1
Q
acute bronchitis –> clinical presentation
A
- 5day-3wk
- productive cough
- wheeze/rhonchi
- tender chest wall
- no systemic findings
2
Q
definition of resistant HTN
A
persistent HTN despite >3 antiHTN agents
3
Q
systolic-diastolic abd bruit –> condition?
A
renal A stenosis –> renovasc HTN
4
Q
HBV infect –> how dx?
A
- HBsAg
- IgM anti-HBc
5
Q
pleural effusion –> findings?
- breath sounds
- tactile fremitus
- percussion
A
- decreased breath sounds
- decreased tactile fremitus
- dull to percussion
6
Q
nonsmoker w/out pulm dz –> chronic cough –> 3 MC causes?
A
- postnasal drip
- GERD
- asthma
7
Q
suspect postnasal drip (upper airway cough synd) –> dx?
A
dx by empiric tx:
- oral 1st gen antihist (chlorpheniramine)
- combined antihist-decong (brompheniramine + pseudoephedrine)
8
Q
gout d/t increased urate production –> cause (4)?
A
- 1ary gout
- myeloprolif/lymphoprolif dz
- tumor lysis synd
- hypoxanthine guanine phosphoribosyl transferase def
9
Q
polycythemia vera –> ssx
A
- aquagenic pruritis
- HA
- HSM
10
Q
S4 –> represents what? indicates?
A
blood hit stiff/hypertrophic LV
LVH
11
Q
ischemic stroke w no prior antiplatelet tx–> tx?
A
ASA w/in 24hr to reduce recur
12
Q
stroke on ASA tx –> tx?
A
ASA + dipyridamole/clopidogrel
13
Q
common variable immunodef –> pathophys?
A
- impaired B cell diff
- hypogammaglobulin
- -> increased susceptibility to bact infect
14
Q
CVID –> clinical manifestation
A
- recurrent infect: resp, GI
- autoimmune dz
15
Q
CVID –> dx?
A
- quantitative measurement of Ig level –> sig decreased IgG, decreased IgA/IgM
- no response to vaccine
16
Q
adult –> recurrent bact infect –> condition?
A
common variable immunodef
17
Q
warfarin –> excess anticoag –> tx?
A
- IV vitK
- prothrombin complex concentrate
18
Q
situational syncope –> pathophys
A
reflex or neurally-med syncope:
trigger –> micturition, defecation, cough –> alter autonomic response –> cardioinh/vasodepressor/mixed response
19
Q
acute bact prostatitis –> ssx
A
- UTI ssx
- perineal pain
- pronounced systemic ssx (fever, chills, acute illness)
- tender, boggy prostate
20
Q
acute bact prostatitis –> dx
A
mid-stream urine sample
21
Q
acute bact prostatitis –> empiric tx
A
- TMP/SMX
- fluoroquinolones
22
Q
acute bact prostatitis –> trt for how long?
A
4-6wk
23
Q
mult sclerosis –> acute exacerbation –> tx?
A
- high dose IV glucocorticoids
- plasma exchange if not response to steroid
24
Q
pit microadenoma –> galactorrhea –> tx?
A
symptomatic prolactinoma –> dopaminergic agonist (cabergoline, bromocriptine) –> lower prolactin level, reduce tumor size
25
RBC transfusion --> 2hr later --> chills, malaise --> condition?
febrile nonhemolytic transfusion rxn
26
febrile nonhemolytic transfusion rxn --> how long after RBC transfusion?
1-6hr
27
febrile nonhemolytic transfusion rxn --> what could have prevented this?
leukoreduction
28
S3 --> indicates?
heart fail
29
invasive pulm aspergillosis --> clinical presentation
classic triad:
- fever
- pleuritic chest pain
- hemoptysis
30
invasive pulm aspergillosis --> CT finding
halo sign: nodules w surrounding ground glass opacity
31
invasive pulm aspergillosis --> tx
voriconazole + echinocandin (caspofungin)
32
invasive pulm aspergillosis --> RF?
immunocomp:
- neutropenia
- glucocorticoids
- HIV
33
curtain came down over eye --> condition?
retinal detach
34
retinal detach --> ssx
- photopsia (flashes of light)
- floaters (spots in visual light)
- curtain coming down over eye
- gray retina
35
1st deg AV heart block --> EKG finding
prolonged PR interval
36
abd aortic aneurysm --> RF assoc w aneurysm expansion & rupture (3)
- lrg diameter
- rate of expansion
- current cigarette smoke
37
abd aortic aneurysm --> when endovasc repair?
- aneurysm size >5.5cm
- rapid rate of aneurysm expansion
- presence of ssx: abd/back/flank pain, limb ischemia
38
MC drug that cause priapism
prazosin
39
appearance: squamous cell carcinoma vs basal cell carcinoma
SCC: nodule --> keratinized (thick, rough) or ulcerate w crusting/bleeding
BCC: pearly flesh/pink nodule w telangiectatic vessels
40
organ transplant --> chronic immunosupp tx --> #1 skin malig?
SCC
41
asplenia --> why at risk for infect w encapsulated bact?
deficit in:
- Ab-med phagocytosis
- Ab-med complement activation
42
raise cutoff level of dx test --> what happens to:
- false neg
- true pos
- true neg
- false pos
- sens
- specificity
```
FN: increase
TP: decrease
sens: decrease
TN: increase
FP: decrease
spec: increase
```
43
young F --> ant knee pain --> condition?
patellofemoral pain synd
44
patellofemoral pain synd --> cause
- chronic overuse
| - malalignment
45
patellofemoral pain synd --> tx
- activity modification
- NSAID
- stretch, strengthen exercise: quad, knee extensor, hip abductor
46
patellofemoral pain synd --> positive for what test?
patellofemoral compression test
47
vasospastic angina --> tx?
- smoking cessation
| - CCB (diltiazem)
48
common abx options for anaerobe coverage (3)
- metronidazole w amoxicillin
- amoxi-clavulanate
- clindamycin
49
solid organ transplant --> systemic illness involving mult organ systems --> pneumonitis, hepatitis, gastroenteritis --> condition?
CMV viremia
50
CMV --> dx?
PCR
51
brain death: charact findings
- absent cortical & brainstem fxs
| - spinal cord may still be fxing --> normal DTR
52
when? 13-valent pneumococcal vaccine. 23-valent?
>65yo: 13-valent 1x --> then 23-valent
If <65yo --> current smoke, chronic med condition --> 23-valent
53
recurrent nose bleed + oral lesions --> must think of what vasc condition?
hereditary telangiectasia (Osler-Weber-Rendu synd)
54
hereditary telangiectasia (Osler-Weber-Rendu synd) --> characteristics (3)
- diffuse telangiectasia
- recur epistaxis
- widespread AVM
55
hereditary telangiectasia (Osler-Weber-Rendu synd) --> pulm AVM --> manifests as?
- hemoptysis (can be fatal)
| - R to L shunt --> chronic hypoxemia --> reactive polycythemia
56
external hordeolum --> MC org?
staph aureus (but can be sterile)
57
external hordeolum --> tx?
warm compress
58
adult --> #1 cause of gross lower GI bleed
diverticulosis
59
HIV --> fever, HA, bilat papilledema --> condition?
cryptococcal meningitis
60
cryptococcal meningitis --> how dx?
CSF:
- cryptococcal antigen
- org isolation
61
cushing synd --> 3 main charact
- wt gain
- muscle weak
- HTN
62
cushing synd --> catabolic effect on connective tissue --> leads to what ssx (3)?
- easy bruise
- dermal atrophy
- striae
63
cushing synd --> hyperandrogenism --> why?
co-secretion of adrenal androgens w cortisol
64
cushing synd --> co-secrete adrenal androgens --> leads to what ssx (3)?
hyperandrogenism:
- menstrual irreg
- acne
- hirsutism
65
what is severe hyperCa?
>14mg/dL
66
severe or symptomatic hyperCa --> immed tx?
aggressive NS hydration + calcitonin
67
severe or symptomatic hyperCa --> longterm tx?
bisphosphonate (zoledronate)
68
severe hyperCa --> vol depletion --> why?
- hyperCa induced nephrogenic DI --> polyuria
| - GI distress --> decreased oral intake
69
hyperCa --> main charact (3)?
- weak
- GI distress
- neuropsych ssx
70
indications for cystoscopy (6)
- gross hematuria --> but no glomerular dz/infect
- microscopic hematuria + bladder CA RF
- recurrent UTI
- obstruct ssx --> suspect stricture, stone
- irritative ssx --> but no urinary infect
- abnormal bladder image, urine cytology
71
thrombotic thrombocytopenic purpura --> classic pentad
- thrombocytopenia
- microangiopathic hemolytic anemia
- renal insuff
- neuro change
- fever
72
thrombotic thrombocytopenic purpura --> pathophys
hereditary or acq (autoAb) --> low ADAMTS13 --> lrg vWF multimers --> small vessel thrombi --> shear RBC, end organ damage (renal, CNS)
73
thrombotic thrombocytopenic purpura --> tx
emergent plasma exchange
74
bronchiectasis --> pathophys
infect + impaired bact clearance --> recurrent infect, inflamm, tissue damage --> bronchial wall damage --> airway thicken & dilation
75
bronchiectasis --> ssx
similar to chronic bronchitis:
- cough
- daily mucopurulent sputum
- rhinosinusitis
- dyspnea
- hemoptysis
- crackles, wheeze
76
bronchiectasis --> how dx?
high res chest CT
77
acyclovir --> can cause what kind of renal AE?
crystalluria --> renal tubular obstruct --> crystal induced acute kidney injury
78
modified wells criteria --> likely PE --> next step?
1) anticoag (LMW or unfract hep)
| 2) confirmatory diag test
79
neurofibromatosis type 1 --> eye complication?
optic glioma
80
immunocomp --> bact meningitis --> common org (4)
- S pneumo
- N meningitidis
- Listeria
- G- rods
81
immunocomp --> bact meningitis --> tx?
empiric abx + dexamethasone
82
immunocomp --> bact meningitis --> empiric abx
vancomycin + ampicillin + cefepime
83
immunocomp --> bact meningitis --> trt w dexamethasone --> why?
prevent neurologic comp of S pneumo meningitis (deaf, focal deficit) --> d/c when r/o pneumococcal meningitis
84
bact meningitis --> empiric abx --> vancomycin + cephalosporin --> why vancomycin?
cover cephalosporin-resistant pneumococci
85
SLE --> renal comp?
- glomerulonephritis --> nephritic synd
| - membranous glomerulonephritis --> nephrotic synd
86
SLE --> glomerulonephritis --> pathophys? significant lab result?
ds-DNA/Ab immune complex --> deposit in mesangium/subendo space --> intense inflamm rxn --> activate complement --> low C3, C4
87
fever, back pain, focal spinous tenderness --> condition?
vertebral osteomyelitis
88
vertebral osteomyelitis --> workup?
- blood culture
- ESR/CRP
- XR
89
vertebral osteomyelitis --> how dx? how confirm dx?
MRI --> CT-guided bone bx
90
adult --> parvovirus B19 --> arthritis --> where?
symm polyarticular: hand, wrist, knee, feet
91
mult myeloma --> renal involvement --> pathophys?
excessive monoclonal protein --> deposit in renal tubule --> renal insuff
92
myasthenia gravis --> pyridostigmine --> still symptomatic --> next step?
add chronic immunosupp therapy (corticosteroid, azathioprine, mycophenalate mofetil)
93
61yo --> low back pain --> nocturnal pain, wt loss --> next step?
XR
94
LBP --> when do XR (3)?
- osteoporosis/compression fx
- suspected malig
- ankylosing spondylitis
95
ankylosing spondylitis --> LBP charact (3)?
- insidious onset
- nocturnal pain
- better w mvmt
96
LBP --> when do MRI (3)?
- sensory/motor deficit
- cauda equina synd
- suspected epidural abscess/infect
97
chikungunya fever --> presentation
- flu-like illness
- symm polyarthralgia
- limb & trunk --> macular or maculopapular rash
- peripheral edema
- cervical LAD
98
chikungunya fever --> lab results
- lymphopenia
- thrombocytopenia
- elevated LFT
99
chikungunya fever --> transmission?
mosquito-borne viral illness
100
aging adult --> small, red, cutaneous papule --> condition?
cherry hemangioma
101
what produces early decrescendo diastolic murmur?
AR
102
bicuspid aortic valve --> can lead to what in young pt? old pt?
young: AR
old: AS
103
how can bicuspid aortic valve lead to sudden death?
bicuspid aortic valve --> aortic root or ascending aorta dilation --> aortic aneurysm --> dissection --> sudden death
Step 2
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