All Prep Final

Question 1

32 tyear old woman with chronic constipation. took over the cover agent. alleviated her condition, but afterward she experienced flatuelence abdominal distension, and profuse diarrhea. what is the thing she bought?
a. bisacodyl
b. docusate sodium
c. lactulose
d. methylcellulose

Answer 1

C. Lactulose
Mechanism summary:

Lactulose is a non-absorbable disaccharide. In the colon, bacteria ferment it to short-chain fatty acids, which:

Increase osmotic pressure → water retention → diarrhea (therapeutic effect)

Produce gas → flatulence and distension (side effect)

Question 2

What class of drug is lactulose?

Answer 2

Osmotic laxative (non-absorbable sugar)

Question 3

What is the mechanism of lactulose?

Answer 3

Draws water into the colon osmotically; fermented by colonic bacteria into short-chain fatty acids

Question 4

What is bisacodyl and its main side effects?

Answer 4

Stimulant laxative; increases peristalsis; side effects include abdominal cramping, diarrhea, rarely electrolyte imbalance.

Question 5

What is docusate sodium and its main side effects?

Answer 5

Stool softener; lowers surface tension of stool → easier passage; generally well-tolerated, minimal side effects.

Question 6

Which OTC constipation agent is a fiber-based bulking agent?

Answer 6

Bulk-forming laxative; absorbs water → increases stool bulk; side effects are mild bloating, gas, rarely obstruction if not taken with enough water.

Question 7

Alpha-1 selective blockers (mainly for BPH or hypertension) names

Answer 7

(-zosin) Drugs: Prazosin, Doxazosin, Terazosin, Tamsulosin

Mechanism: Block α1 → relax smooth muscle in blood vessels + bladder neck/prostate

Side effects: Orthostatic hypotension (except tamsulosin less), dizziness, fatigue, nasal congestion

Question 8

Non-selective alpha blockers (block α1 + α2) names and suffix-

Answer 8

-amine → non-selective

Drugs: Phentolamine, Phenoxybenzamine

Mechanism:

Block α1 → vasodilation → ↓BP

Block α2 → ↑ NE release → reflex tachycardia

Side effects: Orthostatic hypotension, reflex tachycardia

Use: Pheochromocytoma (phenoxybenzamine chronic, phentolamine acute)

Question 9

Mnemonic for Phentolamine, Phenoxybenzamine

Answer 9

Phent/Phen → both α’s blocked” → strong vasodilation + reflex tachy

Question 10

side effect of non-selective alpha blockers

Answer 10

Reflex tachycardia, hypotension

Question 11

What is the defect in Glanzmann thrombasthenia?

Answer 11

GpIIb/IIIa receptor decreased → impaired platelet aggregation. less platelet to platelet aggregation

Question 12

male neonate is born in the hospital at 35 weeks via vaginal delivery., physical exam reveals cyanosis of the toes but not the hands. there is a murmur upper sternal border. which answer. a. coacratio of aorta with patent dusctus arteriosis b. coronary av fistula c. pulmonary stenosis with ventricular septal defect d. tetralogy of fallot e. transpotition of great arteries

Answer 12

A. Coarctation of aorta with patent ductus arteriosus

Upper sternal murmur supports aortic outflow turbulence

Differential cyanosis (upper body spared, lower body cyanotic) → hallmark of coarctation with PDA

Question 13

Which nerve provides sensory innervation to the maxillary central and lateral incisors?

Answer 13

Anterior superior alveolar nerve – a branch of the infraorbital nerve (V2, maxillary division of trigeminal nerve).

Supplies: maxillary central & lateral incisors, canine, and associated buccal gingiva.

Clinical note: anesthetized via anterior superior alveolar nerve block or local infiltration.

Question 14

Treatment for gram positive clusters cocci, what is it and what treatment

Answer 14

Vancomycin for empiric coverage of Staphylococcus aureus (including MRSA)

Question 15

old woman with osteoporosis is taking calcium and vitamin D. She is 5’3” and 120 lb. What additional measure is recommended to prevent disease progression?

Answer 15

Begin a daily weight-bearing exercise program

Stimulates bone formation, improves strength, reduces fall risk

Weight loss is not recommended if normal weight

Glucosamine sulfate is not effective for osteoporosis

Calcium and vitamin D should be continued if already adequate

Question 16

Blue dome cyst classic, benign cystic lesion breast

Answer 16

Fibrocystic change

Question 17

Firm, mobile, rubbery breast mass in a young woman. Biopsy shows well-circumscribed lesion with stromal proliferation. Diagnosis?

Answer 17

Fibroadenoma

Question 18

Breast mass with granulomas on biopsy, often with caseous necrosis. May be painful or associated with systemic symptoms. Diagnosis?

Answer 18

Granulomatous mastitis / breast granulomatous inflammation

Etiologies:

Infection (e.g., TB, fungal)

Autoimmune (idiopathic granulomatous mastitis)

Clinical: Painful mass, sometimes nipple discharge

Histology: Granulomas with epithelioid histiocytes; may have multinucleated giant cells

Imaging: Non-specific; may mimic carcinoma

Question 19

Mammogram shows microcalcifications, biopsy shows malignant cells confined to ducts. Diagnosis?

Answer 19

Intraductal carcinoma (DCIS)

Epidemiology: Usually detected on mammogram

Clinical: Usually asymptomatic; may have bloody nipple discharge

Histology: Malignant cells confined to ducts, no invasion of basement membrane

Imaging: Microcalcifications; sometimes mass

Risk: Precursor to invasive carcinoma if untreated

Question 20

Phenylephrine

Answer 20

alpha-1 adrenergic agonist
Effect: Vasoconstriction of nasal mucosa → reduces congestion

Route: Topical nasal spray → mainly local effects, minimal systemic absorption if used correctly

Question 21

why does phenylephrine cause rebound nasal congestions?

Answer 21

Occurs after 3–5 days of frequent topical decongestant use

Mechanism: Downregulation of alpha-1 receptors → nasal mucosa vasodilates → congestion returns worse than baseline

after 2 years causes nasla polyps

Question 22

does phenylephrine cause nasal polyps?

Answer 22

after 2 years not 2 weeks.

Question 23

what is buspirone

Answer 23

Anxiolytic (5-HT1A partial agonist)
Used for generalized anxiety disorder, not acute panic attack; onset days–weeks

Question 24

What do we give for panic attacks and it’s mechanism

Answer 24

Diazepam, GABA-A receptor ↑ Inhibition → sedative, anxiolytic, anticonvulsant- allosterically binds gaba

Question 25

What is HELLP syndrome

Answer 25

Subtype of severe preeclampsia with Hemolysis, Elevated Liver enzymes, and Low Platelets H – Hemolysis EL – Elevated Liver enzymes LP – Low Platelets

Question 26

A 30-year-old man is brought to the emergency department after a fight. He is unconscious with labored breathing. Endotracheal intubation fails due to tracheal obstruction, so a tracheostomy is performed. Which structure must be retracted during this procedure? Options: Epiglottis Esophagus Larynx Parathyroid gland Thyroid gland

Answer 26

Thyroid gland A tracheostomy is made between the 2nd and 4th tracheal rings, just below the cricoid cartilage. The thyroid isthmus lies directly over these tracheal rings. To access the trachea, the thyroid gland (isthmus) must be retracted superiorly or inferiorly, or divided.

Question 27

What happens to the hypothalamic set point during fever?

Answer 27

It increases due to pyrogens (e.g., IL-1, prostaglandin E₂), making the body think it should be hotter.

Question 27

woman has 3 months of fatigue, widespread body pain, poor sleep, and multiple tender points above and below the diaphragm. Her labs and imaging are normal. What is the most appropriate method of diagnosis?

Answer 27

✅ Complete history and physical examination

Question 28

Why do people with fever feel cold and shiver even when their temperature is rising?

Answer 28

Because their core temperature is still below the new, higher set point, so the body generates heat by shivering.

Question 29

What happens if a febrile person is suddenly placed in cold water?

Answer 29

The core temperature drops below the hypothalamic set point, triggering intense shivering (rigors).

Question 30

Someone who is pregnant has some slight anemia- do they have anemia or what?

Answer 30

Normal hematology (physiologic anemia of pregnancy)

Question 31

If the left lateral pterygoid muscle is paralyzed, which way will the jaw deviate when the mouth is opened, and why?

Answer 31

The jaw deviates to the left (the weak side). Explanation: Each lateral pterygoid pulls its condyle forward and medially. When both work → the jaw protrudes straight forward. When only one side works → the active side pulls its condyle forward while the other stays back. The chin swings toward the side that didn’t move (the weak side). 💡 Rule: The jaw deviates toward the side of the lesion of the lateral pterygoid (CN V3).

Question 32

Q: What gene is mutated in Rett syndrome?

Answer 32

A: MECP2 gene on the X chromosome (X-linked dominant).

Question 33

Q: Who is primarily affected by Rett syndrome?

Answer 33

A: Girls — because it’s X-linked dominant and usually lethal in boys.

Question 34

Q: When do symptoms of Rett syndrome usually appear?

Answer 34

A: Between 6–18 months, after a period of normal development.

Question 35

Q: What is the hallmark of Rett syndrome?

Answer 35

A: Regression — loss of purposeful hand movements, loss of speech, social withdrawal.

Question 36

Q: What stereotypic hand movement is characteristic of Rett syndrome?

Answer 36

A: Hand-wringing or hand-washing movements. 🧠 Mnemonic: Rett girls wring their hands in Regret. R – Regression (speech & motor skills) E – Exclusively in girls T – Twisting hand movements (hand-wringing) T – Tiny head (acquired microcephaly)

Question 37

Pyloric stenosis

Answer 37

would show projectile vomiting & palpable olive

Question 38

1. What does “dysmorphic RBCs” mean?

Answer 38

Dysmorphic (misshapen) RBCs indicate that RBCs have been damaged while passing through the glomerulus. This points to a glomerular source of bleeding — not from the bladder or urethra.

Question 39

What imaging finding is characteristic of epiglottitis?

Answer 39

📸 “Thumbprint sign” on lateral neck X-ray (enlarged epiglottis).

Question 40

A 2-year-old unvaccinated child presents with fever, drooling, dysphonia, and dyspnea. She sits leaning forward (tripod position) and appears toxic. What is the most likely cause?

Answer 40

Causes acute epiglottitis (life-threatening airway obstruction). Key features (3 D’s): Drooling, Dysphagia, Distress. X-ray: “Thumbprint sign.” Prevention: Hib vaccine.

Question 41

central, smoking, keratin pearls, intercellular bridges

Answer 41

Squamous cell carcinoma

Question 42

A 56-year-old man presents with fever, shortness of breath, fatigue, and a nonproductive cough. CXR shows diffuse fluffy alveolar infiltrates with no cardiomegaly, no Kerley B lines, and no pleural effusions. ABG shows acute respiratory failure. What is the most likely diagnosis, and what is the most appropriate treatment for his shortness of breath?

Answer 42

➡️ Diagnosis: Acute Respiratory Distress Syndrome (ARDS) ➡️ Treatment: Mechanical ventilation with 100% oxygen (with PEEP) Key clues: Diffuse infiltrates = alveolar damage No signs of left heart failure → noncardiogenic Hypoxemia refractory to O₂ → needs ventilatory support Mnemonic: 🫁 “ARDS = Alveoli Ruined → Demand Support (100% O₂ + PEEP)”

Question 43

A 21-year-old man returns from his honeymoon in Central America with a 2-day history of bloody diarrhea. Stool microscopy shows trophozoites containing ingested RBCs. What is the most likely diagnosis, and what is the appropriate treatment?

Answer 43

Diagnosis: Entamoeba histolytica infection (Amebic dysentery) ➡️ Treatment: Metronidazole kills trophozoites, followed by paromomycin or iodoquinol to eliminate cysts. Key clues: Recent travel Bloody (not watery) diarrhea Flask-shaped ulcers in colon Trophozoites with ingested RBCs Mnemonic: 🩸 “EntAmoeba Eats RBCs” → invasive, bloody diarrhea after travel

Question 44

woman is brought to the emergency department with headache, dizziness, and confusion. Pulse oximetry shows normal oxygen saturation, but co-oximetry confirms carboxyhemoglobin. What is the most likely mechanism causing her symptoms?

Answer 44

Mechanism: Switch to anaerobic metabolism with resulting cell death CO binds hemoglobin with high affinity → prevents O₂ binding and release Causes tissue hypoxia despite normal SpO₂ readings Cells switch to anaerobic metabolism → lactic acidosis → cell injury/death Treatment: 100% oxygen or hyperbaric oxygen therapy → displaces CO from hemoglobin Mnemonic: ☠️ “CO cuts off O₂ → Cells go anaerobic.”

Question 45

What is the correct HVLA thrust direction for upper cervical (C1–C2) dysfunctions?

Answer 45

Thrust toward the opposite eye 👁️

Question 46

What is the correct HVLA thrust direction for lower cervical (C3–C7) dysfunctions?

Answer 46

Thrust toward the opposite shoulder 💪

Question 47

A 45-year-old woman presents with swelling of the left arm. Exam shows a swollen area just distal to the clavicle and enlarged axillary lymph nodes. Venous return from the left upper limb is obstructed. Which lymph node group is most likely causing the impingement?

Answer 47

Apical lymph nodes Explanation: The apical (subclavicular) lymph nodes lie at the apex of the axilla, just distal to the clavicle, near the subclavian vein. Enlargement here can compress the subclavian vein, leading to impaired venous return and arm swelling. Key anatomy: Apical nodes receive lymph from all other axillary groups (pectoral, subscapular, humeral, central). Drain into the subclavian lymph trunk.

Question 48

A 45-year-old woman presents with a 2-month history of cold intolerance, fatigue, and depression. Labs: TSH = 25.0 mcIU/mL (↑) Total T4 = 2.3 mcg/dL (↓) Her symptoms resolve after treatment with the appropriate medication, about half of which is metabolized via which of the following processes? A) 5′-deiodination to triiodothyronine B) Cleavage to 2 diiodotyrosines C) Conversion to tyrosine D) Decarboxylation E) Iodination to reverse triiodothyronine

Answer 48

5′-deiodination to triiodothyronine Levothyroxine (T₄) → T₃ (active) via 5′-deiodination in peripheral tissues (mainly liver and kidney). 💡 Explanation: The patient has primary hypothyroidism, treated with levothyroxine (T₄). Roughly half of circulating T₄ is metabolized by 5′-deiodinase to form T₃, the active thyroid hormone. T₃ is 3–4× more potent than T₄ and mediates most thyroid hormone effects at the cellular level.

Question 49

A 47-year-old man develops a dull, persistent headache 2 weeks after striking his forehead on a windshield in a car accident. Neuro exam is normal. What is the most likely identifiable mechanism of his continuing headache? A) Anterior/posterior sphenobasilar compression B) Bilateral external rotation of the temporal bones C) Facilitated cranial flexion pattern with increased CRI rate D) Frontoparietal (coronal suture) override E) Occipitoatlantal flexion dysfunction

Answer 49

A) Anterior/posterior sphenobasilar compression Explanation: A frontal impact drives the sphenoid posteriorly and occiput anteriorly, compressing the sphenobasilar synchondrosis (SBS). This decreases cranial motion and produces a constant, dull, post-traumatic headache—the hallmark of SBS compression.

Question 50

A 52-year-old woman with rapidly progressive dementia, gait ataxia, and startle-induced myoclonus shows cortical ribboning and basal ganglia hyperintensity on MRI. What is the underlying mechanism of her condition? A) Atrophy of the caudate nucleus and putamen B) Loss of axons and gliosis in the posterior columns C) Loss of cerebellar Purkinje and granule cells D) Spongiform transformation of the cerebral cortex E) Widespread gliosis and myelin degeneration

Answer 50

D) Spongiform transformation of the cerebral cortex Creutzfeldt–Jakob disease (CJD) is a prion disorder characterized by spongiform degeneration of the cortex and basal ganglia, leading to rapidly progressive dementia, myoclonus, and ataxia.

Question 51

What is the histopathologic feature described as atrophy of the caudate nucleus and putamen, and which condition is it associated with?

Answer 51

Huntington disease Explanation: Caused by CAG trinucleotide repeat expansion in the HTT gene on chromosome 4. Leads to neurodegeneration of the caudate and putamen (neostriatum). Produces chorea, psychiatric symptoms, and progressive dementia. MRI: enlarged lateral ventricles due to caudate atrophy.

Question 52

Loss of cerebellar Purkinje and granule cells is most characteristic of which neurologic condition?

Answer 52

Cerebellar degeneration (alcoholic or paraneoplastic) Explanation: Alcoholic cerebellar degeneration → due to thiamine deficiency and ethanol toxicity. Paraneoplastic cerebellar degeneration → autoimmune (anti-Yo, anti-Hu antibodies). Leads to truncal and gait ataxia, dysmetria, intention tremor, but no dementia or myoclonus.

Question 53

A 25-year-old man presents with tremor, photophobia, nausea, headache, tachycardia, and dilated pupils 2 days after returning from a vacation with heavy alcohol use. What is the most likely cause of his symptoms? A) Alcohol withdrawal B) Cocaine overdose C) Food poisoning D) Opiate withdrawal E) Sleep deprivation

Answer 53

A) Alcohol withdrawal Explanation: Abrupt cessation of heavy alcohol intake leads to CNS hyperexcitability due to loss of GABAergic inhibition and unopposed glutamate activity. Symptoms typically begin within 6–24 hours and peak at 48–72 hours after the last drink, including tremors, anxiety, tachycardia, nausea, and headache.

Question 54

Euphoria, agitation, restlessness, paranoia Tachycardia, hypertension, chest pain (can cause MI or arrhythmias) Dilated pupils, diaphoresis, hyperthermia, possible seizures

Answer 54

Cocaine blocks reuptake of dopamine, norepinephrine, and serotonin, leading to excess sympathetic stimulation.

Question 55

Anxiety, restlessness, yawning, lacrimation, rhinorrhea Piloerection (goosebumps) Abdominal cramps, diarrhea, nausea Dilated pupils, sweating, muscle aches

Answer 55

6–48 h after last dose opiate withdrawal

Question 56

A 57-year-old woman has tinnitus, vertigo, and aural fullness with normal ear exam findings and an externally rotated right temporal bone. What is the most likely cause of her symptoms? A) Acoustic neuroma B) Central demyelination C) Increased intralabyrinthine pressure D) Tumor of the vestibular nerve E) Vasospasm of the vertebrobasilar artery

Answer 56

C) Increased intralabyrinthine pressure Ménière disease (endolymphatic hydrops) results from increased endolymphatic pressure in the inner ear, leading to episodic vertigo, tinnitus, and aural fullness. External rotation of the temporal bone can contribute by altering the position of the endolymphatic sac, impeding endolymph drainage.

Question 57

increased intralabyinthine pressure is what

Answer 57

Increased intralabyrinthine pressure refers to excess buildup of endolymph (inner ear fluid) within the membranous labyrinth of the inner ear. This condition is also called endolymphatic hydrops, and it’s the key pathophysiologic mechanism of Ménière disease.

Question 58

A 35-year-old woman one day after laparoscopic cholecystectomy has mild abdominal pain and no bowel movement. Inhibitory techniques to which spinal levels would help prevent worsening of her symptoms? A) C3–C5 B) C7–T3 C) T6–L2 D) L3–L5 E) S1–S3

Answer 58

C) T6–L2 Inhibitory or rib-raising techniques at T6–L2 reduce sympathetic tone to the intestines, restoring parasympathetic dominance and improving bowel motility after surgery — helping to prevent postoperative ileus.

Question 59

A fetus with a 69,XXY karyotype is found to have syndactyly, microcephaly, and a cystic placenta. What is the mechanism of this abnormality?

Answer 59

Triploidy — presence of an extra haploid set of chromosomes (3n = 69) due to dispermy (fertilization by two sperm). Leads to partial hydatidiform mole and is lethal in utero.

Question 60

Q: What type of diverticulum is Zenker’s diverticulum?

Answer 60

A: A false diverticulum — it contains only mucosa and submucosa, not all layers of the wall.

Question 61

Zenker’s diverticulum occurs between which two muscles?

Answer 61

Between the thyropharyngeus (above) and cricopharyngeus (below) parts of the inferior pharyngeal constrictor.

Question 62

Q: What is the weak area where Zenker’s diverticulum forms called?

Answer 62

A: Killian’s dehiscence (Killian’s triangle).

Question 63

What is the mechanism of tissue injury in Rocky Mountain Spotted Fever?

Answer 63

A: Rickettsia rickettsii invades vascular endothelial cells, causing vasculitis, increased vascular permeability, and microhemorrhages. Explanation: The organism enters endothelial cells via induced phagocytosis, escapes the phagosome, and multiplies in the cytoplasm. Endothelial injury leads to leakage of blood components and the characteristic petechial rash.

Question 64

Q: What are the classic clinical features of Rocky Mountain Spotted Fever?

Answer 64

Fever, headache, myalgia (flu-like prodrome) Petechial rash that begins on wrists and ankles and spreads to trunk, palms, and soles History of tick exposure (Dermacentor tick) in the southeastern or western United States Explanation: The rash pattern reflects the underlying vasculitis in small dermal vessels, and its spread toward the trunk is a hallmark clue for RMSF on exams.

Question 65

How is Rocky Mountain Spotted Fever diagnosed and treated?

Answer 65

Clinical diagnosis (do not delay for serology) Treatment: Doxycycline (first-line for all ages) Explanation: Early doxycycline dramatically reduces mortality. Even in children, the benefits outweigh the risk of tooth discoloration. Lab findings may show thrombocytopenia, hyponatremia, and elevated liver enzymes due to endothelial damage.

Question 66

S₃ is caused by

Answer 66

rapid passive filling of a volume-overloaded ventricle, leading to oscillation of blood and the ventricular wall.

Question 67

S₄ causes

Answer 67

S₄: Pressure overload → late diastole → stiff ventricle (e.g., LV hypertrophy, hypertension)

Question 68

What causes ascites in liver cirrhosis?

Answer 68

Combination of portal hypertension, hypoalbuminemia, and secondary hyperaldosteronism, leading to sodium and water retention.

Question 69

What age do you give hpv vaccine

Answer 69

11-12 years before sexual activity

Question 70

Initial management of supraspinatus impingement?

Answer 70

Activity modification + NSAIDs + physical therapy. Explanation: Focus on rotator cuff strengthening and correcting scapular mechanics; OMT to balance shoulder and thoracic motion.

Question 71

Initial management of supraspinatus impingement?

Answer 71

Activity modification + NSAIDs + physical therapy. Explanation: Focus on rotator cuff strengthening and correcting scapular mechanics; OMT to balance shoulder and thoracic motion.

Question 72

paramesonephric (Müllerian) ducts develop into:

Answer 72

Uterine tubes (fallopian tubes) Uterus Cervix Upper portion of the vagina

Question 73

new mass in axillary after pregnancy

Answer 73

accessory breast tissue

Question 74

Q: What is the greatest risk in a trauma patient with DIC?

Answer 74

A: Hemorrhage. ✅ Explanation: Depletion of clotting factors and platelets leads to uncontrolled bleeding — especially at surgical or wound sites.

Question 75

What histologic finding is characteristic of Alzheimer Disease?

Answer 75

A: Neuritic (senile) plaques made of β-amyloid and neurofibrillary tangles of hyperphosphorylated tau. Explanation: These abnormal protein accumulations disrupt synaptic transmission and lead to neuronal death.

Question 76

What virus commonly causes severe respiratory distress with wheezing in immunocompromised adults after child exposure?

Answer 76

Respiratory Syncytial Virus (RSV) ✅ Explanation: RSV is highly contagious and causes bronchiolitis in children and severe pneumonia or wheezing in adults with weakened immunity.

Question 77

How is RSV transmitted?

Answer 77

Via respiratory droplets and direct contact with secretions or contaminated surfaces. Explanation: The virus is not airborne but can survive on hands and fomites for hours.

Question 78

Levator scapulae function

Answer 78

Lift the scapula and lean the head toward it.

Question 79

Holosystolic murmur over the left fifth intercosttal space in the midclavicular

Answer 79

mitral regurgitation

Question 80

A patient presents with fever, chills, and malaise after recent travel to an endemic area. Labs show anemia (hematocrit 30%), and a peripheral smear shows intraerythrocytic ring forms or trophozoites. Question: What is the vector for this disease?

Answer 80

Mosquito

Question 81

What is the primary function of the psoas major?

Answer 81

Hip flexion

Question 82

A hypertonic or shortened psoas muscle restricts which hip motion?

Answer 82

Extension. ✅ Explanation: Because the psoas is a flexor, contraction limits its opposite movement.

Question 83

What postural finding is often seen with psoas hypertonicity?

Answer 83

Increased lumbar lordosis and anterior pelvic tilt. ✅

Question 84

What spinal levels are commonly affected by a right psoas spasm?

Answer 84

L1–L2 rotated and sidebent toward the side of the tight psoas (right).

Question 85

What does a BUN/Creatinine ratio > 20:1 indicate?

Answer 85

Prerenal azotemia — due to decreased renal perfusion (e.g., dehydration, heart failure, shock, GI bleed).

Question 86

Q: What condition are broad waxy casts most associated with?

Answer 86

A: End-stage renal disease (ESRD)

Question 87

: What are the symptoms of primary coccidioidomycosis?

Answer 87

Flu-like illness: fever, cough, chest pain, fatigue, arthralgias, erythema nodosum (“desert bumps”).

Question 88

Q: What is the treatment for coccidioidomycosis?

Answer 88

Mild cases: often self-limited Severe/disseminated: fluconazole or amphotericin B

Question 89

Q: What does Coccidioides look like under the microscope?

Answer 89

A: Large spherules filled with endospores in tissue (not yeast forms).

Question 90

Where in the United States is Coccidioidomycosis (Valley Fever) most common?

Answer 90

Southwestern United States, especially: Arizona (highest incidence) California’s San Joaquin Valley (Central Valley) Also found in parts of New Mexico, Texas, and Nevada Endemic areas have hot, dry climates with sandy soil — ideal for Coccidioides growth.