Third Year Shelf > IM > Flashcards

IM Flashcards

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1
Q

Pigmented gallstones

A

Caused by chronic hemolysis such as from hereditary spherocytosis

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2
Q

Fever, severe body aches, marked fatigue, 2 days, non-productive cough, and nasal congestion. Tonsillar erythema but no exudate. Anterior cervical LN are mildly tender to palpation

Acute nasopharyngitis
Acute retroviral syndrome
Commonunity acquired pneumonia
Influenza
Streptococcal pharyngitis
A

Influenza

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3
Q

Acute nasopharyngitis

A

Common cold

Rhinitis and nasal congestion

Fever uncommon in adults

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4
Q

Acute retroviral syndrome

A

High fevers, myalgias and malasie

Pronounced and generalized non-tender lymphadenopathy

Painful mucous membrane ulcerations

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5
Q

Streptococcal pharyngitis

A

Group A strep

High fever, anterior cervical lymphadenopathy and severe pharyngitis with tonsillar exudates

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6
Q

34 y.o w/ painful finger. Throbbing. Smokes two packs a day for 15 years. Second digit on right hand is dark purple in color and 3 mm erythematous superficial ulceration at tip of second digit on right

Decreased sensation on palmar aspect. Strength and reflexes in tact. Right radial pulse diminished

A

Thromboangiitis obliterans

Digit ischemia and associated ulceration is common presenting sign

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7
Q

Livedo reticularis

A

Purple colored lace-like discoloration of the skin

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8
Q

Peripheral artery disease

Diagnose?

A

Atherosclerotic plaques

Affects lower extremities

Crampy pain w/ exertion or rest pain, diminished pulses and ulceration if long standing

ABI test

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9
Q

Polyarteritis nodosa

A

Necrotizing vasculitis

Present with systemic symptoms (WL, fatigue, fever, arthralgias) signs of multisystem involvement

Tender nodules or purpura
HTN
Renal insufficiency
Abdominal pain
Neurological dysfunction
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10
Q

Sepsis vs septic shock

A

Sepsis

  • Fever
  • Leuocytosis
  • Hypotension
  • Tachycardia

Septic shock

  • sepsis
  • elevated lactate >2 mmol
  • hypotension
  • requires vasopressor tharpy
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11
Q

Bacteremia

A

Bacteria in blood documented by positive cultures

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12
Q

Interstitial cystitis

A

Known as bladder pain syndrome

Unpleasent pain or pressure involving bladder

Suprapubic pain or spasm, urinary frequency and urgency

Symptoms worse when bladder full and relieved by voiding

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13
Q

Hypomagnesemia leads to

A

Refractory hypokalemia

Hypomagnesemia (mg < 1.6)

Leads to renal potassium wasting

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14
Q

Medication induced hypokalemia associated with

A

Insulin use

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15
Q

Third heart sound that sounds like a plop in mid-diastole

A

Left atrial myxoma

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16
Q

AA w/ chest pain, painful extremities, productive cough, bilateral conjuctival icterus

A

Sickle cell disease

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17
Q

Methylmalonic acid level is elevated in

A

Vitamin B12 deficiency

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18
Q

First step in acute urinary retention secondary to benign prostatic hyperplasia

A

Decompress the bladder

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19
Q

Eosinophilia and chronic ulcer in person from middle east

Leishmania major
Paracoccidioides lutzii
Schistosoma mansoni
Treponema pallidum pertenue
Trichinella spiralis
A

Leishmania major

Sandfly bites

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20
Q

Paracoccidioides lutzii

A

Eosinophilia and cutaneous ulcerations similar to leishmaniasis

but confined to south africa

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21
Q

Eosinophilia, Middle east, intensely purpuric, scabies like cutaneous larva migrans

A

Schistosoma mansoni

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22
Q

Africa
chronic ulcer
Normal eosinophilia

A

Treponema pallidum pertenue

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23
Q

Hunter who consumes undercooked game meat

Myalgia

Eosinophilia

A

Trichinella spiralis

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24
Q

First step in evaluation of an acute stroke

A

head CT scan w/o contrast to rule out hemorrhage

Brain MRI w/o contrast second

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25
Brain aneurysm imaging
Brain MR angiography
26
Brain MRI w/ contrast
Brain lesions Brain abscess, toxoplasmosis, and tumor
27
What decreases mortality in patients w/ COPD w/ chronic hypoxemia
Supplemental oxygen
28
Tx acute exacerbations of chronic COPD
10 days oral corticosteroid therapy
29
42 y.o male headaches, decreased vision. Baseball caps no longer fit. Coarse facial features and bitemporal hemianopia. What hormone Confirm diagnosis with?
Growth hormone Acromegaly Pituitary adenoma Confirm diagnosis w/ serum insulin like growth factor I level
30
Excess aldosterone leads to
Hypokalemia | Hypertension
31
Pathyophysiology of BPH
1) Obstruction: where the enlarged prostate obstructs the lumen of the urethra and increase resistance to urine flow Due to obstruction and increased pressure --> detrusor muscle thickening and decreased bladder compliance.
32
Patient with urinary frequency or urinary incontinence with history of stroke, MS or spinal cord injury
Neurogenic bladder Diminished sphincter tone on PE
33
Symmetric scaly flaking plaque like lesions on areas on skin with sebaceous glands ( scalp, eyebrows, eyelashes, beard) Tx
Seborrheic dermatitis Selenium sulfide (antifungal shampoo) or ketoconazole
34
Coal tar used for
removal of thick plaques
35
Isotretinoin
systemic therapy reserved for refractory seborrheic dermatitis Suppresses sebaceous gland activity
36
Joint pain, gradual loss of libido. Progressive aching in hands. Tanned skin. Non-tender hepatomegaly with normal sized spleen. No lymphadenopathy Highly elevated AST Elevated ALT Elevated iron Low TIBC Tx Risk of developing
Hemochromatosis Phlebotomy Second line: deferoxamine Congestive heart failure Cirrhosis Hepatocellular carcinoma [Siblings who die of liver or heart disease] Order iron studies
37
Interferon alpha
tx for chronic hepatitis C
38
Penicillamine
Anticopper tx for Wilson's disease ``` Liver disease - elevaed AST/ALT Neurologic disorder - tremor -dystonia Psychiatric illness ```
39
2 day hx w/ gait difficulty. 2 weeks ago had dry cough and low grade fever. Developed bilateral lower extremity weakness Tx
Guillain-Barre Acute demyelinating neuropathy Intravenous immune globulin or plasma exchange
40
Bullseye rash Facial nerve palsy Tx
Lyme disease Oral doxycycline
41
Proximal muscle weakness Ptosis Diplopia Dysphagia Worse with repeat muscle use Tx
Myasthenia gravis Oral pyridostigmine Acetyl cholinesterase inhibitor
42
Empiric therapy for patients with uncomplicated mild case of pyelonephritis
Ciprofloxacin Fluoroquinolone
43
Tx cystitis
ORal nitrofurantoin
44
Patient w/ renal insuffiency who develops elevated potassium level Tx
Hyperkalemia If experiencing concerning ECG changes calcium should be administered immediately (cardioprotective and prevents arrhythmias) Followed by insulin and glucose And sodium polystyrene sulfonate to normalize potassium level
45
Painful blistering lesions. Erupt easily. Epidermis easily detaches from skin. IgG and C3 deposits in the epidermis
Pemphigus vulgaris Nikolsky sign : epidermis easily detached from skin
46
Bullous pemphigoid
Blistering disease Subepithelial blistering and presence of IgG and C3 deposition in linear pattern along BM Not fragile blisters
47
Chronic pruritic papulovesicular lesions and urticara on extensor surfaces Papule or vesicle formation followed by excoriation and crusting Group together IgA deposits
Dermatitis herpetiformis
48
Erythema multiforme
Hypesensitivity skin rxn Target appearance 20-40 y.o Herpes simplex or mycoplasma pneumoniae or certain drugs (barbs, nsaids, penicillins, sulfonamides)
49
Blisters, pruritic vesicles, papules and bullae that appear on extensor surfaces Excoriation of lesions Linear IgA deposition along BM
Linear IgA dermatosis
50
Tx chronic sinusitis
Amoxicillin/ clavulanate or cephalosporin 21 days
51
Acute sinusitis that worsens after 5 days or persists after 10
S. pneumoniae H. influenza Moraxella catarrhalis Tx Amoxicillin/ clavulanate or cephalosporin 10 days
52
AA w/ no signs of infection but low leukocytes and neutrophils
Chronic benign neutropenia
53
Paraneoplastic hypercalcemia has an increase of
Parathyroid hormone-related protein [Not Serum intact parathyroid hormone will be low]
54
ACTH causes release of
cortisol
55
34 y.o with headaches. Using kerosene heater to stay warm. Elevated hemoglobin, Hematocrit. Erythropoietin is elevated Appropriate next step
Polycythemia Hemoglobin > 18.5 M > 16.5 F Hematocrit > 52% M > 48% F Carbon monoxide poisoning causes secondary polycythemia with elevated erythropoietin level Assay for blood carboxyhemoglobin greater than 5% is diagnostic
56
Polycythemia vera
Myeloproliferative disorder Low EPO Polycythemia Severe pruritus after shower transient visual disturbances Painful red pruritic palms JAK2 mutation
57
URI followed by eye pain, redness, burning or tearing that spreads from one eye to the other No vision changes
Acute conjunctivitis
58
Eye pain, blurry vision in patient with UC, Crohns, psorasis, ankylosing spondylitis, or sarcoidosis
Anterior uveitis tx corticosteriods
59
Asymptomatic, increased cup to disc ratio
Open angle glaucoma Tx prostaglandin analogs (latanoprost) or topical beta blockers (timolol)
60
Type of polyp to form colorectal cancer
Sessile villous adenoma tubular adenomas < tubulovillous adenomas < villous adenomas
61
Elevated pulmonary arterial pressure tx ``` Albuterol Heparin Prednisone Sildenafil Theophylline ```
Sildenafil Potent vasodilator Tx for primary pulmonary htn
62
Incidental finding of 4 mm mass on right kidney. Uniform density, round, unilocular and no perceptible wall It does not enhance after contrast Management?
No intervention now; reevaluate if symptoms change
63
Methotrexate SE
Hepatotoxic Myelosuppression Pancytopenia
64
64 y.o 2 wk history gradually incrasing back pain radiates to RUQ. Stabbing. Rash appeared yesterday. Erythematous papules and bullae Management?
Begin valacyclovir
65
Anti-mitochondrial antibody testing
Confirm primary biliary cholangitis Present with - cirrhosis elevated alk phos jaundice, fatigue, pruritius
66
Peripheral sensory neuropathy due to what deficiency Decreased sensation in feet. Numbness and burning
Vit B6 Isoniazid classic cause fo Vit B6 deficiency
67
Peripheral neuropathy w/ ataxia, increasing confusion and delirium Weakness in stocking-gllove Diminished reflexes Nystagmus
Vitamin B1 (thiamine)
68
Peripheral neuropathy spasticity and dementia. Ataxia loss of vibration and proprioception of lower extremities Hyperactive reflexes Positive Babinski
B12 def
69
Africa, flu like, rash on stomach and back spread to arms and legs Fever Confusion ``` Clostridium perfringens Human T cell lymphotropic virus Rickettsia prowazekii Salmonella typhi Streptococcus pyogenes ``` - Source - Diagnosis - Tx
Rickettsia prowazekii Human louse borne (flea) Indirect immunofluorescence and ELISA Tx doxycycline
70
Solitary blanching pink papules on trunk, HA, cough, fever, abdominal pain, constipation or pea soup diarrhea 7-10 days
Salmonella typhi
71
75 y.o new onset SOB over 2 months, dry cough, takes hydrochlorothiazide, simvastin, warfarin and amiodarone. CXR diffuse bilateral infiltrates with a ground glass appearance. PFR at 70%
Medication toxicity w/ amiodarone Ground glass Foamy
72
Patietn with mulitplesmall brown cicular macules on body. Skin color papules on back. Test to do
Slit lamp Neurofibromatosis (NF) Looking for iris hamartomas and optic gliomas
73
Cafe au lait macules Fibrous skeletal dysplasia precocious puberty Test
McCune-Albright syndrome Hormone studies - elevated testosterone (M) - elevated estrogen (F) - low levels of FSH and LH
74
HA, intolerance to light, hiking in woods in wisconsin. Targetoid plaque on arm spontaneously recovered in a week. Flexion of neck causes hip and knee to flex What should be administered
Ceftriaxone Lyme meningitis - 28 day IV ceftriaxone
75
16 y.o with yellow firm papules on both arms from elbow to mid forearm and inferior margin of butt Tender to palpation and non-blanching What also do you expect to find
Palpable fusiform mass on Achilles tendon Xanthomas are skin or tendon nodules of abnormal lipid deposition are characteristic of familial hypercholesterolemia
76
Risk of what cancer 17 y.o intellectual disability, refractory seizures, multiple skin hamartomas, chronic renal failure due to AD disorder
Renal cell carcinoma in patients with tuberous sclerosis Also at risk for cardiac rhabdomyomas and astryocytomas in brain
77
Risk of what cancer 24 y.o w/ megaloblastic anemia, loss of proprioception and impaired gait. Elevated methylmalonic acid and positive schilling test
Gastric adenocarcinoma Increased risk of gastric adenocarcinoma in patients with pernicious anemia Autoimmune destruction of parietal cells of the stomach - confirmed by schilling tests
78
Risk of what cancer Previous burkitt lymphoma and chemotherapy Peripheral smear shows dysplastic myeloblasts w/ rod-shaped cytoplasmic inclusion bodies
Acute myeloid leukemia Auer rods
79
Risk of what cancer 18 y.o wrinkled and leathery skin who appears much older than age AR defect of nucleotide excision repair
Cutaneous carcinomas (squamous cell carcinoma or basal cell carcinoma) Risk increased in xeroderma pigmentosa
80
Risk of what cancer 53 y.o difficulty breathing, anti-acetylcholine receptor Ab detected
Malignant thymoma Myasthenia gravis at risk for malignant thymoma
81
Risk of what cancer Paget disease of bone
Fibrosarcoma of the bone
82
72 y.o with abrupt severe abdominal pain in left lower quadrant. Bloody stool. PMH DM, coronary artery disease, htn and hyperlipidemia. Leukocytosis
Mesenteric ischemia
83
Skip lesions
Crohns
84
Colon and rectum | continuous
UC
85
Pap smear w/ HPV testing
once every 5 years
86
Sigmoidoscopy
every 5 years
87
Herpes simplex virus type 1 vs herpes simplex virus type 2
Type 1: oral vesicular lesions Type 2: genital
88
Coxsackievirus
children under age 5 hand, foot and mouth disease
89
Pink maculopapular rash starts on face and spreads to trunk and extremities Febrile illness Tender lymphadenopathy
Rubella
90
Adults with headaches and ring-enhanging mass on CT
Glioblastoma multiforme Not surgically removable Aggressive
91
Craniopharyngioma
Children Supratentorial tumor Vision changes (bitemporal hemianopia) Stunted growth Hypopituitarism Calcification is common Arise from Rathke's pouch
92
Medulloblastoma
Children Cerebellum involvement Compress 4th ventricle - HA, papilledema Increased intracranial pressure (HA, N/V, neurologic changes)
93
24 who gave birth complicated my massive bleeding and transfusions. Drop in BP. Failure of lactation and extreme fatigue. Low prolactin, cortisol, ACTH. Next step in management
Sheehan's syndrome resulting in acute adrenal insufficiency Pituitary necrosis caused by blood loss and hypotension Decreased prolactin, free T4, ACTh and cortisol IV dexamethasone ("stress dose" steroids)
94
ACTH stimulation test
Diagnose primary and secondary adrenal insufficiency. Small rise in cortisol after ACTH given indicated primary. Large rise in cortisol (3-4x normal) indicates secondary
95
Test to identify pituitary pathology
MRI
96
Young woman who has never smoked. Peripheral lung mass ``` Adenocarcinoma Large cell carcinoma Metastatic disease Small cell carcinoma Squamous cell carcinoma ```
Adenocarcinoma
97
Smoker | Peripheral lung tumor
Large cell carcinoma
98
Smoker Central tumor in lung Profound weakness or hyponatremia
Small cell carcinoma
99
Central tumor in lung | Hypercalcemia
Squamous cell carcinoma
100
Epigastric pain 2-3 hrs after meal relieved by antiacidds. Decreased libido. Diminished visual acuity in far left temporal field. Gynecomastia. Family history parathyroid adenomas
MEN type 1 Pituitary adenoma Parathyroid adenomas Zollinger Ellison syndrome (pancreatic islet tumors, gastrinomas)
101
MEN type 2a
medullary thyroid carcinoma Pheochromocytoma Parathyroid adenoma
102
MEN type 2b
``` Medullary thyroid carcinoma Pheochromocytoma Mucosalneuromas Intestinal ganglioneuromas Marfanoid body habitus ```
103
Elderly older than 50. Hip and shoulder pain and stiffness that is worsened after a period of immobility No loss of muscle strength Diagnose?
Polymyalgia rheumatica Elevated erythrocyte sedimentation rate Tx corticosteriods
104
Muscle disease with elevated creatine phosphokinase
Polymyositis, dermatomyositis | Duchenne muscular dystrophy
105
Difference in polymyalgia rheumatic and rheumatic arthritis
Symmetric joint pain Stiffness Rheumatoid arthritis will have evidence of inflammation in hands and feet
106
Anti-centromere antibody
CREST syndrome ``` Calcinosis Raynaud phenomen Esophageal dysmotility Sclerodactyly Telangiectasias ```
107
Anti-double stranded DNA ab
SLE
108
Acute swelling of right eye. Significant pain and blurry vision. Nasal congestion and fevers 3 weeks ago. PMH MS, smokes, swims and drinks Cause?
Orbital cellulitis from acute sinusitis inflammation of extraocular muscles, orbital fat and optic nerve Anterior displacement of the globe
109
Preseptal cellulitis vs orbital cellulitis
both have painful eyelid edema and erythema Preseptal cellulits: will not have ophthalmoplegia (paralysis of eye muscles), proptosis or decreased visual acuity, inflammation confined to eyelids
110
Common visual finding in MS
Internuclear ophthalmopelgia Disorder of conjugate gaze caused by demyelination of the medial longitudinal fasciculus Impairment of adduction in the affected eye and nystagmus while abducting the CL eye
111
Tobacco use is associated with increased risk of what to eyes
cataract formation
112
Swimming risk to eyes
Viral conjunctivitis monoocular irriation with foreign body sensation Watery discharge Conjuntival swelling
113
Chest pain for 4 hrs, worse with deep inspiration. SOB. Recent lumpectomy and axillary LN dissection Test?
PE Initial test is CT angiography (aka spiral CT scan)
114
``` Vertigo Slurred speech Inability to swallow Bilateral nystagmus Left eyelid drooping Left pupil constricted Loss pain and temp on left side of face and right side of body ```
Left posterior inferior cerebellar artery lesion
115
Posterior inferior cerebellar arterial lesions
Lateral medullary syndrome (Wallenbergs) Vertigo Nystagmus Horner's syndrome Ipslateral face CL body Dysphagia Dysarthria Diplopia
116
Contralateral lower extremity weakness and sensory deficit CL upper extremity weakness and sensory deficit not as significant Personality changes
Anterior cerebral artery lesion
117
Contralateral upper extremity weakness and sensory deficit Aphasia (broca's) or wernickes if dominant side Neglect CL homonymous hemianopia (visual field loss on one side of vertical midline) w/ macualr sparing
Middle cerebral artery lesion Eyes will deviate away from lesion
118
``` Vertigo Vertical nystagmus Dysarthria Dystonia ataxia Sensory changes in face "Drop attack" loss of postural tone w/o loss of consciousness ```
Vertebrobasilar artery lesion
119
Vertigo Nystagmus Right sided horner syndrome Loss of pain and temp on right face and left side of body
Right posterior inferior cerebellar
120
Acute onset flank pain, nausea, hematuria. | Crohns disease
Nephrolithiasis caused by hyperoxaluria Fat malabsorption excess bowel fat binds calcium
121
Tx magnesium ammonium phosphate stones
Abx to tx UTI Proteus vulgaris - Urease producing struvite stones (Klebsiella and Ureaplasma)
122
Tx uric acid stones
Allopurinol and potassium citrate which alkalinizes the urine
123
Nephrolithiasis in childhood | pHurine < 5.5 acidic
Cystinuria
124
Tx acute bacterial meningitis w/ gram-negative diplococci
Cefotaxime Neisseria meningitis
125
Tx Acute bacterial meningitis w/ gram positive cocci
Streptococcus pneumoniae vancomycin, ceftriaxone, and dexamethasone
126
Colicky abdominal pain, n/v, brown urine, legs gave away and weak.
Porphyria ``` Colicky abd pain Neuropathy Seizures Hallucinations paranoia Cutaneous porphyrias: accumulation porphyrin in skin= photosensitivity and blistering in sun ```
127
Needed in patients beginning chemotherapy to prevent tumor lysis syndrome
Allopurinol and IV bicarb
128
Tumor lysis syndrome
Sudden release of potassium, phosphorus, and uric acid from rapidly dying cancer cells
129
Tx SIADH
Fluid restrictiona nd demeclocycline
130
Tx hypercalcemia of malignancy
IV zolendronate and oral phosphorous
131
Tx Cushing syndrome by ectopic ACTH neoplasm
Ketoconazole and glucocorticoid replacement
132
Patient with DM with repeat htn readings place on what medication ``` Amlodipine Atenolol Furosemide Hydralize Hydrocholorthiazide Lisinopril ```
Lisinopril
133
Bronchospasm in asthmatic patient is an adverse effect of
beta blocker therapy
134
Amlodipine AE
Lower extremity edema
135
Furosemside AE
Hypokalemia Metabolic alkalosis Ototoxicity Gout
136
Pregnant lady w/ preeclampsia give
Hydralazine
137
Painful rash all over body 2 days after given trimethoprim-sulfamethoxazole for UTI Itchy painful confluent erythematous desquamating rash
Toxic epidermal necrolysis
138
Stevens johnson syndrome
skin reaction Itchy painful confluent erythematous desquamating rash 10% of body
139
Chinese woman Painful oral and genital ulcers Relapsing Yellowish necrotic center Tx
Behcet syndrome Tx Colchicine Inferior vena cava filter
140
Type 1 diabetes is caused by
failure of beta cells of the islets of langerhans to secrete insulin
141
Warfarin therapy causes a deficiency of what
Factor VII Warfarin inhibits activation of Vit K which leads to decrease production of clotting factors II, VII, IX, X
142
Vomiting see what lab values
pH 7.52 pCO2 60 mmHg Bicarb 30 mEq/L Metabolic alkalosis Increased pH Increased pCO2 Increased bicarbonate
143
Kidney stones imaging
Non-contrast CT scan of abdomen and pelvis
144
Cerebral edema on CT scan of head
Hypernatremia if corrected too rapidly
145
U waves on ECG
Hypokalemia
146
Rheumatic fever as child. Loud S1 and high-frequency S2 followed by low pitched mid diastolic rumble
Mitral valve stenosis
147
Camping, rash over back, non itchying, fatigue HA, arthralgia.
Lyme disease Erythema migrans Erythematous patch with central hypopigmentation surround a hyperpigmented or indurated bite site
148
Confluent, white non scaling edematous papules coalescing into plaques
Urticarial wheal in urticaria (hives)
149
Erythematous patch with annular clearing and central hyperpigmentation
Lyme disease Erythema migrans
150
Raised, skin-colored pearly papules with central umbilication
Molluscum contagiosum
151
Sharply demarcated erytematous plaque covered with silvery scale
Psoriasis
152
Superficial ulcer with clean base and firm, indurated margins
Painless ulcer of primary syphilis
153
Double layered basement membrane with subendothelial deposits
Membranoproliferative glomerulonephritis
154
Thickening of the glomerular BM with deposits of immunoglobulin G and C3
Membranous nephropathy
155
Risk factor for choleithiasis
obesity
156
Urine frequency. Administration of desmopression causes urine osm to double
Central diabetes insipidus Large amounts dilute urine
157
51 y.o post chemotherapy for bladder cancer, hearing loss ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
C. Carboplatin
158
Severe gout attack after chemo ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
6- merocaptopurine
159
Chemo for chondrosarcoma can induce abortion ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
F. Methotrexate
160
Heart failure after chemotherapy. Diagnosed with dilated cardiomyopathy ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
E. Doxorubicin
161
Breast cancer started on adjuctive medical therapy warned could cause hot flashes and risk of endometrial carcinoma
Tamoxifen
162
Recently began chemo, feeling acutely ill and dark brown oliguria. Acute renal failure, hemolysis and thrombocytopenia ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
G. Mitomycin HUS - acute renal failure - hemolytic anemia - thrombocytopenia
163
Chemo can cause skin rashes and teratogen ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
I. Tretinoin
164
25 y.o AIDS and Burkitt, to Er w/ hematuria ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
Cyclophosphamide Hemorrhagic cystitis
165
Cyclist on chemo forced to retired due to pulmonary fibrosis ``` A. 6-merocaptopurine B. Bleomycin C. Carboplatin D. Cyclophosphamide E. Doxorubicin F. Methotrexate G. Mitomycin H. tamoxifen I. Tretinoin J. Vincristine ```
B. Bleomycin
166
13 y.o ALL develops glove and stocking paresthesias after chemo starts
J. Vincristine
167
Palpable prostate nodule, greatly elevated PSA, osteoblastic lesions on xray. Tx
Metastatic prostate cancer Tx GnRH agonists (androgen deprivation) Leuprolide or goserelin or GnRH antagonists (degarelix Desensitize GnRH reeptors suppress gonadotropin secretion or Stimulation of gonadotropic-releasing hormone receptors in pituitary gland SE gynecomastia, hot flashes
168
Tx benign prostatic hyperplasia (BPH)
Alpha receptors Terazosin, doxazosin, tamsulosin
169
Inhibition of osteoclastic bone resorption
MOA for bisphosphonates SE osteonecrosis of the jaw, erosive esophagitis, and hypocalcemia
170
Muscle weakness Flattening of T wave Increased P wave U wave
Hypokalemia
171
``` Dull flank pain Hematuria HTN bilateral flank masses Headaches Father some kidney disease ```
Autosomal dominant polycystic kidney disease Get Magnetic resonance angiography if cerebral aneurysm
172
Myelodysplastic disorder vs myeloproliferative disorder
Myeloproliferative disorder - hyperproliferation of one or more myeloid cells lines MDS - cytopenia on CBC
173
MRI ring-enhancing lesion with surrounding cerebral edema
Toxoplasma gondii
174
Eosinophils rod shpaed cytoplasmic inclusion bodies
AML Auer rods All trans retinoic acid
175
Churg- Strauss
Asthma Vasculitis Eosinophilia Collagen vascular disease
176
``` Brown urine Fever, malaise, WL Periorbital edema Cough productive of blood tinged sputum Protein in urine 2 grams Positive c-anca ``` -Kidney biopsy
Granulomatosis w/ polyangiitis Nephritic syndrome Subnephrotic proteinuria (0.3-3 grams) Biopsy: no immune deposits
177
Dense subepithelial deposits on kidney biopsy
Post-infectious glomerulonephritis IgG and C3 deposits
178
Diffuse mesangial IgA and C3 complement deposits
IgA nephropathy
179
Linear IgG on glomerular BM
Anti-GBM disease Kidney and respiratory
180
Sub-endothelial and sub-epithelial deposits
Membranoproliferative glomerulonephritis
181
Anti-basement membranes Ab
Goodpasture's syndrome Lung and kidney
182
EGFR genetic mutations
Lung cancer
183
Lung cancer with low sodium
Small cell lung carcinoma SIADH Lambert Eaton syndrome
184
Squamous cell lung carcinoma extra symptom
Hypercalcemia Secretion of PTH-like hormone
185
Elderly patient with gradual onset of bilateral central vision loss with preservation of peripheral vision
Age related macular degeneration Characterized by presence of drusen (subretinal deposits)
186
Cherry red spot on the fovea
Central retinal artery occlusion
187
Cupping of the optic disk
Open angle glaucoma
188
Dilated nonreactive pupil
Closed angle glaucoma
189
Relative afferent pupillary defect
Optic neuritis MS
190
Rheumatoid arthritis on xray
bony erosions | Joint space narrowing
191
Cartilage calcification is seen with
Chondrocalcinosis Found in pseudogout
192
Punch-out erosions with overhanging bone found in
gout
193
Subcondral cysts and osteophyte
bone spurs Osteoarthritis
194
Multiple hypopigmented macules on the back that show up chronically
Tinea versicolor Malassezia furfur Scrapings and KOH prep "Spaghetti and meatballs" tx selenium sulfide shampoo
195
Pityriasis rosea
Herald patch first Single red or hyperpigmented plaque on trunk Days to weeks later "Christmas tree" trunk Resolve on own
196
Tinea corporis
erythematous ring-shaped lesions that scales and has central clearing
197
Decreased pH Increased PCO2 Decreased bicarb elevated anion gap
Respiratory acidosis with anion gap metabolic acidosis Acidosis resp PCO2 >40 metabolic Bicarb <24 Alkalosis resp PCO2 <40 metabolic Bicarb >24 Anion gap Na- Cl- Bicarb Normal 8-12
198
Determine acidosis vs alkalosis
Acidosis resp PCO2 >40 metabolic Bicarb <24 Alkalosis resp PCO2 <40 metabolic Bicarb >24 Anion gap Na- Cl- Bicarb Normal 8-12
199
Elevated ACTH Dexamethasone suppression test shows pituitary adenoma MRI confirms microadenoma TX
Transsphenoidal resection of the adenoma
200
Tx adrenal adenoma causing cushings
Unilateral adrenalectomy
201
Fever Tachycardia Leukocytosis
systemic inflammatory response syndrome (SIRS) Sepsis
202
Severe sepsis
Sepsis with >1 sign of organ dysfunction ``` Hypotension Decreased urine output Respiratory distress Decreased platelets Unexplained metabolic acidosis ```
203
Car accident | Increase in sodium
Impaired central release of ADH
204
What distinguishes asthma from COPD
Carbon monoxide diffusion capacity Is normal w/ asthma Decreased in COPD FEV1 decreased in both FVC normal/ slight decreased both FEV1/FVC decreased both TLC increased both
205
3 day history HA. Worsen with supine position. Double vision. Papilledema
Pseudotumor cerebri or idiopathic intracranial htn Common in patients taking isotretinoin or vit A supplements
206
Most common electrocardiography in PE
sinus tachycardia
207
Peaked T waves
hyperkalemia
208
Pruritus after bath Headaches Palpable spleen Increased platelet and hematocrit
Poycythemia vera Overproduction of RBC independent of erythropoietin leads to suppressed erythropoietin levels JAK2 mutation
209
Acute MI lab levels 60 minutes
Negative CK-MB Elevated myoglobin Negative troponin Troponin takes 3 hrs CK-MB takes 4 hrs
210
Male with elevated lactate | Pain in inginal region
Incarcerated inguinal hernia
211
HIV with focal areas of demyelination
Progressive multifocal leukoencephalopathy (PML) Caused by JC virus
212
``` 1 year fatigue Feverish, WL. Asthma exacerbations Sinus infections Low neutrophils Elevated eosinophils Elevated ESR P-anca positive ```
Churg-Strauss syndrome
213
Arm claudication Raynaud phenomenon Visual changes, syncope Abd pain, n/v Elevated ESR Mild anemia
takayasu arteritis Tx Bypass surgery
214
Fungating mass in colon Infective endocarditis Organism?
Streptococcus gallolyticus Strong association with colonic neoplasia
215
Weakness, N/V. Crohns disease who had recent tx w/ corticosteriods but did not complete. Low sodium. Decreased cortisol. Hypotension What else would you see
Decreased ACTH levels Secondary adrenal insufficiency
216
Diagnostic tool for PE
Spiral CT of the chest
217
Fatigue and bone pain in lower extremities. Temperature. Conjunctival pallor. Petechiae. Bilateral lower extremities tender to palpation Low hemoglobin Low platelets High leukocyte
Acute leukemia
218
Severe episodic headaches, htn, family history of medullary thyroid cancer. Diagnose by?
Phenochromocytoma MEN 2A 2B Urinary metanephrines
219
Gram positive rods | Meningitis
Listeria monocytogenes Elderly
220
Gram positive cocci | Meningitis
Streptococcus pneumoniae
221
Infant Gram-negative coccobacilli Meningitis
Haemophilius influenza
222
Prophylaxis for contrast nephropathy
IV hydration alone with low-weight/ non-ionic contrast
223
IV drug use and new onset heart murmur waht organism
Staph aureus
224
Dental procedure | Organism
Viridans streptococci
225
First line tx for long term management of relapsing remitting MS
Interferon beta or Glatiramer acetate
226
High fever, N/V change in metal status in patient with acute infection and history of noncompliance w/ tx for hyperthyroidism
Thyroid storm Confirmed by decreased TSH Elevated thyroid hormone levels Tx: Beta blocker, propylthiouracil (PTU), hydrocortisone and stable iodine Give iodine once patient is stabilized
227
Wright-Giemsa stained bone marrow aspirate
used to detect leukemic myeloblasts (auer rods) for AML
228
Fever, fatigue, rash, arthralgias, sore throat, N/V, diarrhea Lymphadenopathy Hepatosplenomegaly Rash
Acute HIV infection
229
Severe hip pain after fall Bone pain Anemia Recurrent infections Diagnosis
Multiple myeloma Plasmacytosis on bone marrow biopsy
230
Apple green birefringence
Amyloidosis
231
Bilateral hilar adenopathy
Sarcoidosis Bilateral hilar adenopathy with significant interstitial disease SOB AA erythema nodosum Biopsy of LN to confirm - noncaseating granulomas ACE elevated
232
IgM spike on electrophoresis
Waldenstrom macroglobulinemia MM has IgG spike Will not see lytic bone lesions
233
Smudge cells
CLL Older patients Lymphocytosis Lymphadenopathy Hepatosplenomegaly
234
ACTH stimulation test
Distinguish between pituitary and adrenal causes of low cortisol Dose of ACTH given, low level of cortisol afterwards indicates problem in adrenal glands
235
Right handed male Difficulty speaking suddenly while eating Cant construct sentence But comprehension is fine
Broca's aphasia Middle cerebral artery on dominant side Left sided occlusion of the middle cerebral artery, superior division
236
Occlusion of the inferior division of the middle cerebral artery on the left side
Wernicke aphasia
237
Alpha 1 antitrypsin affects
Lungs | Liver
238
Can cause siadh
carbamazepine
239
Spontaneous nystagmus in all directions
Aminoglycoside toxicity
240
meniere disease
triad vertigo unilateral hearing loss Unilateral tinnitus
241
vestibular neuronitis
``` vertigo n/v disequilibrium flu like Unidirectional nystagmus ```
242
AIDS patient | Small purple papules that expand into friable nodules that bleed w/ trauma
Bacillary angiomatosis or Kaposi sarcoma
243
Test for c. diff
Stool ELISA for toxins
244
Fatigue, weakness, myalgia for six weeks. Purple rash around eyes and dorsal knuckles of the hands. Difficulty getting up from seated position Diagnosis
Dermatomyositis Muscle biopsy Heliotrope rash (periorbital purple papules) Gottron's papules (flat papules on knuckles) Shawl sign
245
Difficulty seeing at night. Keratin accumulation in the conjunctiva
Vit A deficiency Bitot spots
246
Shoulder and neck weakness | Elevated ESR
Polymyositis
247
Polymyalgia rheumatica
Elderly hip and shoulder muscle PAIN Normal strength Elevated ESR
248
Reactivated Tb on X ray
Left apical cavitary consolidation with bilateral patchy infiltrates
249
Bilateral hilar adenopathy with a single caseous focus in the right lower lung field
Primary tb infection
250
Left apical cavitary consolidation with bilateral patchy infiltrates
Reactivation Tb
251
Right sided pulmonary infiltrate with associated effusion
community acquired pneumonia
252
Tx Pyelonephritis
Levofloxacin Oral fluoroquinolone - levofloxacin - ciprofloxacin
253
Tx PID
Ceftriaxone | Doxycycline
254
Sudden onset dyspnea and hypoxia Diffuse bilateral alveolar and reticular infiltration Rales and Rhonchi
Acute respiratory distress syndrome
255
45 y.o n/v. Now having mental status changes. Took medications, didnt eat breakfast. Tremor. Whats causing confusion ``` Acute GI illness Enalapril Glipizide Hctz Metformin ```
Glipizide Hypoglycemia
256
Suspect pheochromocytoma what imaging
CT scan of abdomen Lesion in in an adrenal gland
257
Chronic watery diarrhea in AIDS patient ``` Cryptosporidium parvum Entameoba histolytica Giardia lamblia Rotavirus Shigella dysenteriae ```
Cryptosporidium parvum [Entamoeba histolytica causes bloody diarrhea and liver abscesses; tx metronidazole] Tx increased CD4 count Nitazoxanide
258
Giardia lamblia
Foul smelling diarrhea Steatorrhea Hiking and stream water Elisa or stool microscopy Double eyed trophozoite Metronidazole
259
Rapid onset tenderness in LLQ, painless hematochezia. Elevated lactic acid.
Large bowel ischemia [Small bowel ischemia has pain out of proportion on PE, vomiting]
260
25 y.o asain, for wellness. Hemoglobin normal/low | MCV low
Alpha thalassemia Asian and African decent Asymptomatic microcytosis Mildly depressed hemoglobin
261
Beta thalassemia
Mediterranean descent Asymptomatic Microcytosis Mild anemia ``` Two copies - chipmunk facies - shortened limbs - hepatosplenomegaly - hemolysis Elevated hemoglobin F and A2 ```
262
Hemoglobin Barts
Hydrops fetalis Defect all four alpha globin genes Incompatible wi/ life
263
``` Stumbling Crohns disease pmh Loss of position and vibratory sense Positive babinski No head injury Low Hemoglobin High MCV Folate and B12 low Hypersegmented polymorphonuclear leukocytes ``` Test?
B12 deficiency Methylmalonic acid test
264
The schilling test
Pernicious anemia
265
COPD lung values
Low FEV1 Low FVC Low FEV1/fVC High TLC
266
Restrictive lung values
Low FEV1 Low FVC High FEV1/FVC Low TLC
267
``` Hypotension Confusion Diffuse abdominal tenderness Corticosteriod therapy Recent surgery ```
Adrenal crisis
268
2 month lump in neck growing. Pruritus and fevers. 2 cm mass in left supraclavicuclar region. Abnormal, large B cells w/ bilobed nuclei Non-caseating granulomas in lungs Rod-shaped cytoplasmic inclusions in blast cells Translocation between chrom 8 and 14 Translocation between chrom 9 and 12
Hodkin lympoma Cervical lymphadenopathy and B symptoms (fever, pruritus, fatigue, night sweats, WL) Reed Sternberg cells - large bilobed or multinucleated cells w/ owl eye appearance
269
Translocation between chromosome 8 and 14
Burkitt lymphma EBV, young AA w/ tumor in jaw or maxilla Older who develops abdominal mass, "starry sky" appearance
270
Translocation between chromosomes 9 and 22
Chronic myelogenous leukemia (CML) Philadelphia chromosome Bcr-abl fusion Tx Tyrosine kinase inhibitors (imatinib) 50s/60s Low grade fever, fatigue Splenomegaly Leukocytosis
271
73 y.o increased difficulty reading. Normal intraocular pressure. Yellowing deposits clustered around macula in both eyes
Dry age-related macualr degeneration
272
Night blindness Xerophthalmia (dry eye) Third world
Vit A deficiency
273
``` Sickle cell disease Acute onset fever Dyspnea chest pain pulmonary infiltrate Low Hemoglobin and Hct Elevated platelets, WBC and reticulocytes ```
Acute chest syndrome Pulmonary fat embolism from infarct bone marrow is likely mechanism
274
Fever, malaise, and rigors Shivering Recent travel Diagnosis
Malaria Thick and thin blood smears
275
``` Traveler Febrile Fever Retro-orbital pain Muscle or bone pain Rash ``` Testing
Dengue virus PCR for virus or serum testing for IgM ab
276
Bleeding disorder uncoverered by aspirin or clopidogrel and NSAIDS
Von Willebrand disease
277
Epistaxis Easy bruising Heavy bleeding after tooth extractions Heavy menstrual bleeding
Von Willebrand disease Prolonged bleeding time Prolonged PTT Normal platelets
278
Bernard-Soulier syndrome
Rare Thrombocytopenia Giant platelets on peripheral smear Excessive bleeding Low platelet count
279
Mucocutaneous bleeding | Clumped platelets on peripheral smear
Glanzmann thrombasthenia GPIIb/IIIa
280
Hemophilia A
Bleeding into joints Hemorrhages Platelet fxn not affected Normal bleeding from small wounds Bleeding time normal Factor VIII
281
Hemophilia B
Deficiency Factor IX
282
Tx for GERD
PPI Inhibition of parietal cell H/K/ATPase
283
Spelunking in north eastern missouri
Histoplasmosis
284
``` Broad based budding yeast Chronic PNA Mississippi/ Great lakes Soil/ rotten wood Skin ulcers ```
Blastomycosis
285
CA, NM, AZ, San Jauquin river valley Erythema nodosum Fever, myalgias, chills, HA Erythematous nodules on her chest
Coccidioidomycosis
286
South America Painful lymphadenitis Malaise, myalgia, fever
Paracoccidioidomycosis
287
Viral meningitis
Lymphocyte predominance Normal glucose Slightly elevated protein
288
Gram-negative cocci in pairs
Neisseria gonorrhoeae and Neisseria meningitidis
289
Gram-negative rods w/ thick capsule
Klebsiella
290
Gram-positive cocci in chains
Group A streptococci - strep throat - rheumatic fever - scarlet fever - TSS
291
Gram-positive cocci in clusters
Staphylococcus aureus
292
Gram-positive cocci in pairs
Streptococcus pneumoniae
293
Gram positive rods with branching filaments
Actinomyces | Nocardia
294
Arrhythmia characterized by increased atrial and ventricular rates 2:1
Atrail flutter
295
Number one risk factor for stroke
Hypertension
296
Paraneoplastic syndrome associated with squamous cell lung cancer
Hypercalcemia PTH
297
Tx DIC
treat underlying cause If sepsis Abx
298
``` Pneumonia Placed on Abx Bleeding from central line Large bruises on back/ butt Elevated PT, PTT Decreased platelets Decreased haptoglobin Schistocytes ```
DIC
299
DVT tx w/ _____ MOA
Heparin Increases activity of antithrombin III
300
Decreased synthesis of vit K dependent factors
Warfarin
301
Enlarged extremely tender thyroid gland 2 wks after URI.
Subacute thyroiditis Cause mild hyperthyroidism
302
Acute thyroiditis
Bacterial infection in children w/ congenital piriform sinus (remnant of fourth pouch) Staph/ Strep Unilateral neck pain Fever Tender goiter Thyroid tests nromal
303
Diffuse nontoxic goiter
Caused by iodine deficiency
304
Fever Night sweats Back pain Africa
Tb of the spine (pott's disease)
305
Childhood Tdap | Wound on barb wire
Tetanus toxoid-containing vaccine alone
306
Secondary hyperparathyroidism
Elevated PTH in response to Vit D deficiency Typically due to kidney failure Kidney lose ability to secrete phosphate, decrease phosphate intestinal absorption
307
Tx community acquired pneumonia
Azithromycin Clarithromycin Erythromycin
308
Cirrhosis serum- ascites album gradient
>1.1 g/dL
309
DEXA scan at what age
65
310
Pneumococcal vaccination at what age
65
311
Zoster vaccination at what age
60
312
GERD symptoms 2x week tx
Lifestyle | H2RA
313
Refractory GERD
Lifestyle | PPI
314
Pap smear age
30-65 w/ HPV testing Every 5 years
315
Prophylaxis for HIV patients w/ CD4 less than 200
Trimethoprim/ sulfamethaxoazole For pneumocystis jirovecii pneumonia
316
Prophylaxis for HIV patients w/ CD4 less than 50
Azithromycin Mycobacterium avium complex
317
Positive TB induration in HIV patient
> 5 mm
318
Primary lesion | Marked solitary lymphadenopathy in node proximal to initial lesion
Cat scratch disease Bartonella henselae
319
Eczematous dermatitis in an ineterdigital web
scabies
320
Pink oval macules with dust like scales
Tinea vesicolor "wrinkled"
321
Lung cancer screening
55-80 30 pack year history
322
Risk of what with autosomal dominant polycystic kidney disease
Cerebral aneurysms --> subarachnoid hemorrhage Middle cerebral artery
323
Schatzki ring
anatomic circular extension of the lower esophagus consisting of mucosa and submucosa. Intermittent dysphagia to solids only
324
9;22 translocation Myeloblasts Tx
CML Imatinib tx BCR-ABL
325
Tx hairy cell leukemia
Cladribine
326
T(15;17) Tx
Acute promyelocytic leukemia APL AML-M3 Auer rods All-trans-retinoic acid
327
Red burning water eyes after URI
Viral conjunctivitis Adenovirus
328
Tx bacterial conjunctivitis
Sulfonamides
329
First line tx sinusitis
Amoxicillin
330
Muddy brown casts or heme granular casts
Acute tubular necrosis
331
White cell casts w/ eosinophils
Allergic interstitial nephritis
332
Sausage fingers Nail pitting Achilles tendinitis
Psoriatic arthritis
333
Muscle weakness Hypokalemia Hypertension Test
Hyperaldosteronism Measurement of aldosterone-renin ratio
334
Hemolytic anemia Low hemoglobin Elevated bilirubin Lactate dehydrogenase organism
Babesia microti
335
Sudden fever 3-6 days Afebrile for 2 weeks Fever returns Splenomegaly Petechial bleeding
BOrrelia recurrentis Spirochetes on peripheral smear Giemsa stain
336
Achalasia Megacolon Cardiomyopathy resulting in heart failure South America
Trypanosoma cruzi Chagas disease
337
Dementia Urinary incontinence Gait
Normal pressure hydrocephalus
338
Otitis externa organism
Pseudomonas | Staph aureus
339
History otitis media develops swollen red painful mastoid process
Mastoiditis S. pneumoniae Haemophilus influenzae Moraxella catarrhalis
340
Paranoia and acne in athlete | Fist fight
Anabolic steroid abuse
341
Older patient Smokes, WL, jaundice Palpable gallbaldder
Pancreatic cancer
342
Elevated in pancreatic cancer
CA 19-9
343
Chronic diffuse watery diarrhea Hypokalemia Elevated VIP levels Tumor on abdominal CT scan
Vasoactive intestinal polypeptide (VIP)
344
Fever chills and flank pain 12 hrs after blood transfusion | Back pain
Acute hemolytic transfusion rxn Back pain IV fluids Mannitol or furosemide
345
Delayed hemolytic reactions
Occurs days after a transfusion and cause extravascular hemolysis Low grade fever
346
Febrile nonhemolytic reactions
Occur within a few hours of a transfusion Caused by host antibodies directed against donor leukocytes and other cytokines Fever chills (no back pain) Acetaminophen and meperidine [Centrally acting COX inhibitor]
347
Transfusion related acute lung injury
Occurs within first 6 hrs white blood cells aggregating and degranulating within the pulmonary vasculature Predominance of pulmonary findings Respiratory distress
348
Ptosis Diplopia Down and out position Nonreactive pupil
Oculomotor palsy Aneurysm of posterior communicating artery --> leads to subarachnoid hemorrhage
349
Acute onset ptosis Miosis Anhidrosis
Acute-onset Horner syndrome Common carotid artery dissection Common risk factor is chiropractic manipulation
350
Hemiparesis Aphasia Unilateral neglect
Middle cerebral artery aneurysm --> subarachnoid hemorrhage
351
Tender skin nodules Non-ulcerated lesion Arterial wall necrosis in the deep dermis without granuloma formation
Polyarteritis nodosa Systemic necrotizing vasculitis Tx corticosteroids 20% infected w/ hepatitis B or C and in the cases of plasma exchange is performed to eliminate the virus
352
Tx CHF that causes hearing loss
Furosemide Na-K-2CL cotransporter
353
Ototoxicity
Aminoglycosides Furosemide Cisplatin Aspirin
354
Diuretic aldosterone antagonist in collecting tubules SE
Spironolactone SE: hyperkalemia, gynecomastia
355
Diuretic block reabsorption of NaCl in the distal convoluted tubule SE
Thiazide diuretic Hypokalemic metabolic alkalosis
356
Diuretic that increases osmotic pressure within the glomerular filtrate
Mannitol
357
Diuretic that inhibits carbonic anhydrase at the PCT SE
Acetazolamide SE: metabolic acidosis
358
Sudden SOB Chest pain on left side BOdy mass index 19 kg CXR apical thin, visceral pleural line displaced form the chest wall on the left side
Primary spontaneous pneumothorax Risk factors male, age 10-30, tall thin body habitus
359
Protein > 0.5 Pleural fluid to serum lactate dehydrogenase ratio is greater than 0.6 Pleural fluid lactate dehydrogenase is greater than two thirds the upper limit of normal (300)
Exudative Chylothorax Malignancy Pneumonia Tb
360
Transudative on pleural fluid analysis
Cirrhosis | CHF
361
Household contacts of Tb induration
5 mm
362
5 mm positive Tb test
HIV positive Immunocompromised Household contact of TB
363
10 mm positive Tb test
Immigrants from countries w/ high TB High risk living conditions High risk occupation Children under age of 4 CKD on dialysis, DM, IV drug users
364
First line pharmacologic agent for smoking cessation when bupropion is contraindicated
Varenicline
365
HIV with red or purple papules or plaques in the oral cavity (hard palate)
Kaposi sarcoma Caused by human herpesvirus-8 (HHV-8)
366
Area of hypodensity in the left temporal lobe
Ischemic stroke
367
Borrelia burgdorferi location
Midwest | Northeast
368
Rash wrist and ankes
Rocky Mountain Spotted fever
369
Suspect coarctation what test order
Echocardiogram
370
Heart burn and steathorhea
Zollinger-Ellison syndrome Low pH PPI resistance Acidic breakdown of pancreatic enzymes that digest fat
371
Upper abdominal and suprapubic tenderness w/ echogenic kidneys Hesitancy Nocturia Post-void residuals Test?
Hydronephrosis caused by bladder obstruction Benign prostatic hyperplasia causing this Pelvic ultrasound examination w/ measurement of post-void residual for diagnosing BPH
372
Nausea Vomiting Elevated liver enzymes Chronic headaches Nsaid use
Acetaminophen toxicity
373
Nutmeg liver
Congestive hepatopathy Hepatomegaly Elevated jugular venous pressure Peripheral edema
374
Low neutrophils Fever No area looking of infection Not responding to antibiotics Tx
Neutropenic fever Tx antifungal - Candida most likely - Caspofungin or voriconazole
375
Unstable gait | Small cell lung cancer
Paraneoplastic cerebellar degeneration Anti-Hu antibodies (small cell lung) Anti-Yo (breast and gynecologic)
376
Anti voltage gated calcium channel antibodies
Lambert Eaton syndrome Proximal muscle weakness that improves with activity
377
``` Bloody diarrhea Abdominal pain Elevated ESR Elevated alkaline phosphatase Elevated total bilirubin Elevated direct bilirubin ```
Primary sclerosing cholangitis which is associated with UC PSC leads to dilated intrahepatic and extrahepatic bile ducts
378
Osteoarthritis is due to what cells
Chondrocytes Degenerative disorder of the articular cartilage
379
Tx Penumocystis jirovecci
TMP-SMX | Prednisone added if PaO2 is less than 70 mmHg
380
Elevated anion gap metabolic acidosis in septic shock is caused by
lactic acidosis
381
High pitched diastolic decrescendo murmur Visable and palpable cardiac pulsations
Aortic valve regurgitation Rapid and forceful arterial pulse with fast collapse (water hammer) Head bobbing w/ pulsation Visible pulsation of the uvula Capillary pulsation with light compression of the nail bed
382
Autoimmune hemolytic anemia reaction
Type II hypersensivity rxn
383
Type II hypersensitivity rxn
Autoimmune hemolytic anemia rxn Good pastures Rheumatic fever
384
Type III hypersensitivity rxn
Serum sickness immune complex glomerulonephritis SLE Rheumatoid arthrits
385
Type IV hypersensitivity rxn
TB skin etst Transplant rejection Contact dermatitis
386
Fever Sore throat Lymphadenopathy Rash Given amoxicillin Peripheral smear?
Infectious mononucleosis Large, dark lymphocytes on blood smear
387
Neutrophil count > 250 Cirrhosis
Spontaneous bacterial peritonitis Infection of peritoneal ascitic fluid Tx empirically w/ 3rd gen cephalosporins, cefotaxime
388
What to do next for suspected giant cell arteritis
High dose glucocorticoid therapy Before temporal artery biopsy
389
First line tx for BPH
Doxazosin Alpha 1 adrenergic antagonist [Finasteride takes 6 months to be in effect]
390
First line tx for cluster headache
high flow 100% oxygen
391
Prophylactic therapy for migraine headache
Amitriptyline
392
Solar lentigo
Liver spot Flat oval shaped evenly pigmented macules
393
Bronzing Increased glucose Cirrhosis
Hereditary hemochromomatosis Serum iron panel HIgh ferritin Increased transferrin
394
First trimester hyperthyroidism
Propylothiouracil [Methimazole in second trimester]
395
Valproic acid can cause
aplastic anemia
396
30 y.o HTN elevated creatinine Elevated BUN
prerenal acute kidney injury due to Fibromuscular dysplasia
397
Definitive tx for achalasia
Surgical myotomy of lower esophageal sphincter
398
Chest radiograph reveal bilateral fluffy/ alveolar infiltrates
Acute respiratory distress syndrome
399
Psychogenic polydipsia
Euvolemic Hypotonic Hyponatremia
400
``` Dark lines on gums Basophilic stippling of erythrocytes Ringed sideroblasts Confusion Abdominal pain ``` Tx
Lead poisoning Ca-EDTA [ Succimer in children] Can also see wrist and foot drops
401
Endocarditis heart finding
Tricuspid regurgitation w/ vegetations
402
A dual alpha beta agonist
Epinephrine Anaphylactic txns
403
NF-KB inhibitor
Corticosteriods
404
``` Neutropenia Thrombocytopenia Frequent infections Decreased IgM Eczema Increased IgE ```
Wiskott Aldrick sydnrome High risk of bleeding High risk of malignancies (lymphoma) Suspectible to encapsulated organisms
405
Bruton's agammaglobulinemia
Defective B cells Otitis media frequently Sinus infections Hypogammaglobulinemia Tx Immuneglobulin IVIG Boys @ 6 months
406
Positive straight leg test
Herniated disc
407
Sickle cell anemia is caused by
Mutated hemoglobin that polymerizes under deoxygenated conditions Causes - Cholelithiasis (pigmented stones) - painful crisis in back, legs or arms - chest pain - hip pain (avacular necrosis) - aplastic crisis
408
Abnromalities in red blood cell surface membrane proteins
Hereditary spherocytosis ``` Younger patient Pallor Fatigue Jaundice Family hx Splenomegaly peripheral smear: RBC w/o any central pallor ```
409
Abd pain WL Hematochezia Change in bowel habits (pencil stool) Location
Descending colon cancer
410
Panacinar emphysema
alpha 1 antitrypsin Loss of elastin
411
Pain relieved by bending forward
Spinal stenosis
412
Type IV hypersensitivity rxn what happens
Sensitized T cells contact antigens and release cytokines, activating macrophages
413
Type III hypersensitivty rxn what happens
Antibody antigen immune complexes depositing in tissues
414
Type I hypersensitivity rxn what happens
Antigens cross linking adjacent igE molecules leading to degranulation of mast cells
415
Type II hypersensitivity rxn what happens
IgG binding cell surface antigens activating the complement cascade Leading to destruction by cytotoxic T cells
416
Vaso-occlusive crisis
Sickle cell disease IV hydration Oxygen Pain control Crew cut appearance on X ray
417
SCD Tx
Folate supplementation Hydroxyurea (chronic tx) - increases fraction of fetal hemoglobin Pencillin (give prophylactically) -SCD patients >5
418
Fatigue Pallor Petechiae Malignancy
AML
419
Hemophilia A has what abnormal lab value
aPTT
420
Fibrinogen concentration decreased in
DIC
421
Ristocetin cofactor assay -2 lab values
Confirm the diagnosis of von willebrand disease Prolonged aPTT prolonged bleeding time
422
SOB Decreased breath sounds Dullness to percussion
Pleural effusion [Cough,fever] Dmiminished tactile fremitus Xray confirm
423
SOB Decreased breath sounds Hyper-resonant to percussion Chest pain
Pneumothorax Xray
424
hernia through external inguinal ring
Indirect inguinal hernia
425
On chemotherapy Develops fever Decreased leukocyte count Tx
Neutropenic fever Broad spectrum antibiotics [Monotherapy w/ cefepime, meropenem, iripenem or piperacillin-tazobactam] Order blood and urine cultures
426
Complication of chemotherapy
Neutropenic fever Fever Decreased leukocyte count
427
Severe diarrhea causes
Non-anion gap metabolic alkalosis Hypokalemia Hyperchloremia Alkalosis
428
What is expected in untreated chronic kidney disease
Hyperphosphatemia Bicarb low Hypocalcemia Low sodium
429
Proximal muscle weakness Progressive weakness Dry mouth Erectile dysfunction
Lambert Eaton syndrome Paraneoplastic syndrome from small cell lung carcinoma Auto-Ab to VG calcium channels
430
Distal muscle weakness
Muscular dystrophies
431
Agraphia Acalculia R/L confusion Finger agnosia
Dominant inferior parietal lobe Gerstman syndrome
432
Bilateral visual loss | Unawre or denial of blindness
Anton syndrome Posterior cerebral artery
433
CL weakness of extremtiies Ipslateral cranial nerve III palsy Dilated pupils
Weber syndrome Posterior cerebral artery
434
Laxative abuse Finding
Hypokalemia Weakness Muscle cramps U waves of electrocardiogram
435
Widening QRS
Hyperkalemia
436
Female with family history of PE and DVT as well as spontaneous abortions, stillbirth or preeclampsia
Antiphospholipid syndrome Ab against beta-2 glycoprotein I Anti-cardiolipin ab
437
Increased bleeding time Family hx of bleeding into joint Platelet normal Decreased platelet aggregation PT normal aPTT prolonged + ristocetin
Von Willebrand disease Bleeding involving skin and mucosal surfaces
438
Dull to percussion Decreased breathe sounds Decreased tactile fremitus
Pleural effusion
439
Chemotherapy Elevated creatinine Hyperkalemia Hyperuricemia Also seen?
Tumor lysis syndrome Hyperphosphatemia Hypocalcemia
440
SE cyclophosphamide
Abundant RBC in urine Hemorrhagic cystitis
441
Methotrexate SE
Decreased folic acid levels
442
MI | 2 days later new onset blowing systolic murmur heard at apex and S4 gallop
Rupture of valvular papillary muscle Acute mitral regurgitation
443
Alcoholic | Vomiting bright red blood
Ruptured varices Portal htn secondary to cirrhosis
444
Streptococcal pharyngitis Given penicillin Develops erytehmatous subcutaneous nodules on lower legs
Erythema nodosum Delay hypersensitivity rxn Self limiting Tx NSAIDS Potassium iodine Oral glucocorticoids
445
Hematologic stem cell transplant Rash Elevated liver enzymes Diarrhea
Graft versus host disease Minor histocompatibility antigen mismatch
446
Anti-A or Anti-B antibodies
Hyperacute transplant rejection Immedicate commencement of organ destruction due to thrombi that causes diffuse ischemia of the transplanted organ Preformed Ab
447
Immunologically mediated fibrosis
Cause of chronic transplant rejection Months to years Caused by T cell and homral (antibodies/ Bcell) immunity
448
T cell mediated transplant destruction
Acute transplant rejection Days to weeks Vasculitis of the transplanted tissue Present with signs of failure of the tissue graft Tx immunosuppressive (cyclosporine)
449
SOB Fatigue Exercise intolerance DVT history Morning episodes of blood that resolve BP drops w/ standing Anemia Low platelets Hemoglobin in urine Serum LDH elevated Haptoglobin depressed
Paroxysmal nocturnal hemoglobinuria (PNH) Deficiency of CD55 and CD 59 Normocytic hemolytic anemia Diagnosis w/ flow cytometry
450
Tx to confirm sickle cell
Hemoglobin electrophoresis
451
Osmotic fragility test
Hereditary spherocytosis Howell-Jolly bodies after spleen removed Risk of cholelithiasis
452
Thick and thin films
Diagnose malaria
453
Radiculopathy along lateral part of leg and dorsum of foot Weakness w/ dorsiflexion
L5
454
Weakness in plantar and toe flexion
S1
455
``` 24 never had period Hirsutism Acne elevated K Elevated renin ```
21-hydroxylase deficiency Congenital adreanl hyperplasia (CAH) diagnose w/ 17-hydroxyprogesterone serum
456
Cosyntropin stimulation test
Diagnosis of addison disease (adrenal insuffiency) Acutely w/ shock Fatigue, anorexia, postural dizziness, hypotension, hyperpigmentation
457
Tx frontotemporal dementia
Tx behavioral symtpoms w/ SSRI | paroxetine, fluoxetine, trazadone
458
Large cells w/ well circumscribed nuclei, profuse quantities of cytoplasm, and areas of hyperpigmentation that are arranged around nucleus in a clock face pattern
Multiple myeloma Elevated IgG
Third Year Shelf
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