricyclic antidepressant (amitriptyline, nortriptyline) + acute antiviral therapy (Val acyclovir or acyclovir). 247. Why are serum amylase/lipase high in acute pancreatitis? - Correct answer Early on, there's a dysfxn in the synthesis-secretion relationship of pancreatic digestive enzymes: synthesis continues despite blockage in secretion -> leakage of enzymes from cigar cells into interstitial space and eventually the systemic circulation. 248. What's the classic U/S finding in pancreatitis? - Correct answer diffusely enlarged, hypo echoic pancreas. But U/S not reliable for dx b/c bowel gas obscures the pancreas in 25-35% of pts. U/S primarily used for dx gallbladder dz. 249. What would you use ERCP for? - Correct answer in dx and TX of chronic pancreatitis or common bile duct pathology (remove stones). 250. When would you use bad CT in pancreatitis? - Correct answer Useful in identifying presence, severity, & complications of pancreatitis. Use in pts. Who fail to improve w/conservative TX -> search for areas of *infection/necrosis*. 251. What 2 factors cause 75% of cases of acute pancreatitis? - Correct answer Gallstones and chronic Ethos abuse 252. What're some chest X-ray abnormalities asset w/acute pancreatitis? - Correct answer Pleural effusions, atelectasis, elevated hemi diaphragm, & pulmonary infiltrates. These are often due to activated pancreatic enzymes (*phospholipase, trypsin*) and cytokines (*TNF*) released from the inflamed pancreas and cause inflammation elsewhere. 253. Complications of acute pancreatitis? - Correct answer Pleural effusion, pancreatic psuedocyst/abscess/necrosis, ileus, ARDS, & renal failure 254. What's the ALT level in biliary pancreatitis? - Correct answer ALT > 150 units/L 255. Besides gallstones & chronic Ethos use, what are other causes of acute pancreatitis? - Correct answer Hyperlipidemia, certain drugs (*didanosine, azathioprine, valproic acid*), infections (*CMV, Legionella, Aspergillums*), trauma, & iatrogenic (post- ERCP) 256. How does mesenteric ischemia usually present? - Correct answer Severe acute per umbilical bad pain that's out of proportion to findings on physical exam. P a g e 15 | 63 257. Risk factors: advanced age, diffuse atherosclerosis, alular abnormality, cardiac arrhythmias, or recent MI. 258. How long should you continue an antidepressant if treating for a single episode of major depression? - Correct answer *6 moss* following the patient's response 259. How does cirrhosis predispose to upper GI bleeding? - Correct answer via varies, portal gastropathy, PUD, and Mallory-Weiss tears (retching). 260. How can upper GI bleeding precipitate hepatic encephalopathy in pts. With cirrhosis? - Correct answer Upper GI bleeding -> ink delivery of blood-derived protein to small bowel ->-> hepatic encephalopathy 261. TX: lactulose 262. What are treatments for bleeding varies? - Correct answer Sclerotherapy, endoscopic band ligation, & surgery. 263. Last resort would be a Porto systemic shunt (connecting portal venous system to systemic venous system) via surgery or TIPS procedure. 264. When is surgery for PUD indicated? - Correct answer Perforation, gastric outlet obstruction, or bleeding that can't be controlled with endoscopic TX. 265. How to treat nonbreeding varies? - Correct answer Nonselective beta-blockers like propranolol. 266. What virus causes measles? - Correct answer Paramyxovirus 267. What's the course of measles? - Correct answer Exposure (rasp droplets) -> prodromal after 10 days (*coria/fever, conjunctivitis, cough*) -> Kalpak’s spots (buckle mucosa) -> skin rash (erythematous maculopapular from face to entire body). 268. What are the complications of measles? - Correct answer PNA, vet a deficiency, & bronchiectasis. 269. Late: immunosuppression & sub-acute sclerosing pan encephalitis. 270. What infection is caused by herpes virus 6, and what's it look like? - Correct answer Rosella infant. Six’s: fever -> maculopapular rash from trunk to extremities after 4-5 days. 271. What infection is caused by toga virus, and what's it look like? - Correct answer Rubella (aka "3-day measles"). Six’s: erythematous maculopapular rash (fine, pink, spreads from face to trunk in 3 days) w/generalized LAD. Also slight fever, polyarthritis, & polyarthralgia. 272. What does chicken pox look like? - Correct answer Fever, malaise, & anorexia -> rash from trunk to extremities -> vesicles -> scabs. 273. What infection is caused by parvovirus, and what's it look like? - Correct answer Erythema infectious. Ex's: erythema of cheeks -> erythematous rash from arms to trunk & legs. 274. What are some behavioral therapies for specific phobias? - Correct answer Flooding, biofeedback, relaxation therapy, & exposure desensitization. 275. What's 1st line TX for generalized anxiety d/o? - Correct answer Buspirone 276. When should you screen/treat asymptomatic bacteriuria in pregnant women? - Correct answer between 12-16 wks. GA -> significantly decreases incidence of symptomatic UTIs, LBW babies, and preterm deliveries. P a g e 16 | 63 277. When should you screen for HIV in pregnant women? - Correct answer at first prenatal visit, and again in the 3rd trimester before 36 wks. for those at high risk of acquiring HIV. 278. What are major risk factors for squamous cell carcinoma of the esophagus? - Correct answer Smoking, Ethos, dietary deficiency of beta-carotene, vet B1, zinc, selenium, environmental viral infections, toxin producing fungi, hot food/beverages, pickled veggies, & food rich in N-nitro so compounds. 279. What are major risk factors for adenocarcinoma of the esophagus? - Correct answer Barrett's esophagus, obesity, high dietary calorie/fat intake, smoking, & medications promoting GERD. 280. What's placenta prevail? - Correct answer Insertion of the placenta in a way that obstructs the internal cervical so partially/completely -> may cause bleeding as the inferior uterus develops & stretches the placenta. Cause of 20% of all cases of antepartum bleeding. Typically painless. 281. What are risk factors for placenta prevail? - Correct answer Multiparty, advanced maternal age, prior C/S, smoking, multiple gestation, & prior placenta prevail. 282. How can placental abruption present? - Correct answer Variable clinical presentation: pts. may be asymptomatic with intrauterine fetal death, or may present with dark red vaginal bleeding & painful uterine contractions. 283. What's vasa prevail? - Correct answer Rare condition in which fetal blood vessels cross the fetal membranes in the lower uterus btw fetus & internal cervical so. Painless antepartum hemorrhage, but rapid deterioration of fetal heart tracing (hemorrhage is from fetus). 284. How does PE (w/subsequent minor/massive pulmonary infarction) usually present? - Correct answer *Plevritis chest pain* in the setting of prolonged immobility, *hemoptysis*, dyspnea, *tachycardia*, & *OCP use*. 285. What does dermatomyositis look like? - Correct answer autoimmune condition causing a proximal extensor muscle inflammatory myopathy & cutaneous findings (lilaceous poikiloderma over various regions of body). Face + per orbital edema = heliotrope sign. Chest & lateral neck = shawl sign. Knuckles, elbows, & knees = Gorton’s sign. Lichened papules overlying joints = *Gorton’s papules* (pathognomonic). 286. What's the classic Abs in dermatomyositis? - Correct answer Anti-Mi-2 Abs (against *helicase*) 287. What condition is associated with dermatomyositis? - Correct answer Malignancy (>10%), usually: *ovarian* > breast/lung/female GU in women, and colorectal/lung in men. 288. What inflammatory ds are associated with aortic aneurysm? - Correct answer Behest syndrome, Takayasu arteritis, giant cell arteritis, enclosing spondylitis, rheumatoid arthritis, relapsing polychondritis, & reactive arthritis. 289. What autoimmune ds are associated with renal failure? - Correct answer SLE, scleroderma, Good pasture syndrome, relapsing polychondritis, & Wegener's granulomatosis w/polyangiitis. 290. What inflammatory ds are associated w/alveolar hemorrhage? - Correct answer Good pasture syndrome, Wegener's granulomatosis w/polyangiitis, polyarthritis, Chug- Strauss syndrome, Behest syndrome, & ant phospholipid antibody syndrome. P a g e 17 | 63 syndrome. Caused by disruption of vasculature to affected bone -> bone & bone marrow infarction. MRI is the most sensitive test (X-ray may not show anything). 327. What causes trochanteric bursitis (inflammation of the trochanteric bursa)? - Correct answer caused by friction btw the tendons of the gluteus Medias & tensor fascia late over the greater trochanter of the femur. -> Pain over the lateral hip, worsened by palpation. May interfere w/sleeping. 328. What's Erich syndrome? - Correct answer *Aortoiliac* occlusion. Six’s: low back, hip, buttock, & thigh claudication + impotence + atrophy of lower extremities. Weak femoral pulses. ~Bruit over iliac/femoral arteries. 329. What's Shy-Dragger syndrome (multiple system atrophy)? - Correct answer Degenerative disease characterized by: 1) Parkinsonism, 2) autonomic dysfxn (orthostatic hypotension, incontinence, impotence, etc.), & 3) widespread neuron signs. 330. *Bulbar dysfxn & laryngeal stridor may be fatal. 331. TX: intravascular volume expansion w/*fludrocortisone*, salt supplementation, a- adrenergic agonists, & leg constrictors. 332. What causes idiopathic orthostatic hypotension? - Correct answer 2/2 degeneration of postganglionic sympathetic neurons - pathology confined to autonomic nervous system. 333. What's the triad of Horner's syndrome? - Correct answer Anhidrotic (no sweating), mitosis (pupil constriction), & ptosis. 334. What's Riley-Day syndrome (familial dysautonomia)? - Correct answer AR ds seen in Ashkenazi Jews. Gross dysfxn of the autonomic nervous system w/severe orthostatic hypotension. 335. What's polycythemia Vera? - Correct answer it’s a myeloproliferative disorder (of RBCs, basophils) -> splenomegaly, pruritus with hot baths (histamine release from ink basophils), and ink catabolism/turnover of purines -> uric acid overproduction -> gout in 40% of pts. 336. What are some organ-specific consequences of hemochromatosis (iron overload in organs)? - Correct answer Hepatic dysfxn -> cirrhosis, diabetes, hypogonadism, skin pigmentation, & arthritis. 337. How does Lesch-Nyhan syndrome present? - Correct answer Genetic deficiency of enzyme *HPRT* -> overproduction of uric acid, behavioral problems (self-injury), and neuron disability, in childhood. 338. Why is portal hypertension associated with severe pruritus? - Correct answer Inc. serum concentrations of bilirubin. 339. What is injured in penile fracture? - Correct answer the *tunica albuginea*, which invests the corpus cavernous, is torn. 340. TX: emergent urethrogram to assess for urethral injury + emergent surgery to evacuate the hematoma & mend the tunica albuginea. 341. What does circumcision treat? - Correct answer Pharoses, paraphimosis, & Zoon's banalities. 342. How does intussusception usually present? - Correct answer Most common cause of intestinal obstruction in children 6-36 mos. Lead point sometimes from viral GI infection, Mackle’s diverticulum, polyps, or hematomas (HSP) - though most times no identifiable lead point. Use involves ileocolic Jan. Intermittent *telescoping* of 1 bowel P a g e 20 | 63 segment into another -> periodic pain, emesis, tubular "sausage-shaped" mass, "currant jelly" stools. 343. Ds: U/S. TX: immediate air/contrast enema reduction - emergency! 344. What does a technetium-99m pertechnetate scan ("Mackle’s scan") detect? - Correct answer Detects gastric mucosa, which is present in ~1/2 of Mackle’s diverticula. 345. How does meconium ileus usually present? - Correct answer Bilious vomiting, failure to pass meconium at birth, hex of polyhydramnios, family hex cystic fibrosis, & typical appearance on bad X-rays (dilated small bowel, ground glass appearance in lower bad). 346. Complications include *intestinal perforation*. 347. *This condition is diagnostic of cystic fibrosis. 348. What is meconium plug syndrome? - Correct answer Similar presentation to meconium ileus (bilious vomiting, failure to pass meconium at birth, hex of polyhydramnios), but occurs in *non-cystic fibrosis* babies. No complication of intestinal perforation. 349. Why is atropine contraindicated in acute glaucoma? - Correct answer Atropine can dilate the pupil and worsen the glaucoma (ink intraocular pressure). 350. How to manage acute glaucoma? - Correct answer it’s a medical emergency. TX: narcotics for pain, manifold/tombolo/acetazolamide/pilocarpine to Dec intraocular pressure. 1st line = *IV manifold* (osmotic diuretic that works immediately). Pilocarpine (topical) opens the canals of Schema -> drainage of aqueous humor. 351. *Avoid atropine (dilates pupil, worsens glaucoma)! 352. How does exceptional heat stroke present? - Correct answer in extreme heat & humidity: temp > 105F, *altered mental status*, hypotension, tachycardia, & tachypnea. Pts. often aren't volume depleted. Large blood on UA dipstick w/o RBCs by microscopy suggests rhabdomyolysis. 353. Pathophys: thermoregulatory center fails to dissipate heat at the rate necessary to maintain euthermia. 354. What's the underlying pathophys of malignant hyperthermia? - Correct answer Uncontrolled efflux of CA from sarcoplasmic reticulum. Rare AD disorder. Occurs in these pts. after administration of anesthetic drugs *halothane & succinylcholine*. 355. What's the pathophys of heat exhaustion? - Correct answer inadequate sodium & water replacement during physical activity -> inability to maintain cardiac output -> heat exhaustion. Core temp use < 104F. No significant CNS dysfxn. 356. What's the usual presentation of hypertrophic cardiomyopathy? - Correct answer Young, physically active individuals -> cardiac outlet obstruction -> dyspnea, palpitations, syncope, and sudden cardiac death. 357. What is pulses paradoxes? - Correct answer fall in systolic arterial pressure >10 mmHg during inspiration. Most commonly seen in cardiac tamponed, but also seen in COPD & asthma b/c of great drop in intrathoracic pressure (ink negative P). 358. How does pulses paradoxes occur? - Correct answer Relatively low LV preload or end diastolic volume during inspiration -> Dec stroke volume -> much reduced systolic bop (>10mmHg) during inspiration. 359. What is the most common congenital obstructive urethral lesion in males? - Correct answer Posterior urethral valves = ban folds in posterior urethral wall that obstruct urine flow. Presents w/distended bladder (midline bad mass) - shows that obstructive lesion is distal to bladder neck. P a g e 21 | 63 360. Ds: voiding cystourethrogram (VCUG). 361. What is the rachis? - Correct answer a tubular extension of the allantois that extends from bladder to umbilicus. Normally obliterated during development. Patent rachis -> racial fistula, cyst, or sinus. 362. What's an omphalomesenteric duct cyst? - Correct answer a focal failure of vitalize duct obliteration. May cause a small midline mass deep to umbilicus. If attached to umbilicus & wall of ileum, the cyst could cause a small intestinal volvulus. 363. What should you do in dysfunctional uterine bleeding? - Correct answer heavy vaginal bleeding in the absence of structural/organic ds (normal pelvic exam, negative pregnancy test). Need to do *endometrial biopsy* to r/o hyperplasia or carcinoma. If negative, TX involves *cyclic progestin’s*. Endometrial ablation or hysterectomy only if hormonal TX fails. 364. What're the risk factors for endometrial hyperplasia or carcinoma? - Correct answer Women > 35yo, obese, chronically hypertensive, or diabetic. 365. What are the most frequent (>90%) causes of chronic cough in nonsmokers w/o pulmonary disease? - Correct answer Postnasal drip (upper-airway cough syndrome), GERD, & asthma. 366. TX for postnasal drip: oral first-gen antihistamine (*chlorpheniramine*) or combined antihistamine-decongestant (*brompheniramine & pseudoephedrine*). Should clear in 2-3 wks. 367. What's the difference btw symmetric and asymmetric IUGR? - Correct answer Symmetric IUGR: often begins before 28 wks., usually from fetal factors (char ban, congenital infections, etc.). 368. Asymmetric IUGR: fetal adapts to maternal factors (HTN, hypoxemia, smoking, vascular ds, pre-ex) by redistributing blood flow to more important areas (brain, heart, placenta). 369. What does schizoid personality d/o look like? - Correct answer Social detachment, restricted range of expressed emotion, don't enjoy close relationships, prefer to be aloof/isolated, indifferent to praise or criticism. 370. What does schizotypal personality d/o look like? - Correct answer Eccentric behavior, reduced capacity for close relationships, "magical thinking," may have bizarre fantasies. 371. What does avoidant personality d/o look like? - Correct answer Hypersensitivity to criticism, social inhibition, feelings of inadequacy, avoid intimate relationships b/c they fear ridicule, perceive self as inferior, reluctant to take risks. 372. How to manage a newborn of a mother with active hip B (Hear positive)? - Correct answer Passive immunization at birth with hip B I, followed by active immunization with recombinant HBV vaccine. 373. *Standard neonatal immunization schedule includes 3 doses of HBV vaccine. 374. What's alcoholic hallucinosis? - Correct answer predominantly auditory hallucinations that occur either during or after (12-24 hrs. after) a period of heavy Ethos use, usually resolving within 24-48 hrs. 375. *Not the same as DTs! 376. What're the signs of DTs? - Correct answer Delirium tremens: fever, HTN, tachycardia, diaphoresis, hallucinations, disorientation, starts 48-96 hrs. after last drink. 377. *Mild withdrawal or withdrawal seizures (but not alcoholic hallucinosis) can progress to DTs. P a g e 22 | 63 erode and locally invade. Potentially dangerous b/c made up of many blood vessels which can readily bleed. Surgical removal is difficult b/c tumor is encapsulated and may be deeply invasive. Recurrence is common. 416. What's the usual course of acute hip B infection? - Correct answer >90% of adults will recover completely. A minority of adults will develop chronic hip B infection. 0.1-0.5% will develop fulminant hepatic failure (FHF) - hepatic encephalopathy w/in 8 wks. of onset of acute liver failure. These pts. are high-priority for liver transplant, the only cure. 417. What are contraindications for liver transplantation? - Correct answer Irreversible cardiopulmonary ds causing prohibitive risk, incurable or recent (<5yrs) cancer outside the liver, and active Ethos/drug abuse. 418. What is chronic granulomatous disease (CGD)? - Correct answer Defect of phagocytic cells due to dysfxn of NADPH oxidase enzyme complex -> recurrent/uncontrolled infections w/catalase-positive organisms (*Staph aurous, Serration, Burkholderia, Klebsiella, Aspergillums*). Ds: nitro blue tetrazolium slide test, flow cytometer, or cytochrome C reduction. TX: daily TMP-SMX, gamma-interferon 3x/wk. 419. What's Chadian-Higashi syndrome? - Correct answer Decreased degranulation, chemo taxis, & granulopoiesis. Multisystem d/o. Ds: neutropenia & giant lysosomes in neutrophils. TX: daily TMP-SMX & ascorbic acid. 420. What are leukocyte adhesion syndromes? - Correct answer Failure of innate host defenses against microorganisms 2/2 defective tethering, adhesion, & targeting of myeloid leukocytes to sites of microbial invasion. Hallmark: neutrophil w/o polymorphs in infected tissue/pus. Hex of delayed separation of umbilical cord, recurrent bacterial infections, necrotic skin lesions, etc. 421. What's hyper-I.e. (Job's) syndrome? - Correct answer High serum I.e. levels, eosinophilia -> chronic pruritic dermatitis, recurrent Staph infections (skin & rasp tract), coarse facial features, bone fractures. 422. What happens in Cushing's syndrome? - Correct answer High *cortisol* levels -> vasoconstriction (HTN), insulin resistance (hyperglycemia), and mineralocorticoid activity (hypokalemia). Also: central adiposity, skin thinning, weight gain, and psych problems (sleep, depression, psychosis). 423. What causes Cushing's syndrome? - Correct answer Adrenal cortical hyperplasia, ACTH-producing pituitary adenoma (Cushing's disease), ectopic ACTH production, or exogenous steroids. 424. What happens after a stroke involving the ventral poster-lateral (VPL) nucleus of the thalamus? - Correct answer VPL transmits sensory info from the contralateral body. Classic presentation of stroke: contralateral hemi anesthesia, transient hemiparesis, athetosis (ballistic mgmts.), thalamic pain phenomenon (synesthesia/pain of area affected by sensory loss). 425. What's the definition of hazard ratio? - Correct answer Ratio of an event rate occurring in the TX group compared to an event rate occurring in the non-TX group. 426. What is cluster analysis for an exit? - Correct answer Grouping of diff data points (ex: individuals) into similar categories - use involves randomization at the level of groups rather than individuals. P a g e 25 | 63 427. What's a parallel study design? - Correct answer randomizes one TX to one group and a diff TX to the other group. There are usually no other independent variables measured. 428. What test is usually used to screen for macular degeneration? - Correct answer the grid of parallel vertical & horizontal lines -> one of the earliest findings in macular degeneration is distortion of straight lines such that they appear wavy. Fine visual acuity will be affected. 429. Ophtho exam might also find druse deposits in the macula. 430. How does TB usually present initially? - Correct answer Initial infection: peripheral pulmonary focus of infection + mediastina/hila LAD on CXR. Typically asymptomatic. Primary site of infection (Goon focus) remains as calcified granuloma. 431. How does reactivation TB usually present? - Correct answer during periods of immunosuppression (ex: HIV): fever, night sweats, fatigue, weight loss, productive cough, hemoptysis, pleurisy chest pain. CXR: apical caviar pulmonary lesion (aerobic organism - likes the oxygen tension in the lung apices). 432. How does coccidiodomycosis usually present? - Correct answer Inhalation of soil-borne organism in endemic areas (Southwest US). Sx's: flu-like illness, dyspnea, slightly productive cough, varying lung lesions (usu miliary pattern in HIV+ ppl). 433. How does the CXR present in pneumocystis PNA? - Correct answer CXR: diffuse "ground glass" infiltrates. 434. Typically in HIV+ pts with CD4 count <200. 435. What defines complicated cystitis? - Correct answer Women who are pregnant, very young, very old, diabetic, immunocompromised, or have abnl anatomy of GU tract. And men. 436. Tx: fluoroquinolone (*levofloxacin or ciprofloxacin*). 437. How to manage uncomplicated cystitis? - Correct answer Oral TMP-SMX and nitrofurantoin. 438. How does atelectasis develop after abdominal/thoracoabdominal surgery? - Correct answer One of most common postop pulm complications. 439. Surgery -> pain/change in lung compliance -> impaired cough & shallow breathing -> limit recruitment of alveoli at lung bases, small-airway mucus plugging -> hypoxia -> inc resp rate +/- inc work of breathing. 440. Which hypoglycemic agents lead to weight gain in the long term? - Correct answer Sulfonylureas, thiazolidinediones (pioglitazone, rosiglitazone), and insulin. 441. Metformin is the only antidiabetic drug that causes some weight loss. 442. What can happen with metformin in a pt with compromised renal status (BUN, Cr)? - Correct answer Metformin can produce *lactic acidosis* in a pt w/o good renal fxn. 443. How to manage septic arthritis? - Correct answer 1) Obtain blood & synovial fluid cultures (usu Staph aureus & Strep). 2) Empiric IV abx (vancomycin). 3) Ortho consult for emergency surgical drainage - can prevent long-term disability. 4) Physical therapy +/- hip replacement surgery if osteoarthritis develops. 444. What is herpetic whitlow? - Correct answer A common viral infection of the hand, caused by type 1 or 2 herpes simplex virus, usu self-limiting. Most commonly seen in women w/genital herpes or kids w/herpetic gingivostomatitis, or health care workers. Dx: non-purulent vesicles, hx of exposure, & *multinucleated giant cells in Tzanck smear*. Tx: perhaps oral acyclovir and topical bacitracin. P a g e 26 | 63 445. What is felon? - Correct answer Bacterial infection of distal volar space (pulp of finger), characterized by a tense abscess & intense throbbing pain. Tx: incision & drainage w/abx (cephalosporins). 446. What does aspirin sensitivity syndrome look like? - Correct answer Sx's: aspirin ingestion, persistent nasal blockage, & episodes of bronchoconstriction. Pathophys: pseudo-allergic rxn (exaggerated release of vasoactive & inflammatory mediators in susceptible individuals). 447. What is the mechanism of aspirin sensitivity syndrome? - Correct answer Aspirin is a COX-1 & COX-2 inhibitor -> arachidonate diverges to 5-lipoxygenase pathway -> accumulation of leukotrienes triggers rxns (bronchoconstriction, nasal polyp formation) in susceptible individuals. 448. Tx: *leukotriene inhibitors* vs topical corticosteroids vs aspirin desensitization tx. 449. How does Chagas disease (chronic protozoal dz caused by Trypanosoma cruzi) typically present? - Correct answer Someone from Latin America with either of 2 primary manifestations: 1) megacolon/megaesophagus (2/2 smooth m nerve destruction), or 2) cardiac dz (prolonged myocarditis -> CHF). 450. What is giant cell myocarditis? - Correct answer Rare & frequently fatal myocarditis. Underlying pathophys probably involves autoimmunity. Severe & acute sx's. 451. What's presbyopia? - Correct answer A common age-related d/o of loss of lens elasticity -> prohibits accommodation of the lens -> can't focus on near objects. Pts often have no hx of eye problems. 452. How does generalized resistance to thyroid hormones usually present? - Correct answer Receptor defects on peripheral tissues. 453. Pts usually present at early age w/growth & MR, but milder cases can present later. Labs: high T3/T4, normal/high TSH. 454. Why is the incidence of carpal tunnel syndrome increased in pregnancy? - Correct answer 2/2 estrogen-mediated depolymerization of ground substance -> interstitial edema in hands & face -> inc P in carpal tunnel. Tx: neutral position wrist splint & analgesia. 455. *NSAIDs are assoc w/inc risk of miscarriage, may promote premature closure of fetal ductus arteriosus. 456. What does a D-xylose test with oral xylose load assess? - Correct answer The absorptive capacity of the proximal small intestine. Pts w/dz like *celiac sprue* can't absorb D-xylose in small intestine -> not excreted in urine, but in stool. 457. *False positive with bacterial overgrowth (bacteria ferment the D-xylose -> reduces absorption & urinary excretion). 458. What is D-xylose? - Correct answer It's a simple sugar (monosaccharide) that doesn't need any digestive process before being absorbed by *proximal* small intestines into venous circulation -> urinary excretion. 459. What is modafinil approved to treat? - Correct answer Narcolepsy 460. How do you manage cocaine-induced coronary vasoconstriction & MI? - Correct answer 1) IV BDZs for BP & anxiety, 2) Aspirin, 3) Nitroglycerin & Ca channel blockers for pain, 4) Immediate cardiac cath w/reperfusion when indicated (ST elevation or persistent chest pain despite meds). 461. *Beta-blockers are contraindicated (can cause unopposed alpha adrenergic stimulation)! Fibrinolytics not preferred due to inc risk of intracranial hemorrhage. P a g e 27 | 63 498. How does warfarin work? - Correct answer Inhibits synthesis of vit K-dependent clotting factors II, VII, 9, & X (prothrombin), as well as vit K-dependent anticoag proteins C & S. It can therefore cause a false-positive test for protein S deficiency. 499. How does heparin work? - Correct answer Activates antithrombin III -> inactivates thrombin, factor IXa, & factor Xa. 500. How does clopidogrel work? - Correct answer Antiplatelet agent that prevents platelet activation by blocking platelet surface ADP R's. 501. What drugs (and in which types of pts) can cause pancreatitis? - Correct answer 1) Diuretics (furosemide, thiazides). 2) Drugs for IBD (sulfasalazine, 5-ASA). 3) Immunosuppressives (azathioprine, L-asparaginase). 4) AEDs/Bipolar drugs (valproic acid). 5) AIDS drugs (didanosine, pentamidine). 6) Abx (metronidazole, tetracycline). 502. What's the classic tetrad of Tetralogy of Fallot? - Correct answer 1) Overriding aorta, 2) RV hypertrophy, 3) Subpulmonary stenosis (single S2 sound), and 4) VSD (pansystolic murmur). Most common cyanotic congenital disease in kids <4yo; presents with cyanotic spells. 503. How does hypoplastic left heart syndrome usually present? - Correct answer Heart failure in first few wks of life, and has a bad prognosis. 504. How does neurogenic arthropathy (Charcot's joint) occur? - Correct answer Diabetic neuropathy: decreased pain/proprioception/temp perception -> unknowingly traumatize weight bearing joints -> 2ndary degenerative joint dz, joint deformation -> loss of cartilage, osteophyte development, & loose bodies. 505. Tx: tx underlying dz and provide mechanical devices (special shoes). 506. What should an HIV+ pt have received if his CD4 count <50 and he is now suffering fever and cough? - Correct answer Azithromycin as prophylaxis against Mycobacterium avium complex - atypical mycobacterial infection is likely with his CD4 count <50 but no past hx of TB. 507. Tx of MAC: clarithromycin + ethambutol. 508. What tx is recommended for PCP PNA prophylaxis - Correct answer TMP-SMX. Dapsone is an alternative agent. 509. What's used both as prophylaxis and tx of CMV infection in HIV+ pts? - Correct answer Ganciclovir, when CD4 count <50 and serum CMV IgG is positive, or when there's a positive biopsy for CMV. 510. How does gynecomastia usually present in boys? - Correct answer Can occur in up to 2/3 of pubertal boys (due to transiently increased testicular production of estrogen & peripheral conversion), unilateral or bilateral, resolves in most pts w/in a few months to 2 yrs on its own. 511. What is a hematological complication of mono? - Correct answer Autoimmune hemolytic anemia and thrombocytopenia, 2/2 cross-reactivity of EBV-induced Ab's (IgM cold-agglutinin Ab's) against RBCs and platelets -> complement-mediated destruction of RBCs (usu Coombs'-test positive). 512. *Onset can be 2-3 wks after onset of mono sx's. 513. What is a feared complication of mono? - Correct answer Splenic rupture, mainly caused by trauma (NOT splenic infarction) - tell pts not to play contact sports until their spleen regresses in size and is no longer palpable (~1-3 mos). P a g e 30 | 63 514. What's a possible cardiac complication of diphtheria (Corynebacterium)? - Correct answer Dilated cardiomyopathy. 515. What effect does CO have on the oxyhemoglobin dissociation curve? - Correct answer L shift + shape change (sigmoid to asymptotic) to the curve. In effect, CO displaces O2 from Hb, and disallows unloading of O2 from Hb in the tissues. 516. How do Leydig cell tumors usually present? - Correct answer Most common type of testicular sex cord stromal tumor, may occur in all age groups. Leydig cells are primary source of testosterone & capable of estrogen production (inc aromatase expression) -> inc estrogen production, with 2ndary inhibition of LH & FSH -> gynecomastia, precocious puberty in prepubertal cases. 517. What does choriocarcinoma produce? - Correct answer Inc serum beta-hCG 518. What does a yolk sac tumor produce? - Correct answer Germ cell tumor accompanied by an increase in serum AFP 519. How does primary biliary cirrhosis usually present? - Correct answer Pruritis (bilirubin), jaundice, steatorrhea, hepatosplenomegaly, inc alk phos/bilirubin, anti- mitochondrial Ab's, xanthomas & xanthelasmas on skin, osteoporosis (can't absorb/store fat-soluble vitamins). Progressive autoimmune dz: immune-mediated destruction of intrahepatic bile ducts -> bile stasis, cirrhosis. 520. What's a chalazion? - Correct answer A chronic, sterile, granulomatous inflammatory lesion of the meibomian glands. 521. What's a hordeolum? - Correct answer Purulent infection of one of the eyelid glands, usu caused by Staph. A stye is a small, external hordeolum involving Zeis's or Moll's glands. 522. What's molluscum contagiosum? - Correct answer Dz caused by poxvirus. Presents as asymptomatic, centrally-umbilicated papules on face, neck, & anogenital areas. 523. What is premature ovarian failure? - Correct answer Primary hypogonadism in a woman <40yo. Causes include: chemo, radiation, autoimmune ovarian failure, Turner's syndrome, & fragile X. Impaired follicular development -> low estrogen -> loss of feedback inhibition on FSH & LH -> FSH increased more than LH (slower clearance from circulation). 524. Dx: FSH elevation in >3 mos of amenorrhea in woman <40yo. 525. How to tx suspected PCP PNA in an HIV+ pt with CD4 count <200? - Correct answer TMP-SMX, along with prednisolone when PaO2 <70 mmHg. 526. What are some metabolic consequences of pts with OSA and obesity hypoventilation syndrome (leading to chronic resp failure)? - Correct answer Resp acidosis -> inc bicarb retention -> dec chloride reabsorption. Also, volume overload -> hypervolemic hypoNa. 527. When would you perform a VCUG to identify structural abnormalities predisposing to UTIs? - Correct answer If pt is <10yo, male, or a prepubertal non- sexually active female. 528. What happens with hypercalcemia? - Correct answer HyperCa -> induces urinary salt wasting -> volume depletion -> exacerbates hyperCa by impairing renal clearance of Ca -> vicious cycle. P a g e 31 | 63 529. Tx: normal saline at 200ml/hr with goal urine output of 100-150 ml/hr. Plus *calcitonin* + *bisphophonate (zoledronic acid)* to rapidly reduce serum Ca. Continue bisphosphonate long-term for hyperCa of malignancy. 530. How do you treat vit D-related hypercalcemia (ie, sarcoidosis & lymphoma)? - Correct answer Glucocorticoids 531. Which tumors metastasize most commonly to the liver? - Correct answer Primary tumors of the GI tract, lung, and breast. 532. How does hyperPTH usually present? - Correct answer Elevated Ca, low P -> constipation, fatigue, XS urination, abd pain, urinary stones (Ca phosphate), mental status changes, osteoporosis, pseudogout of knee (calcium pyrophosphate dihydrate crystals). Synovial fluid will reveal rhomboid-shaped, positively birefringent crystals. 533. How does adult polycystic kidney disease usually present? - Correct answer AD progressive kidney disease. Recurrent flank pain, renal infections, & nephrolithiasis, inc risk of RCC -> end stage renal dz in most pts by 60yo. 534. How does acute glomerulonephritis usually present? - Correct answer Proteinuria, edema (usu periorbital), HTN, renal insufficiency. 535. How does Schistosoma haematobium infection usually present? - Correct answer Dysuria & urinary frequency -> gross hematuria & bladder pain later on. Common cause of hematuria in Middle East & Africa. Snail = intermediate host. 536. What's the most common cause of painless hematuria in adults? - Correct answer Bladder tumors. 537. How does Coxsackie viral infection usually present? - Correct answer Fever, HA, stiff neck (ie, aseptic meningitis). Can also cause myocarditis, hand-foot-and-mouth dz, and herpangina (vesicles on the hard palate). 538. Which regions are hyperendemic for Giardia? - Correct answer Nepal and certain mountainous areas of northern & western US. 539. How does antiphospholipid antibody syndrome usu present in pregnant women? - Correct answer Commonly causes a false positive VDRL (confirm w/FTA-ABS test), hx of arterial/venous thromboses, hx of spontaneous abortions, thrombocytopenia & prolonged PTT. 540. Tx: LMW heparin during pregnancy (warfarin contraindicated in pregnancy). 541. What are the K+ sparing diuretics? - Correct answer Spironolactone, eplerenone, triamterene, & amiloride - act on principal cells in cortical collecting tubule. 542. What's the dx for generalized anxiety d/o? - Correct answer XS anxiety about multiple things, plus 3+ sx's for >6 mos: impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, & restlessness. 543. Which neutrophilic fxn is impaired in chronic granulomatous disease (CGD)? - Correct answer Intracellular killing. Other neutrophilic fxns (chemotaxis, phagocytosis, & degranulation) are intact. So a Gram stain of infection will show neutrophils filled with bacteria. 544. What's adenosine deaminase deficiency? - Correct answer AR cause of severe combined immunodeficiency (SCID). PCP, Candida, Parainfluenza, & herpesvirus infections are most common. Lymphopenia is a classic finding. P a g e 32 | 63 576. How to differentiate septic arthritis and crystalline arthritis? - Correct answer Joint aspiration. They both tend to be monoarticular and affect the knee. 577. How does polymyalgia rheumatica usually present? - Correct answer Pts >50yo, inflammatory condition, sore/stiff muscles esp in neck & shoulders, ESR >40, normal ANA. 578. How does SCID usually present? - Correct answer Recurrent sinopulm infections, oral candidiasis, persistent diarrhea, opportunistic infections, viral infections. Life-threatening. 579. Dx: absent lymph nodes/tonsils, lymphopenia, absent thymic shadow on CXR, & abnormal T/B/NK count by flow cytometry. 580. How does CVID (common variable immunodeficiency, aka acquired hypogammaglobulinemia) usually present? - Correct answer Similar presentation to Bruton's agammaglobulinemia (recurrent pyogenic infections), but these pts have less severe sx's at a later age (15-35yo). Dec serum IgG, IgA, IgM, & IgE, but no decrease in circulating B cells (vs Bruton's). 581. What're the diagnostic criteria for Bruton's (X-linked) agammaglobulinemia? - Correct answer 1) Onset of recurrent bacterial infections in first 5yrs. 2) Very low serum IgG, IgM, & IgA levels (2SD below mean). 3) Absent isohemagglutinins or poor response to vaccines. 4) <2% CD19+ B cells in peripheral circulation. 582. What's the most common congenital heart defect in Down syndrome? - Correct answer Endocardial cushion defect of AV canal. Dx: echo. Can rapidly develop into pulm HTN (loud P2 sound). 583. How can coarctation present? - Correct answer Can present in an infant with absent distal pulses & CHF (2/2 narrowing of aorta), and in Turner's syndrome. Dx: echo. Tx: surgical repair at time of dx. 584. What congenital heart condition is associated with congenital rubella? - Correct answer PDA (continuous murmur along the chest wall). Dx: echo. Tx: repair at time of dx. 585. How should you manage a foreign body obstruction in a child's airway? - Correct answer If a coin is visualized in the esophagus and pt is symptomatic or if time of ingestion is unknown -> remove promptly via flex endoscopy. Also if the object is a battery, sharp object, or 2+ magnets. 586. *If coin is visualized and pt is asymptomatic, observe up to 24 hrs after ingestion. 587. *Rigid bronchoscopy is 1st line for foreign body aspiration. 588. When does stranger anxiety usually stop? - Correct answer 3yo. After this age, a persistent fear of strangers is usually due to other causes. 589. What's selective mutism? - Correct answer A condition in which children have a fear of situations that call for them to speak (school, formal social gathering, etc). 590. What does theophylline toxicity look like? - Correct answer CNS stimulation (HA, insomnia, SZ), GI disturbance (n/v), and cardiac toxicity (arrhythmia). Theophylline is metabolized by cytochrome oxidase system in liver - these enzymes can be inhibited by concurrent illness or drugs (cimetidine, cipro, erythromycin, clarithromycin, verapamil). 591. What are the two most common peripheral artery aneurysms? - Correct answer Popliteal aneurysm > femoral artery aneurysm (either may be assoc w/AAA) 592. What usually causes femoral vein aneurysm? - Correct answer Femoral vein dilation usually results from AV fistula (typically traumatic) -> venous HTN. P a g e 35 | 63 593. How does herpes simplex keratitis usually present? - Correct answer Frequent cause of corneal blindness in the US, usu in adults. Pain, photophobia, blurred vision, tearing, & redness of eye. Hx of prior episodes. Precipitated by XS sun, outdoor occupation, fever, or immunodeficiency. Corneal vesicles & *dendritic ulcers*. Tx: antiviral (oral or topical). 594. How does bacterial keratitis usually present? - Correct answer Contact lens wearers, following corneal trauma or entry of foreign body. Cornea looks hazy with a central ulcer & adjacent stromal abscess. 595. How does herpes zoster ophthalmicus usually present? - Correct answer Elderly pt. Fever, malaise, burning, itching in periorbital region. Vesicular rash in distribution of cutaneous branch of CNV1. 596. How does fungal keratitis usually present? - Correct answer Occurs after corneal injury in agricultural workers or immunocompromised pts. Cornea shows multiple stromal abscesses. 597. How do you a manage a mildly tender breast lump of a young woman with no obvious signs of malignancy? - Correct answer Ask her to return after her menstrual period for re-exam. If mass decreases in size after period, most likely benign. Otherwise, do U/S, FNA biopsy, and/or excisional biopsy. 598. *Mammography usu not helpful here b/c density of breast tissue is high in young women. 599. What type of imaging can confirm the presence, size, and location of an intracranial hemorrhage? - Correct answer Head CT w/o contrast 600. How would you evaluate a couple for infertility, after doing physical exam and getting history? - Correct answer 1) Semen analysis (male factor is 20-30% of infertility causes). 2) Evaluate for anovulation via basal body temperature measurement, serum progesterone level (during mid-luteal phase), & endometrial sampling. 3) More complicated tests: hysterosalpingography, laparoscopy. And serum prolactin level. 601. What's postop endophthalmitis? - Correct answer Most common form of endophthalmitis. Usu occurs w/in 6 wks of surgery. Infection within the eye, particularly the vitreous. Sx's: pain & decreased vision, swollen eyelid/conjunctiva, corneal edema, infection. Tx: based on severity, intravitreal abx injection or vitrectomy. 602. How does conjunctivitis usually present? - Correct answer XS tearing, burning, mild pain, conjunctival & eyelid edema. Vision isn't affected. 603. How does uveitis usually present? - Correct answer Blurred vision with moderate pain, conjunctival injection, & constricted pupils. Keratic precipitates ("mutton fat") and iris nodules may be seen. Assoc w/HLA B27-related conditions. 604. How does cavernous sinus thrombosis usually present? - Correct answer Proptosis, ophthalmoplegia, chemosis, & visual loss. Occurs due to hematogenous spread from an infected, inflamed sinus. 605. How can effect modifiers be distinguished from confounders? - Correct answer Perform a stratified analysis centering on the variable of interest. If the variable is a confounder, there won't be a significant difference in risk btw stratified groups (confounding effects have been removed through stratification). If variable is an effect modifier, there will be a significant difference btw the 2 groups. 606. What's the age group that typically develops imaginary friends? - Correct answer 2-6yo, typically in response to times of change or stress P a g e 36 | 63 607. What should you be concerned for with a middle-aged woman with dry eyes, dry mouth, trouble swallowing, and dental caries? - Correct answer Sjogren syndrome: an autoimmune condition with lymphocytic infiltration of the salivary glands -> enlargement & firmness of these glands. Dx: dry mouth & eyes with histo evidence of lymphocytic infiltration of salivary glands or serum Ab's against SSA (Ro) and/or SSB (La). 608. What're the three A's of negative sx's in psychosis? - Correct answer Affective flattening, Asociality, & Alogia (won't talk). 609. What are the majority of lip cancers? - Correct answer Well-differentiated squamous cell carcinomas, which on histo looks like invasive cords of squamous cells with keratin pearls. Also hx of occupational sun exposure. 610. What are clues that a woman is ovulating regularly? - Correct answer Regular menstrual cycles accompanied by midcycle pelvic pain and discharge consistent with ovulation ("egg-like" thickening), & rise in body temperature during the luteal phase. 611. What're some causes of anatomic defects in the uterus or fallopian tubes leading to infertility? - Correct answer Hx of PID, endometriosis, in utero DES exposure, congenital malformations, & other acquired abnormalities. 612. Why are pts with PCOS typically anovulatory? - Correct answer XS serum androgen levels -> suppress GnRH as well as FSH release via feedback inhibition -> suppress ovulation. You can also tell b/c XS androgen can give hirsutism, acne, & virilization. 613. What does serum inhibin B test? - Correct answer Determines ovulatory reserve. 614. What would you suspect in a pt with cupping of the optic disc and loss of peripheral vision? - Correct answer High intraocular pressure - may indicated open angle glaucoma, usu asymptomatic in earlier stages, but more common in AAs, family hx of glaucoma, & diabetes. Tx: beta-blockers (timolol) -> laser traculoplasty as adjunct -> surgical trabeculectomy if continuous inc in IOP. 615. How to manage eclampsia? - Correct answer 1) Administer anticonvulsant (mag sulfate). 2) Attempt delivery. 616. What kind of eye condition is most common with neurofibromatosis type 1? - Correct answer Optic glioma (15%), mostly in kids <6yo. Hx of slowly progressive unilateral visual loss & dyschromatopsia (dec brightness sensation). Sometimes exophthalmos. 617. How should you treat a neonatal clavicular fracture (crepitus, asymmetric Moro reflex)? - Correct answer Supportive care & avoiding tension on the affected arm. Most neonatal clavicular fractures heal within weeks. 618. What should you be concerned about with absent Moro, biceps, & grasp reflexes in an infant? - Correct answer C5-C7 damage (ie, Erb-Duchenne paralysis), or brachial plexus injury. 619. How do the presentations of HSV retinitis and CMV retinitis differ? - Correct answer HSV retinitis: rapidly progressing bilateral necrotizing retinitis ("acute retinal necrosis syndrome"), visual loss, keratitis, conjunctivitis with eye pain. 620. CMV retinitis: painless, fluffy/granular retinal lesions near the retinal vessels and assoc hemorrhages, no initial conjunctivitis or keratitis. 621. What's the leading complication of severe burns in the first week with adequate initial fluid resuscitation? - Correct answer Bacterial infection (usually bronchopneumonia P a g e 37 | 63 650. In which population does slipped capital femoral epiphysis usually occur? - Correct answer Obese adolescents. Mean ages: 12yo in girls, 13.5yo in boys. 651. What condition presents with asymmetric resting tremor in the distal part of an upper extremity? - Correct answer This is the most common presenting sign of Parkinson disease. It's a clinical diagnosis (physical exam is more accurate than imaging!). 652. What condition presents with a dull aching and fullness of the scrotum, swelling of the scrotum, negative transillumination test, and increased swelling with Valsalva maneuver? - Correct answer Varicocele - a tortuous dilation of pampiniform plexus of veins surrounding the spermatic cord & testis in the scrotum. Results from the incompetence of the venous valves, L > R (L testicular vein enters the L renal vein inferiorly at a right angle -> inc risk of impaired drainage). 653. How to differentiate transudate from exudate fluid accumulation? - Correct answer Serum ascites albumin gradient (SAAG) = serum albumin - ascites albumin. 654. Transudate (portal HTN, etc from inc capillary hydrostatic P): SAAG > 1.1. 655. Exudate (infection, trauma, pancreatitis, malignancy - from inc capillary permeability): SAAG < 1.1. 656. How would you treat hemochromatosis? - Correct answer Early dx & tx have significant impact. Tx: avoid all iron-rich foods, weekly phlebotomies for 2-3 yrs, deferoxamine (iron chelator) is 2nd line for pts who can't tolerate phlebotomies. All first- deg relatives should consider genetic testing. 657. Labs: mildly elevated LFTs, elevated iron with >50% saturation of transferrin, elevated ferritin. 658. What condition presents with 1-2 wks of fever, RUQ pain starting w/in 5 mos of returning from an endemic area, diarrhea, and occasionally jaundice? - Correct answer Amebic liver abscess - can also involve other organs (lung, heart, brain). Confirm dx with U/S, CT, or MRI. Next step is serologic testing for Ab's. Tx: oral metronidazole for 7-10 days. If tests are negative for ameba or pt not improving, do percutaneous drainage to r/o pyogenic absceess. 659. *No needle aspiration b/c of risks! (bleeding, amebic peritonitis, etc) 660. For what liver abscess would you treat with IV abx and drainage? - Correct answer Pyogenic (bacterial) abscess - typically occurs in older, debilitated pts. Use empiric broad-spectrum abx (ceftriaxone) in conjunction with metronidazole. 661. What does an antibody titer of 1:4 mean? - Correct answer Indicates that the solution has to be diluted 4 times before the antibodies are undetectable. (Thus an Ab titer of 1:4 has less Ab's than a titer of 1:16.) 662. *Ab titers > 1:6 means a mother is sensitized for D antigen -> RhoGAM is no longer helpful, close fetal monitoring for hemolytic dz is required. 663. Which CN is responsible for corneal sensation? - Correct answer CN V1 664. How do you treat social phobia? - Correct answer Assertiveness training (a subset of CBT) + SSRI 665. When you have a pt with hx of breast cancer, lytic bone lesions, hyperCa, and normal PTH levels, what is the underlying process? - Correct answer Breast cancer metastasizing into bone -> tumor cells secrete factors that activate osteoclasts to indirectly cause bone resorption, and produces PTHrP locally when metastasized -> hyperCa locally. P a g e 40 | 63 666. Where do most (90%) medulloblastomas develop? - Correct answer In the cerebellar vermis. Posterior vermis syndrome: truncal dystaxia, horizontal nystagmus, papilledema, unbalanced gait. 667. What condition presents with both lower and upper motor neuron damage, with muscle weakness beginning distally and asymmetrically? - Correct answer Amyotrophic lateral sclerosis (ALS). 668. How to manage a child who has accidentally taken liquid alkali (oven cleaner)? - Correct answer 1) Maintain airway patency. 2) Upper GI endoscopy in first 24 hrs to assess injury & dictate mgmt. 669. *Using vinegar or NG lavage are dangerous b/c they may increase the extent of the injury! 670. What would you suspect in a 58yo man with no medical problems except recent seizures and MRI showing several lesions at the jxn of gray-white matter with edema? - Correct answer Metastatic malignancy: lung > breast (solitary met) > unknown primary > melanoma > colon (solitary met). Brain mets are the most common intracranial tumors in adults. Perform chest CT next to determine primary source. 671. What does glioblastoma multiforme usually look like on brain imaging? - Correct answer Solitary mass with central necrosis and extensive vasogenic edema. 672. What are the risk factors for neonatal RDS? - Correct answer Prematurity, male, C/S w/o labor, perinatal asphyxia, & maternal diabetes (fetal hyperinsulinemia counteracts actions of cortisol -> delays lung maturation). 673. What condition presents in three phases: abd pain/n/v/diarrhea (week 1), "splinter" hemorrhages/periorbital edema (week 2), and muscle pain/tenderness/swelling/weakness? - Correct answer Trichinosis, a parasitic infection caused by the roundworm Trichinella. Acquired by eating undercooked pork containing encysted Trichinella larvae. Blood count usu shows eosinophilia. 674. What condition presents with constipation, descending paralysis, and respiratory failure? - Correct answer Botulism 675. What condition presents with lip & tongue swelling, associated with ACEi use? - Correct answer Angioedema. Deficiency of C1 inhibitor. 676. What condition presents in a child <3yo who has a "barky" cough, hoarseness, and varying respiratory distress over time? - Correct answer Croup, aka laryngotracheitis or laryngotracheobronchitis. Most common agent is Parainfluenza virus. Usu a clinical dx. Lateral neck Xrays will show subglottic narrowing. 677. How does epiglottitis usually present? - Correct answer Cough is not "croupy," and pt appears toxic - high-grade fever, tachypnea, tachycardia, stridor, & XS drooling. Lateral Xrays will show: swollen epiglottis (thumb sign), thickened aryepiglottic folds, & obliteration of vallecula. 678. How are laryngotracheobronchitis (croup) and laryngotracheobronchopneumonitis different? - Correct answer Bacterial laryngotracheobronchopneumonitis has signs of *lower* airway involvement, like wheezing & interstitial changes on CXR. Usu w/hypoxia 2/2 lower airway dz. Croup is upper airway. 679. How do you manage epiglottitis? - Correct answer Endotracheal intubation and set-up for possible tracheostomy (nebulized racemic epi is for croup). P a g e 41 | 63 680. What deficiency would you suspect in a malnourished child with sore throat, cheilitis, stomatitis, glossitis, anemia (normocytic-normochromic), seborrheic dermatitis, & photophobia? - Correct answer Riboflavin (B1) deficiency. 681. What condition presents with the triad of dyspareunia, dysmenorrhea (pain with menses), and dyschezia (pain when passing stool)? - Correct answer Endometriosis. Other features include pelvic pain & infertility. Women 20-30 yo. Definitive dx: laparoscopy. Tx: combined estrogen & progestin pills, GnRH analogs (leuprolide), or danazol. 682. How do you treat involuntary contractions of the vaginal musculature that interfere w/sex? - Correct answer Vaginal dilators. This is vaginismus. Presentation: complaints of unsuccessful attempts at intercourse. 683. How quickly can someone develop hyperCa from immobilization? - Correct answer 2/2 inc osteoclastic bone resorption. Inc risk with pre-existing high bone turnover (young ppl, older ppl with Paget's dz). Median onset ~4 wks after immobilization, but as early as 3 days after in pts w/chronic renal insufficiency. 684. Tx: hydration, bisphosphonates. 685. What is the recommendation for AAA screening? - Correct answer Men aged 65- 75yo who have smoked cigarettes should have a one-time abd U/S. Also, surgical repair of large AAAs (>5.5cm). 686. What's the pathophysio of diabetic nephropathy? - Correct answer Hyperfiltration (inc GFR) & microalbuminuria (incipient nephropathy) -> macroproteinuria (>300 mg/d) - > progressive decline in GFR. 687. *Intensive bp control is the only proven intervention to reduce the decline in GFR once azotemia develops. 688. What do you do with a pregnant patient who tests positive for syphilis but has a penicillin allergy? - Correct answer 1) Make sure this is a true allergy (do a skin test). 2) Do penicillin desensitization (incremental doses of oral penicillin V). 689. How does cirrhosis usually present? - Correct answer Hepatomegaly + ascites and significant peripheral edema. Other signs: esophageal varices, spider nevi, palmar erythema, & caput medusa. Thrombocytopenia & coagulopathy are often seen. Hepatic hydrothorax usually occurs on the R side. 690. What're the leading causes of nonalcoholic steatohepatitis? - Correct answer Obesity, DM, & hypertriglyceridemia. 691. How does autoimmune hepatitis usually present? - Correct answer Young to middle-aged women, presents as acute or chronic hepatitis. Significant hepatocellular injury, with LFTs > 1000 U/L. 692. What's CREST syndrome? - Correct answer Calcinosis cutis (localized dystrophic deposition of Ca in the skin, looks like subcutaneous pink-white nodules on upper extremities), Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, & Telangiectasias ("mat-like" patches most commonly on face & palms). It's a limited form of systemic sclerosis. 693. How to manage gout? - Correct answer 1) Cessation of EtOH, 2) Eat a low- purine diet, 3) Avoid drugs such as diuretics & pyrazinamide. 694. Tx acute attacks with NSAIDs > colchicine or steroids. 695. How to manage SIADH? - Correct answer If asymptomatic: remove offending cause. If tumor, fluid restrict (<800ml/day). +/- Loop diuretics with salt tablets. 696. If severe, symptomatic, or resistant hyponatremia: give hypertonic saline. P a g e 42 | 63 Bronchoscopy is initial procedure of choice - can localize bleeding site, provide suctioning, & include other tx. 728. What's adenomyosis? - Correct answer Presence of endometrial glands in the uterine muscle, most commonly in women >40yo, typically presents with 2ndary dysmenorrhea & menorrhagia. 729. What are some ototoxic medications (cause sensorineural hearing loss)? - Correct answer Vancomycin, loop diuretics (furosemide), aminoglycoside abx, chemo agents (doxorubicin), & aspirin. 730. What are some predisposing factors for UTIs? - Correct answer Female (shorter urethra), recent abx, sexual intercourse, diaphragm or spermicide use, family hx of multiple UTIs. 731. Where are the two watershed zones in the colon? - Correct answer 1) Splenic flexure (supplied by narrow terminal branches of SMA), and 2) Recto-sigmoid junction (supplied by narrow terminal branches of IMA). Most vulnerable to ischemia during systemic hypotension. 732. What would you suspect in a patient with evidence of atherosclerotic vascular disease, present with abd pain followed by bloody diarrhea, and have minimal abd exam findings? - Correct answer Ischemic colitis 733. What should you suspect in a child with HSP and presents with abdominal pain? - Correct answer 1) GI bleed, and 2) Intussusception. 734. *Volvulus is a condition of the elderly. 735. How should you manage a boy with a febrile illness and 2+ proteinuria on urine dipstick? - Correct answer Proteinuria in children can be transient, orthostatic, or persistent. Transient is the most common, and can be caused by fever, exercise, SZ, stress, or volume depletion. Orthostatic is very common in adolescent boys. Both are benign. If UA is otherwise normal, urine dipstick should be repeated on 2+ additional specimens -> if positive, refer to peds nephrologist for underlying renal dz -> 24-hr urine collection for protein, renal U/S, +/- renal biopsy. 736. What is the most common cause of pleural effusion? - Correct answer CHF 737. What are serum characteristics of a transudate (like a pleural effusion from CHF)? - Correct answer 1) Pleural/serum protein ratio <0.5. 2) Pleural/serum LDH <0.6. 3) Pleural LDH < 2/3 of upper limit of normal serum LDH. 738. *Pleural pH<7.3 indicates pleural inflammation. (pH<7.2 requires a chest tube aspiration to prevent empyema.) 739. What 2/3 signs do >80% of aortic dissections have? - Correct answer 1) Abrupt onset of "tearing" chest/back pain. 2) Variation in pulse or bp btw right and left arms. 3) Widened mediastinum on CXR. 740. *Dissection of ascending aorta may extend into pericardium (cardiac tamponade), coronary arteries (MI), or carotid arteries (stroke). 741. What are the teratogenic vs recommended anti-hypertensives during pregnancy? - Correct answer Teratogenic: ACEi, ARBs. 742. Recommended: Labetalol, Methyldopa. 743. *If a pregnant pt presents with essential HTN but isn't on anti-hypertensives, only start tx if bp >150/95. 744. How does conversion disorder usually present? - Correct answer Psychological stressor/trigger. Sx's aren't feigned or purposefully produced. Pts can be hysterical or strangely indifferent to their sx's. P a g e 45 | 63 745. Tx: hypnosis & relaxation techniques (acute), and psychotherapy long-term 746. When is needle thoracostomy usually used? - Correct answer As an emergency procedure in pts with a life-threatening tension pneumothorax (can occur after blunt chest trauma). 747. What side effect is associated with thioridazine? - Correct answer Pigmentary retinopathy 748. What side effect is associated with quetiapine? - Correct answer Cataracts 749. What type of occlusion/stroke gives contralateral weakness and predominantly affects the lower extremity? - Correct answer Anterior cerebral artery occlusion 750. What's the location of an occlusion/stroke that is characterized by "alternate" syndromes (contralateral hemiplegia and ipsilateral CN involvement)? - Correct answer Lesions in the vertebrobasilar system 751. What would you suspect in an elderly patient with GI bleed, aortic stenosis and/or end-stage renal disease? - Correct answer AVM, or angiodysplasia of the GI tract 752. What's the most common cause of painless lower GI bleeding? - Correct answer Diverticulosis (multiple outpouchings of mucosa through hypertrophied muscular layers in GI) 753. Why is epinephrine the only medication proven to prevent and reverse progression of anaphylaxis? - Correct answer Beta2 agonist: bronchodilation, dec systemic release of inflammatory mediators. 754. Alpha1 agonist: vasoconstriction -> raises bp, dec upper-airway edema. 755. How do diuretics in general have a hyperuricemic effect? - Correct answer Hypovolemia-associated enhancement of uric acid reabsorption in the proximal tubule. 756. What can happen if a pt taking an MAOI (phenelzine) consumes foods high in tyramine (aged meats & cheeses)? - Correct answer Hypertensive crisis 757. Describe early neonatal care - Correct answer 1) Suction airway secretions, 2) Dry & keep infant warm (underdeveloped thermoregulatory center), 3) Preventive care (silver nitrate solution to eyes for gonococcal ophthalmia prevention, and IM vit K). 758. What's reaction formation? - Correct answer A short-term neurotic defense mechanism in which a person does the complete opposite of what he/she really feels b/c the desire might be perceived as unacceptable by others in society 759. What's sublimation? - Correct answer A mature defense mechanism that allows unacceptable or negative impulses (like rage) to be channeled into more acceptable or positive activities (like athletics). 760. When should surgery be advised to correct a congenital umbilical hernia? - Correct answer If hernia persists to 3-4 yo, >2cm diameter, causes sx's, becomes strangulated, or progressively enlarges after age 1-2yo. 761. How does management of omphalocele differ from that of umbilical hernia? - Correct answer Omphalocele: immediate surgical repair before infections take place. 762. Umbilical hernia: surgery only when indicated. 763. What does chronic GERD predispose to? - Correct answer Barrett's esophagus and benign peptic esophageal strictures (symmetric circumferential narrowing of esophagus). P a g e 46 | 63 764. What's negative pressure wound therapy, aka vacuum-assisted wound closure? - Correct answer A wound-dressing system that continuously or intermittently applies subatmospheric pressure to a wound to accelerate the healing process. 765. What's the risk, and should be monitored closely, in postterm (prolonged) pregnancies? - Correct answer Oligohydramnios, which is itself assoc w/increased fetal morbidity. Postterm pregnancies should be monitored for this 2x/wk. 766. What's tic douloureux? - Correct answer Trigeminal neuralgia, manifesting with short bursts of excruciating lancinating pain (secs-mins) in V2 & V3 distributions - 2/2 external compression of trigeminal nerve. 767. How does chronic OCP use cause HTN? - Correct answer Unclear but possibly due to an estrogen-mediated increase in synthesis of angiotensinogen in the liver or involvement of the RAA system. 768. How to differentiate pulmonary contusion from ARDS after a trauma? - Correct answer ARDS: usually 24-48 hrs after trauma, with bilateral lung involvement. 769. Pulm contusion: usu localized, appears more immediately (first 24 hrs) after the trauma. 770. What's Mohs surgery? - Correct answer Special type of surgery where microscopic shaving is done so that 1-2 mm of clear margins are excised. Highest cure rate for basal cell cancer but is indicated only in pts with high-risk features, and those with lesions in functionally critical areas (perioral, nose, lips, ears). 771. What is sildenafil? - Correct answer Phosphodiesterase inhibitor - 1st line tx for erectile dysfxn. But when combined with an alpha-blocker (prazosin, doxazosin), they should be given with a 4+ hr interval in btw to reduce risk of hypotension. It's also contraindicated in pts being treated with nitrates. 772. What's spondylolisthesis? - Correct answer Developmental d/o characterized by a forward slip of vertebrae (usually L5 over S1) -> chronic back pain and neuro dysfxn if significant, palpable "step-off" of vertebral displacement is detected if problem is severe. 773. What's another name for Wilson's disease? - Correct answer Hepatolenticular degeneration 774. What are the indications for the evaluation of neonatal jaundice? - Correct answer 1) Jaundice appearing in first 24-36 hrs of life, 2) Bilirubin rising faster than 5 mg/dl/24hrs, 3) bilirubin >12 in full-term or 10-14 in preterm infants, 4) Jaundice persisting after 10-14 days of life, 5) Conjugated hyperbili >2, and 6) presence of signs or sx's. 775. What to do next with a pregnant woman who's had a nonreassuring non-stress test and vibroacoustic stimulation has failed to increase variability? - Correct answer Do either a biophysical profile or a contraction stress test. 776. What does a biophysical profile measure? - Correct answer 5 parameters: 1) non-stress test, 2) amniotic fluid volume, 3) gross fetal mvmts, 4) extremity tone, and 5) fetal breathing. (Last 4 assessed with OB U/S.) 777. What's a major advantage of chorionic villus sampling over amniocentesis? And major disadvantage? - Correct answer Advantage: it can be performed earlier: 10-12 wks vs 15-20 wks. Disadvantage: fewer physicians trained, may be associated with transverse digital deficiency (limb defect). P a g e 47 | 63 810. Which cancers are associated with ectopic ACTH production? - Correct answer Small cell lung cancer and carcinoid (bronchial, pancreatic, thymus) 811. What are the 3 P's of the causes of arrest of labor? - Correct answer Powers (inadequate contractions or anesthesia), Passenger (baby malpresented or head too big), & Passage (pelvis too narrow) 812. When can forceps be used during labor? - Correct answer When cervix is fully dilated (10cm) and 2nd stage of labor has begun (+2 station or lower). 813. What's the Zavanelli maneuever? - Correct answer Last resort in case of shoulder dystocia: push baby back into uterine cavity and do C/S 814. What infection is associated with paroxysmal cough and/or post-tussive emesis? - Correct answer Pertussis. Confirm dx with bacterial culture and/or PCR from nasopharyngeal secretions in pts with <4wks of sx's. (>4 wks sx's usually requires serology.) 815. What're concerning sexual behaviors in young children? - Correct answer Extensive sexual knowledge, preoccupation with masturbation (vs occasional masturbation), touching others' genitals, XS talk about sexuality, and simulating foreplay or intercourse. 816. What's the workup for breath holding spells in a 6-18mos child? - Correct answer Diagnosed based on clinical history, though tested to r/o iron deficiency anemia as a predisposing cause. No tx necessary otherwise. 817. How to manage a patient with cirrhosis, portal HTN, and acute onset hepatic hydrothorax? - Correct answer Therapeutic thoracentesis then salt-restricted diet and diuretics; if failed diuretics, do a TIPS procedure 818. What are abdominal Xrays especially useful for? - Correct answer Diagnosing ileus or small bowel obstruction 819. What condition presents with decreased visual acuity, sluggish afferent pupillary response to light, changes in color perception, and a swollen disc? - Correct answer Optic neuritis (more common in young females with multiple sclerosis) 820. What're the 5 W's that can cause postop fevers (as well as other causes)? - Correct answer Wind (PNA, 1-2 days postop), Water (UTI, 3-5 days postop), Walking (DVT, 4-6 days), Wound (wound infection, 5-7 days), & Wonder drugs (drug fever, >7 days postop). 821. *Drug fevers typically caused by: AEDs & TMP-SMX. 822. What kind of arthritis occurs in 10-20% of pts with Crohn's or UC? - Correct answer Enteropathic arthritis - most often affects lower extremities & sacroiliac joints, and tends to wax & wane with the sx's of bowel disease. 823. What's the most common cause of death in alpha1-antitrypsin deficiency? - Correct answer Emphysema, though liver disease is the greatest concern in the first 2 decades of life (cirrhosis is 2nd most common cause of death, may also develop hepatocellular carcinoma) 824. What's riluzole? - Correct answer Used to slow the progression of amyotrophic lateral sclerosis (ALS) P a g e 50 | 63 825. What characterizes constitutional growth delay? - Correct answer Delayed growth spurt, delayed puberty, & delayed bone age. But these ppl will eventually catch up and reach normal height. 826. What is the most frequent origin for ectopic foci that cause atrial fibrillation? - Correct answer Pulmonary veins 827. What're the common causes of priapism? - Correct answer Sickle cell disease, leukemia (usu in children/adolescents), perineal or genital trauma (lac of cavernous artery), neurogenic lesions (spinal cord injury, cauda equina compression, etc), & meds (trazodone, prazosin). 828. What's an example of a direct mast-cell degranulation? - Correct answer Immediate hypersensitivity rxn to IV radiocontrast medium. Different from IgE-mediated hypersensitivity rxn (aka, anaphylactic reactions), b/c mast-cell degranulation is not IgE- dependent and doesn't require prior sensitization. Occurs <1 hr after exposure. 829. *Ex of other materials: aspirin/NSAIDs, EtOH, opiates, polymyxin B, anticholinergics (atropine), systemic anesthetics (tubocurarine). 830. What's the most common cause of "locked in syndrome" (quadriplegia & inability to speak in otherwise cognitively normal person, with preserved eye muscle function)? - Correct answer Basilar artery occlusion -> affects the brainstem. Paralysis of all extremities, heavy sensation deficits, difficulty swallowing, difficulty breathing. 831. What does L anterior cerebral artery stroke cause? - Correct answer R sided weakness & sensory deficit of the leg. 832. What conditions is erythema nodosum associated with? - Correct answer Sarcoidosis, IBD, TB, fungal infections, & mediations. Red, painful, warm nodules usually appearing on the shins. 833. What conditions is pyoderma gangrenosum associated with? - Correct answer IBD, rheumatoid arthritis, leukemia, & chronic active hepatitis. Inflammatory ulcer with undermined borders, may occur anywhere on body. 834. What are some CXR findings that are indicative of blunt aortic injury (usu a mechanism of rapid deceleration)? - Correct answer Wide mediastinum (>6cm upright), obscured aortic knob, left "apical cap" (pleural blood above L lung), large L hemothorax, deviation of NG tube rightward, deviation of trachea rightward, & wide L paravertebral stripe. 835. What's a keratoacanthoma? - Correct answer A rapidly growing keratotic lesion often described as "crateriform" or "volcano-like" - many regarded as well-differentiated forms of squamous cell carcinoma -> excised. 836. What's a pyogenic granuloma? - Correct answer Rapidly growing vascular lesion most often occurring at sites of minor trauma. Resemble granulation tissue on histology. Red papules with collarette of scale. 837. What's the most common cutaneous malignancy? - Correct answer Basal cell carcinoma 838. How to best evaluate sx's of acute brain stem infarction (and CT showing such)? - Correct answer Angiography of cerebral/neck vessels will evaluate sources of bleeding/thrombus/stenosis. 839. How to manage an actively seizing patient who has been noncompliant with his AED, phenytoin? - Correct answer 1) Lorazepam in increasing doses -> 2) IV P a g e 51 | 63 fosphenytoin vs. propofol vs. barbiturate -> 3) Move pt to OR and use volatile gases (isoflorane). 840. What's the target systolic bp in the case of a subarachnoid hemorrhage? - Correct answer 160-170 mmHg systolic; use IV nitroprusside (can be titrated easily) 841. Which drugs can cause phototoxic drug eruption (interaction of UV light with drug -> ROS)? - Correct answer Tetracyclines (esp doxycycline), thiazides, sulfonamides, fluoroquinolones, & NSAIDs 842. What's polymorphous light eruption? - Correct answer Idiopathic immune- mediated rxn to UV exposure: confluent pruritic papules & plaques in a photodistributed pattern. 843. What condition presents with severe pain and blurry vision in one eye, brought on by spending a long period of time in a dark room or taking an anticholinergic medication? - Correct answer Acute closed-angle glaucoma, an emergency brought on by increased intraocular pressure. 844. *Hazy-appearing cornea with a partially dilated & fixed pupil. 845. *Open-angle glaucoma is >90% of glaucoma cases, and is insidious over time. 846. What are some complications of PEEP ventilation? - Correct answer Barotraumas (resulting in pneumothorax, pneumomediastinum, subcutaneous emphysema) and ventilator-associated lung injury (2/2 overdistension of alveoli). Inc intrathoracic P -> dec venous return (preload) -> dec cardiac output -> systemic hypotension. 847. How to manage emergency burn patients? - Correct answer 1) ABCs (low threshold for intubation, like hoarseness) -> 2) Assess % of BSA burned and give IVF (large initial bolus of Ringer's lactate 1L/h) -> 3) Insert Foley to monitor fluid balance -> 4) Cover burns with Vaseline gauze to prevent fluid evaporation -> 5) Tests like bronchoscopy & CXR. 848. What's the cause of pronator drift? - Correct answer Upper motor neuron weakness: supination is weaker than pronation in the upper extremity. 849. What germline mutation does familial melanoma syndrome arise from? - Correct answer CDKN2A (cyclin-dependent kinase inhibitor 2A). Also assoc w/pancreatic cancer. 850. What's the constellation of cancers associated with Li-Fraumeni syndrome (loss of p53 function)? - Correct answer Breast carcinoma, soft-tissue sarcoma, osteosarcoma, brain tumors, adrenocortical carcinoma, & Wilms tumor. 851. Which cancers is the RET proto-oncogene mutated in? - Correct answer MEN types 2A & 2B. 852. Which cancer are TSC1 & TSC2 mutated in? - Correct answer Tuberous sclerosis. They code for proteins hamartin & tuberin, respectively. Tuberous sclerosis: facial angiofibromas, periungual fibromas, hypopigmented "ash leaf" macules, and CT nevus (Shagreen patch). Seizures and commonly involvement of heart, lungs, & kidneys. 853. What rapidly counteracts hyperK with ECG changes, and should be administered first in this emergency? - Correct answer IV calcium gluconate - stabilizes cardiac membranes. Then use other meds to decrease the K. P a g e 52 | 63 891. In what type of dementia should typical antipsychotics (haldol) NOT be used? - Correct answer Lewy body dementia - these pts tend to be very sensitive to typical antipsychotics. 892. Damage where would cause loss of pain & temperature sensation on the left side, beginning at T12? - Correct answer Damage to R-sided lateral spinothalamic tracts at T10. Brown-Sequard syndrome: contralateral loss of pain/temp sensation beginning 2 levels below level of lesion. 893. What're maternal factors that increase the risk for resuscitation in a newborn with low Apgars? - Correct answer Very young maternal age, hx substance abuse, & hx DM or HTN. 894. When should chest compressions be performed for newborns? - Correct answer When HR drops below 60. (Normal is >100 beats/min) 895. Why should a coagulation profile be drawn after intrauterine fetal demise is diagnosed? - Correct answer To detect incipient DIC - retention of dead fetus may cause a chronic consumptive coagulopathy 2/2 gradual release of tissue factor (thromboplastin) from placenta into maternal circulation. 896. What're early signs of DIC after an intrauterine fetal demise? - Correct answer Low fibrinogen levels (sign of consumptive coagulopathy) and associated decrease in platelet count, inc PT/PTT, or presence of fibrin split products. 897. What should you suspect in a patient with newly diagnosed diabetes, hepatomegaly, and arthropathy (joint pathology)? - Correct answer Hemochromatosis - AR d/o in which intestinal iron absorption is abnormally increased -> iron deposition in tissue. 898. *Eval: serum iron studies (inc serum iron, ferritin, & transferrin saturation) -> confirm dx w/liver biopsy. 899. What are feared arrhythmia complications of MI's? - Correct answer Vfib & VTach - occur in up to 10% of cases of MI. 900. Tx: early defibrillation. In unwitnessed arrests or witnessed arrests occurring >5 mins before arrival of defibrillator, CPR cycle should precede defibrillation. 901. What infection are patients with hemochromatosis and cirrhosis at increased risk for? - Correct answer Listeria monocytogenes (inc bacterial virulence in presence fo high serum iron, impaired phagocytosis 2/2 iron overload in reticuloendothelial cells). Also at risk for Yersinia enterocolitica and septicemia from Vibrio vulnificus (iron-loving bacteria). 902. What is an abdominal CT good for detecting? - Correct answer Bile & pancreatic duct dilation, mass lesions in pancreas, & indications of extrahepatic spread (mets or ascites). 903. What's flumazenil used for? - Correct answer Treats BDZ toxicity. 904. What condition presents with hx recurrent UTI secondary to reflux, and IV pyelography showing focal parenchymal scarring & blunting of calyces? - Correct answer Chronic pyelonephritis. 905. What condition presents with postprandial abdominal cramps, weakness, light- headedness, and diaphoresis after having had a partial gastrectomy? - Correct answer Early dumping syndrome, a common postgastrectomy complication: rapid emptying of hypertonic gastric content into the duodenum & small intestine -> fluid shift from intravascular space to small intestine, release of intestinal vasoactive polypeptides, & stimulation of autonomic reflexes. P a g e 55 | 63 906. *Clinical dx. Tx: dietary modification (small frequent meals, avoid simple carbs) -> octreotide or surgery in refractory cases. 907. What're the most common sites of mets? - Correct answer Lymph nodes, then liver (large size, dual blood supply, high perfusion rate, & filtration function of Kupffer cells). 908. What condition can present with nephrotic syndrome (facial swelling, leg edema, massive proteinuria) with palpable kidneys, hepatomegaly, and ventricular hypertrophy in the setting of chronic inflammatory dz (psoriasis)? - Correct answer Secondary amyloidosis as a unifying diagnosis. Tx underlying inflammatory disease, and colchicine for secondary amyloidosis. 909. What's the most common organism responsible for pericarditis? - Correct answer Coxsackie virus. Coxsackie B also causes viral myocarditis. 910. What does pulmonary capillary wedge pressure mean? - Correct answer It indicates preload. -> Normal/low in septic shock (peripheral vasodilation, decreased systemic vascular resistance). High in cardiogenic shock (heart can't pump). Low in hypovolemic shock (not enough fluid). 911. What are common clinical findings of septic shock? - Correct answer Hypotension, warm -> cool extremities, elevated lactate levels. Septic shock = form of distributive shock due to underlying systemic infection involving circulatory system. 912. What's the most common congenital cause of aplastic anemia? - Correct answer Fanconi anemia. AR or X-linked. Defect in DNA repair genes -> dx: chromosomal breaks on genetic analysis. Thrombocytopenia, fatigue (macrocytic anemia). 913. *Tx: hematopoietic stem cell transplant. 914. What's the mechanism of iron poisoning? - Correct answer Free radical production and lipid peroxidation -> impairs cell processes -> systemic manifestations (abd pain, hematemesis, hypovolemic shock, & metabolic acidosis). 915. What is sodium bicarbonate the antidote for? - Correct answer TCA & aspirin overdose. 916. How to treat severe lithium toxicity? - Correct answer Hemodialysis - lithium is the most dialyzable toxin. 917. What injury commonly follows blunt abdominal trauma, but can be missed on initial abdominal CT? - Correct answer Pancreatic injury (contusion, crush injury, laceration, or transection, when pancreas is compressed against the vertebral column). 918. What patient group is spironolactone most effective with treating? - Correct answer Patients with ascites from cirrhosis, and those with heart failure class III & IV. 919. How should you treat patients with acne scars? - Correct answer Oral isotretinoin (isotretinoin is very effective for treating nodulocystic acne). Can also give to pts with moderate-to-severe acne that's predominantly nodulocystic. 920. What's demeclocycline? - Correct answer Inhibits effect of AVP or ADH on the distal convoluted tubule in the kidneys. May be used to tx SIADH (but worsens diabetes insipidus). 921. What does blood at the beginning of urination tell you about where the bleeding is originating? - Correct answer Blood at the beginning: urethral lesion. Blood at the end: prostate or bladder cause. Blood during the entire urinary cycle (WITHOUT clots): disease in ureters or kidneys. P a g e 56 | 63 922. What viruses cause almost 90% of cases of viral meningitis? - Correct answer Non-polio enteroviruses, such as echovirus and coxsackievirus. 923. What imaging can you use to identify uric acid stones? - Correct answer CT or IV pyelography, because uric acid stones are radiolucent (Xray can't see). 924. What's Jarisch-Herxheimer reaction? - Correct answer May develop in syphilis treatment - spirochetes die rapidly -> release of antigen-Ab complexes in blood -> immunologic rxn (seems like an acute flare-up of syphilis). 925. What condition presents with a pigmented scaly rash on face/neck/back of hands that increases on sunlight exposure, diarrhea, and irritability/depressed mood? - Correct answer Pellagra (niacin deficiency). Ppl eating corn-based diets (India, Africa, China), alcoholics, carcinoid syndrome, & Hartnup's dz. 3 D's: Diarrhea, Dermatitis (in sun- exposed areas), & Dementia. Death if untreated. 926. When should primitive reflexes start disappearing in infants? - Correct answer By age 4 months, Moro and grasp reflexes should be disappearing. Tongue protrusion reflex should also disappear to allow for coordination to start ingesting solid foods. 927. When should the Babinski reflex disappear? - Correct answer Sometime between 1-2 yo. 928. What condition presents with sudden loss of vision in one eye and floaters in the visual field, and on fundoscopy, a fundus that's hard to visualize with obscure details? - Correct answer Vitreous hemorrhage, most commonly caused by diabetic retinopathy. 929. What should you suspect in an infant who presents with cyanosis when feeding but relieved by crying? - Correct answer Choanal atresia. Most common nasal malformation. May be isolated or part of a dysmorphic syndrome. Can't insert a nasal catheter. Dx: CT with intranasal contrast shows narrowing at level of the pterygoid plate. 930. What are female offspring of women who used DES during pregnancy more at risk of? - Correct answer Clear cell adenocarcinoma of the vagina & cervix, as well as cervical anomalies & uterine malformations. 931. *Exposed males are at risk of cryptorchidism, microphallus, hypospadias, & testicular hypoplasia. 932. What are risk factors for endometrial adenocarcinoma? - Correct answer Obesity, nulliparity, late menopause, HTN, DM, chronic unopposed estrogen stimulation, & chronic tamoxifen use. 933. What are risk factors for ovarian cancer? - Correct answer Family hx, nulliparity, & lack of prior OCP use. 934. What condition presents with normal skin at birth, with gradual progression to dry scaly skin? - Correct answer Ichthyosis vulgaris. Hereditary or acquired. Dry & rough skin with horny plates over extensor surfaces of limbs. Worsens in winter. Aka "lizard skin." 935. How to manage a transplant patient (in terms of prophylaxis against infection)? - Correct answer Give oral TMP-SMX, ganciclovir (prevent CMV), and flu, pneumococcus, and hep B vaccines. 936. What're the most common causes of neonatal conjunctivitis? - Correct answer Chlamydia, gonorrhea, & chemicals. Tx of chlamydial conjunctivitis or PNA = 14 days of oral erythromycin (though risk of hypertrophic pyloric stenosis). Prophylaxis = screening P a g e 57 | 63 966. Pinpoint fixed pupils suggest what drug? - Correct answer Opioid overdose. (Cocaine would be dilated pupils.) 967. How can those with hypothyroidism develop carpal tunnel syndrome? - Correct answer Accumulation of matrix substances (mucin, mucopolysaccharide) within both the perineurium of the median nerve as well as the tendons passing through the carpal tunnel. 968. Who can get carpal tunnel syndrome? - Correct answer Besides just an overuse d/o, carpal tunnel syndrome can arise in: pregnancy, hypothyroidism, amyloidosis (deposition of beta 2 microglobulin), rheumatoid arthritis (tenosynovial inflammation), and acromegaly (synovial tendon hyperplasia). 969. What causes central cyanosis, versus peripheral cyanosis? - Correct answer Central cyanosis is caused by low arterial O2 saturation, while peripheral cyanosis is caused by increased O2 extraction 2/2 sluggish blood flow. 970. What condition presents with yellowish streaks on the palms, and severe epigastric pain & n/v after drinking alcohol? - Correct answer Familial dysbetalipoproteinemia -> severe hypertriglyceridemia. Alcohol consumption can case recurrent pancreatitis. Tx: fenofibrate. 971. How do OCPs decrease the risk of ovarian cancer? - Correct answer Reduces the number of lifetime ovulations. Combination OCPs are also associated with a decreased risk of endometrial cancer, but a slightly increased risk of cervical and breast cancer. 972. What's the mnemonic for hyperCa? - Correct answer Bones, stones, groans, & psych overtones. Meaning: bone pain, nephrolithiasis, GI sx's, & neuro sx's. 973. How to manage acute prostatitis? - Correct answer Fluoroquinolone (ofloxacin) for 4-6 wks (long-term tx required for prostatitis). Most often caused by E. coli or Chlamydia. 974. Blood accumulating in which body parts can lead to hypovolemic shock? - Correct answer Thorax, abdomen, pelvis, and femur (fracture). 975. What're the most likely causes of postop fever and when do they occur? - Correct answer Postop day 1: atelectasis. Day 3: UTI. Day 5: DVT. Day 7: wound infection. Days 10-15: deep abscesses. 976. What are risk factors for squamous cell carcinoma of the head & neck? - Correct answer Alcoholism, chronic tobacco use, and infection with HPV (esp types 16, 18, & 30). Erythroplakia & leukoplakia are common precursor lesions. 977. What diagnostic studies should you do with GI bleeding, depending on bleeding rate? - Correct answer Bleeding >2 mL/min: angiogram. Bleeding <0.5 mL/min: wait until bleeding stops and then do a colonoscopy. Bleeding between 0.5-2 mL/min: tagged RBC study. 978. What's the Weber tuning fork test? - Correct answer Tuning fork struck and placed at midline on the skull. A pt with sensorineural hearing loss will hear it louder in the uninjured ear. A pt with conductive hearing loss will hear it louder in the injured ear (background noise decreased). 979. What should you evaluate before starting lithium on a young woman? - Correct answer Thyroid function (can give hypothyroidism), renal function (creatinine), and check for pregnancy. P a g e 60 | 63 980. What's the most common cause of XS postpartum blood loss/hemorrhage? - Correct answer Uterine atony. Initial tx: bimanual uterine massage, fluid resuscitation, uterotonic agents (oxytocin, methylergonovine, carboprost), and blood transfusion as needed. 981. What's the most common cause of hemoptysis in adults with a hx of smoking? - Correct answer Pulmonary airway disease (chronic bronchitis, bronchogenic carcinoma, bronchiectasis). 982. Which patient populations are more prone to getting Staph aureus PNA? - Correct answer Hospitalized pts, nursing home residents, IV drug users, pts with cystic fibrosis, & people with recent influenza infection. 983. How do allergic conjunctivitis and atopic keratoconjunctivitis differ symptomatically? - Correct answer Atopic keratoconjunctivitis is a severe form of ocular allergy. Sx: itching, tearing, thick mucus discharge, photophobia, and blurred vision. Usually allergic conjunctivitis doesn't have visual disturbances. 984. What's dacryocystitis? - Correct answer Infection of the lacrimal sac 2/2 obstruction of nasolacrimal duct. Pain, swelling, tenderness, & redness in tear sac area. +/- mucus or pus expressed. 985. What's the presentation of pontine hemorrhage? - Correct answer Complete paraplegia -> deep coma within a few minutes. Pinpoint pupils that are reactive to light. Decerebrate rigidity. 986. What's the most common site of hypertensive hemorrhages? - Correct answer Putamen. The internal capsule that lies adjacent to the putamen is almost always involved -> contralateral dense hemiparesis (pure motor stroke). 987. How does acyclovir damage the kidneys? - Correct answer Poorly soluble in urine -> precipitates in renal tubules, causing obstruction and acute renal failure. Crystalluria with renal tubular obstruction in large parenteral doses of acyclovir. 988. What are the TORCHES infections, and what sx's are they characterized by? - Correct answer Toxo, rubella, CMV, HSV, HIV, syphilis. Sx's: hepatosplenomegaly, deafness, microcephaly, growth retardation, chorioretinitis, & thrombocytopenia. 989. *Congenital rubella: sensorineural hearing loss, "blueberry muffin" purpura, microcephaly. 990. How do the presentations of edema from hypoalbuminemia and primary glomerular damage (glomerulonephritis) differ? - Correct answer Hypoalbuminemia can cause significant peripheral edema but does NOT usually cause pulmonary edema! Alveolar capillaries have a higher permeability to albumin at baseline (reducing oncotic pressure difference) & greater lymphatic flow than skeletal muscles, protecting the lungs from edema in hypoalbuminemia. Whereas glomerulonephritis can give edema all over. 991. What's the threshold of severe preeclampsia? - Correct answer HTN > 160/110 mmHg, proteinuria > 5g/24hr, oliguria, elevated liver enzymes, thrombocytopenia, & possibly pulm edema. 992. What condition presents with widened mediastinum on CXR and small amount of pericardial fluid on echo, 3 days after cardiac surgery? - Correct answer Acute mediastinitis, usually 2/2 intraop wound contamination. Tx: drainage, surgical debridement with closure, and prolonged abx. 993. How does nephropathy differ between diabetes and HTN? - Correct answer HTN -> nephrosclerosis (hypertrophy & intimal medial fibrosis of renal arterioles). DM -> increased ECM, glomerular BM thickening, mesangial expansion, & fibrosis. P a g e 61 | 63 994. When should you remove the gonads in androgen sensitivity syndrome, versus XY gonadal dysgenesis (Swyer syndrome)? - Correct answer Androgen sensitivity syndrome: remove gonads after puberty (completion of breast development & attainment of adult height), b/c of increased risk for testicular carcinoma in 2nd or 3rd decade. Swyer syndrome: remove gonads immediately b/c malignant change can occur at any age. 995. With what condition does dermatitis herpetiformis arise? - Correct answer Arises in the context of gluten-sensitive enteropathy (celiac). Pruritic papules & vesicles mainly on the elbows, knees, buttocks, posterior neck, & scalp. 996. When is bronchoalveolar lavage most useful? - Correct answer In evaluating suspected malignancy & opportunistic infection. It's a method of sampling lung cells during bronchoscopy. 997. How do you treat acute bleeding in patients with liver failure? - Correct answer Fresh frozen plasma, which has all the clotting factors. (The liver normally synthesizes all the clotting factors except factor VIII.) 998. What're some contraindications to breastfeeding? - Correct answer Active maternal infections like HIV, TB, HSV lesions near nipple, malaria, sepsis, typhoid fever. Eclampsia, nephritis, substance abuse, & breast cancer. 999. What condition presents with a hospitalized patient after a surgery who's been kept NPO for a prolonged period of time and is receiving broad-spectrum abx, who develops bleeding? - Correct answer Vitamin K deficiency, b/c vit K is produced by gut bacteria and from food (absorbed in small intestine). This pt would get neither of these sources. 1000. How would you initially work up erythema nodosum (painful subcutaneous nodules on the anterior lower legs)? - Correct answer CXR (from sarcoidosis, TB, histo, IBD), PPD skin testing, and antistreptolysin-O titer (recent Strep infection is the most common cause). 1001. What predisposes to warfarin skin necrosis? - Correct answer Congenital protein C deficiency. Protein C has a half life of only 9 hrs (vs 60 hrs for other clotting factors), so warfarin can lead to protein C deficiency in the first days of tx -> hypercoagulable state -> thrombus & skin necrosis risks. 1002. What effects do glucocorticoids have on blood cells? - Correct answer Decrease # circulating eosinophils, lymphocytes. Increase neutrophil count by increasing the bone marrow release and mobilizing the marginated neutrophil pool. -> Neutrophilia. 1003. What's the most common complication of chronic inhaled beclomethasone use in asthma? - Correct answer Oral thrush. Dose-dependent effects (from high doses) can lead to: adrenal suppression, cataract formation, decreased growth in kids, interference with bone metabolism, & purpura. 1004. What condition should you suspect in otherwise young healthy patients who develop CHF? - Correct answer Myocarditis. Viral causes are most common, especially with Coxsackie B. 1005. What condition presents with an enlarged non-tender gallbladder, dilated hepatic ducts, and evidence of biliary obstruction (elevated direct bili & alk phos)? - Correct answer Cancer of the head of the pancreas. -> CT abdomen is the first step. Further imaging (ERCP, PTC) may be required, depending. P a g e 62 | 63