random Flashcards

Question

thoracic outlet syndrome

Answer 1

- combination of numbness, weakness and swelling due to compression of the subclavian vessels and lower trunk of the brachial plexus - a weakened radial pulse and reproduction of symptoms w/ specific arm movements supports the diagnosis

Answer 2

- usually caused by impingement and is most common in middle-aged and older pts who perform repetitive arm movements above the head - presents w/ pain when lifting the arm - may be differentiated from rotator cuff tear and frozen shoulder by injection of the joint w/ lidocaine - in the case of isolated rotator cuff tendonitis, any pain and limitation of motion is resolved by the injection

Answer 3

-pts w/ rheumatoid arthritis, SLE, Sjogren syndrome, dermatomyositis, HCV infection and others

Answer 4

Primary biliary cirrhosis

Answer 5

-granulomatosis w/ polyangiitis (Wegener's)

Answer 6

-autoimmune hepatitis

Answer 7

systemic sclerosis

Answer 8

- form of scleroderma w/ widespread organ involvement - GERD, right heart failure, and hypertension result from involvement of the esophagus, pulmonary arteries and kidneys, respectively. - antinuclear autoantibodies and anti-topoisomerase-1 antibodies would most likely be present

Answer 9

- cannot be reliably distinguished from gout and septic arthritis based on history and physical alone - diagnosed by the presence of RHOMBOID, POSITIVELY birefringent crystals on synovial fluid analysis, and radiographic evidence of CHONDROCALCINOSIS - acute form of calcium pyrophosphate dihydrate (CPPD) crystal disease - frequently precipitated by trauma, surgery, or medical illness - knee is most commonly affected joint

Answer 10

- monosodium urate crystals | - needle-shaped and NEGATIVELY birefringent on synovial fluid analysis

Answer 11

calcium oxalate

Answer 12

Struvite (magnesium ammonium phosphate)

Answer 13

- Methotrexate - side effects: GI symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity, pulmonary toxicity, and bone marrow suppression - FOLIC ACID supplementation has been shown to reduce the incidence of adverse effects of MTX therapy w/o loss of efficacy

Answer 14

- TNF-a inhibitors (etanercept, infliximab, adalimumab), IL-1 receptor antagonists (anakinra, canakinumab), and IL-6 receptor antagonists (tocilizumab) - these agents are generally reserved for use in pts resistant to intitial DMARD therapy - TNF-a inhibitors can cause neutropenia, infections (reactivation of latent TB, opportunists), exacerbations of heart failure, demyelinating illness, and increased risk of malignancy

Answer 15

-weight gain, HTN, peptic ulcer disease, glucose intolerance, myopathy, osteoporosis, increased risk of infections

Answer 16

-clinical disorder seen in pts w/ severe, long-standing (>10 yrs) RA that is characterized by neutropenia and splenomegaly.

Answer 17

- age > 50 - subacute to chronic (>1 month) pain in the shoulder and hip girdles - morning STIFFNESS lasting > 1 hour - constitutional symptoms - elevated ESR (> 40) - no other apparent explanation of symptoms - Tx: low-dose prednisone (if uncomplicated), which should result in rapid relief of symptoms

Answer 18

- most commonly presents in young to middle-aged women w/ widespread pain, fatigue, and cognitive/mood disturbances - pts have point muscle tenderness in areas such as the mid trapezius, lateral epicondyle, costochondral junction in the chest, and greater trochanter - regular aerobic exercise and good sleep hygiene are recommended

Answer 19

- Squamous cell carcinoma - malignancy should be suspected in all non-healing wounds - SCC arising within burn wounds is known as a MARJOLIN ULCER - SCC has also been described arising in the skin overlying a focus of osteomyelitis, radiotherapy scars and venous ulcers; these types tend to be more aggressive - a biopsy should be obtained in all chronic wounds failing to heal in order to rule out malignancy

Answer 20

Marjolin ulcers

Answer 21

-typically occurs in pts w/ a nevus that has increased in size, changed color, become palpable or become symptomatic (painful, pruritic, or bleeding)

Answer 22

- classically presents on chronically sun-exposed skin | - lesions are usually pearly telangiectatic papules w/ a central "rodent" ulceration

Answer 23

- melonocytic nevi exhibiting characteristics not seen in standard nevomelanocytic nevi - size greater than 6 mm, irregular borders, irregular pigmentation - varying degrees of architectural disorders and cytologic atypia

Answer 24

Actinic keratosis (common on chronically sun-exposed skin)

Answer 25

- idiopathic inflammatory muscle disease - slowly progressive PAINLESS, PROXIMAL WEAKNESS of the LOWER EXTREMITIES characterized by difficulty ascending and descending stairs or rising from a seated position; proximal arm weakness usually follows, leading to difficulty combing hair or working w/ the hands overhead - pts may develop dysphagia due to involvement of the striated muscles of the upper pharynx - there are NO skin findings in PM, distinguishing it from dermatomyositis - a MUSCLE BIOPSY is the best diagnostic test and typically shows a mononuclear infiltrate surrounding necrotic and regenerating muscle fibers

Answer 26

- muscle weakness and fatigability - cranial nerve and proximal limb weakness that worsens w/ repeated activity and resolves w/ rest - symptoms resolve rapidly w/ administration of edrophonium (anticholinesterase test)

Answer 27

-used primarily in the evaluation of pts w/ seizure or sleep disorders

Answer 28

-useful to evaluate weakness in cases of suspected Guillain-Barre syndrome (ascending weakness w/ paresthesias and autonomic disturbances) or multiple sclerosis (episodic optic neuritis or transverse myelitis)

Answer 29

- a temporal artery biopsy is necessary to make the diagnosis - usually presents w/ headache, jaw claudication, and systemic symptoms - commonly associated w/ polymyalgia rheumatica, which causes diffuse PAIN in the shoulders and hips but NOT WEAKNESS

Answer 30

- emergency situation and needs immediate needle thoracostomy based on clinical diagnosis (no imaging needed!) - placement of subclavian central venous catheters accounts for approx. 1/4 of iatrogenic pneumothorax - clinically characterized by rapid onset severe SOB, tachycardia, tachypnea, hypotension, and distention of the neck veins due to SVC compression - tx: immediate needle thoracostomy to decompress pleural cavity, followed by an emergency tube thoracostomy w/ underwater seal

Answer 31

- hypotension, tachycardia, elevated systemic venous pressure and pulsus paradoxus - pericardiocentesis is indicated

Answer 32

- pts w/ mild TBI w/ repeated vomiting, headache, or LOC should undergo head CT scan without contrast or observation for 4-6 hours - if head CT scan is normal or the observation period is uneventful, pt can be discharged home w/ a reliable guardian; detailed return precautions should also be provided - Mild TBI: GCS 13-15, LOC

Answer 33

- GCS 5 min, neuro deficit, signs of basilar skull fracture - require neuroimaging w/ non-contrast head CT, close inpatient monitoring w/ neuro checks q2 hrs, and a neurosurgery consult

Answer 34

- GCS of 15, normal mental status, no abnormal neuro or funduscopic findings, and no evidence of skull fracture - do NOT require neuroimaging or hospitalization

Answer 35

because contrast looks like an acute bleed, thus distinguishing them more difficult

Answer 36

- diagnosed when subjective or objective evidence of dry eyes and mouth exists in the presence of either histologic evidence of lymphocytic infiltration of the salivary glands or serum autoantibodies against SSA (Ro) and / or SSB (La). - autoimmune condition that most commonly affects women in their fifth and sixth decade - keratoconjunctivitis sicca (xerophthalmia, dry eyes) and xerostomia (dry mouth); increased incidence of dental caries; difficulty swallowing

Answer 37

-associated w/ Primary Biliary Cirrhosis (PBC), an autoimmune disease characterized by progressive jaundice, varices, and other signs of cirrhosis

Answer 38

-used to assess disease of esophageal motility such as achalasia or presence of esophageal diverticulum

Answer 39

- esophageal endoscopy w/ biopsy | - Barrett's: metaplasia of squamous epithelium to columnar epithelium and is a precursor of esophageal adenocarcinoma

Answer 40

- Venous insufficiency (valvular incompetence) | - classically worsens throughout the day and resolves overnight when the patient is recumbent

Answer 41

- uncommon cause of edema - may result from malignant obstruction of lymph nodes, lymph node resection, trauma, and filariasis - classically affects the DORSA OF THE FEET and causes MARKED THICKENING and RIGIDITY of the skin

Answer 42

pain, pallor, paresthesias, pulselessness, and coolness to the touch

Answer 43

- result from chronic rotator cuff tendonitis and shoulder trauma - shoulder pain and weakness when lifting the arm above the head (or mid arc abduction, external rotation) is suggestive of rotator cuff pathology - a lidocaine injection ameliorates the pain and weakness of rotator cuff TENDONITIS, while it does not improve symptoms of rotator cuff TEAR - MRI is excellent at visualizing soft tissue structures and is the study of choice for diagnosing rotator cuff tears

Answer 44

-fractures, dislocations, and calcific tendonitis

Answer 45

- pain in the spine, ribs, or back | - may be accompanied by hypercalcemia and anemia

Answer 46

- presents w/ dyspnea, confusion and petechiae in the upper part of the body and occurs after multiple fractures of long bones - severe respiratory distress, petechial rash, subconjunctival hemorrhage, tachycardia, tachypnea, and fever - diagnosis can be confirmed by FAT DROPLETS IN URINE or presence of intra-arterial fat globules on fundoscopy; may occur 12 to 72 hrs after the injury - serial x-rays shows increasing diffuse bilateral pulmonary infiltrates within 24-48 hrs of onset of clinical findings - tx: prompt respiratory support (use of heparin, steroids, LMW dextran is controversial)

Answer 47

- can occur in a trauma patient who is on a respirator, or with subclavian vein access - can result in sudden collapse and cardiac arrest

Answer 48

-occurs immediately after the rupture of membranes

Answer 49

-can cause pulmonary embolism in bed-ridden patient

Answer 50

INFLAMMATORY arthritides

Answer 51

- occurs in 5-30% of pts w/ psoriasis - classic presentation involves the DIP joints - morning stiffness, deformity, dactylitis (sausage digit), and nail involvement are common - current tx options for psoriatic arthritis include NSAIDs, methotrexate, and anti-TNF alpha agents

Answer 52

cutaneous deposits of monosodium urate crystals in chronic gout -commonly occur over joints and the helix of the ear, and may ulcerate

Answer 53

- violaceous plaques, slightly scaly - can present with dermatomyositis - usually over the MCP joints, which at times can look similar to psoriasis

Answer 54

- occurs in 10-20% of pts w/ Chron disease and UC - most often affects the lower extremities and sacroiliac joints and tends to wax and wane w/ the symptoms of bowel disease - these pts have prominent GI symptoms and other extraintestinal manifestations of inflammatory bowel disease

Answer 55

- most commonly affects the lower limbs - most cases occur w/ diabetes, but syphilis and alcoholism are other causes - peripheral neuropathy is believed to result in decreased proprioception, which leads to frequent trauma and eventual destruction of the joint

Answer 56

- polyarthritis affecting the ankles and knees - causes protean cutaneous manifestations, the most common of which is ERYTHEMA NODOSUM - also often have cough, chest pain, and dyspnea

Answer 57

- may complicate up to 7% of procedures on the aortoiliac vessels and most commonly affects the distal left colon - pts report dull pain over the ischemic bowel as well as hematochezia - colonoscopy shows a discrete segment of cyanotic and ulcerated bowel

Answer 58

- diarrhea, rectal bleeding, tenesmus and incontinence | - later, strictures and fistulae may form

Answer 59

- abdominal pain, fever, and watery diarrhea | - diagnose by detecting toxin in the stool w/ ELISA

Answer 60

- all trauma pts should be triaged using the GCS, which can predict the severity and prognosis of coma, during the primary survey. - the GCS assesses the patient's ability to open his/her eyes, motor response, and verbal response

Answer 61

- acute carbon monoxide poisoning - tx w/ 100% oxygen via a nonrebreather facemask - early symptoms of carbon monoxide poisoning are typically neurological and include agitation, confusion, and somnolence - diagnosis confirmed clinically and documenting an elevated carboxyhemoglobin level (> 3% in nonsmokers and > 15% in smokers) - pulse ox is unreliable!

Answer 62

-the final sequel of compartment syndrome in which the dead muscle has been replaced w/ fibrous tissue

Answer 63

- vague painful condition seen as a sequel of infection on trauma which may be minor - characterized by pain, hyperesthesia and tenderness, which are out of proportion to the physical findings - Sudeck's atrophy is a radiographic term for spotty rarefaction seen in pts w/ RSD

Answer 64

- constitutional: fever, fatigue and weight loss - symmetric, migratory arthritis - butterfly rash and photosensitivity - serositis: pleurisy, pericarditis, and peritonitis - thromboembolic events (due to vasculitis and antiphospholipid antibodies) - cognitive dysfunction and seizures - hemolytic anemia, thrombocytopenia, and leukopenia - HYPOCOMPLEMENTEMIA (c3 and c4) - ANA (sensitive) and ANTI-dsDNA and ANTI-SM (specific) - renal involvement: proteinuria and elevated creatinine

Answer 65

- autoimmune disease that is most commonly diagnosed in young women - more than 90% of patients w/ SLE have joint involvement, most often affecting the hands - Joint pain may be severe but SLE induced arthritis is usually NON-DEFORMING (unlike RA)

Answer 66

- most pts will respond to conservative treatment w/ NSAIDs | - low dose glucocorticoids or antimalarials (eg hydroxychloroquine) can be added for more severe joint symptoms

Answer 67

-distal phalangeal resorption is characteristic of the ARTHRITIS MUTILANS variant of psoriatic arthritis

Answer 68

- autoimmune disease most commonly diagnosed in young women - 90% of pts have joint involvement, most often affecting the hands - joint pain may be severe but SLE induced arthritis is usually NON-DEFORMING (ie no bone resorption or subluxation or permanent deformity)

Answer 69

- uncommon - presents w/ an erythematous and brawny edematous cutaneous plaque overlying a mass on the breast commonly with axillary lymphadenopathy - 25% of pts w/ this condition will have metastatic disease at time of presentation

Answer 70

- typically in younger lactating women - tx w/ an antibiotic that covers Staph and Strep, and encourage continued breast feeding or breast pumping of the affected breast

Answer 71

- biopsy for culture | - acid-fast organisms and fungi may rarely cause mastitis and breast abscess

Answer 72

- preventable complication of streptococcal group A pharyngitis - usually precedes the onset of rheumatic fever by 2-4 weeks - diagnosed clinically using Jones criteria (2 major, or 1 major and 2 minor) - Criteria includes, major: Carditis, migratory polyarthritis, sydenham chorea, subcutaneous nodules, and erythema marginatum; minor: fever, arthralgias, elevated ESR/CRP, prolonged PR interval - supportive lab findings: positive strep antigen test or elevated ASO titer - prevented w/ treatment w/ penicillin of strep pharyngitis

Answer 73

-malignancy of WBC's that causes lymphocytosis or lymphopenia along w/ anemia or thrombocytopenia

Answer 74

- diagnosed when arthritis is present > 6 weeks | - systemic symptoms including rash, can be seen in children with JIA, but the arthritis is usually NOT migratory

Answer 75

-small vessel vasculitis that can cause a transient, migratory arthritis and rash that is purpuric (arthritis typically involves lower joints)

Answer 76

- peak incidence age 5-15; twice as common in girls - Major: Joints (migratory arthritis), Carditis, Nodules (subcutaneous), Erythema marginatum, Sydenham chorea - Minor: fever, arthralgias, elevated ESR/CRP, Prolonged PR interval - late sequelae: mitral regurgitation/stenosis - prevention: penicillin for GROUP A STREP (strep pyogenes) pharyngitis - diagnosis based on evidence of preceding group A strep infection along w/ 2 major criteria, or 1 major plus 2 minor criteria

Answer 77

- autoimmune disease that affects multiple organ systems - arthritis and elevated CRP/ESR can be seen, but the rash is usually present across the cheeks (malar rash). - Multiple organ system involvement (eg, hematologic, neurologic, renal) is needed for the diagnosis

Answer 78

SOAP BRAIN MD -Serositis (pleuritis/pericarditis) -Oral ulcers -Antinuclear antibody (ANA)- very SENSITIVE -Photosensitivity (skin rash to sunlight) -Blood (hemolytic anemia, leukopenia, thrombocytopenia) -Renal (proteinuria and cell casts) -Arthritis (symmetric, involving 2+ small or large peripheral joints) -Immunologic (anti-dsDNA) -Neurological (seizures, psychosis) Note that anti-smith antibodies are the most SPECIFIC for SLE! -Need 4 out of 11 to diagnose SLE

Answer 79

- CLINICAL diagnosis - classic presentation of migratory RLQ pain, nausea, vomiting, fever, leukocytosis, McBurney point tenderness, and Rovsing sign should have IMMEDIATE appendectomy to prevent appendiceal rupture. - imaging studies such as CT and US are useful for pts with NONCLASSIC symptoms, equivocal findings on initial assessment, or delayed presentation

Answer 80

- Abx should be given PREoperatively to all pts and should be continued POSToperatively for those w/ appendiceal rupture - pts w/ appendicitis who have had symptoms > 5 days usually have a PHLEGMON with an abscess that has walled off; they can be managed conservatively w/ IV abx, bowel rest, and delayed appendectomy weeks later

Answer 81

hypotension, tachycardia, distant heart sounds, neck vein distension, ELECTRICAL ALTERNANS (varying amplitude of the QRS complexes from beat to beat) on ECG

Answer 82

- often causes splenic injury which can present w/ delayed onset hypotension, LUQ pain, and left shoulder pain (Kehr sign) - pts should have an abdominal CT scan w/ IV contrast for diagnosis - those w/ persistent hemodynamic instability require urgent laparotomy

Answer 83

- very common cause of anterior knee pain - symptoms are chronic and associated w/ activities such as CLIMBING STAIRS w/ extension at the knee - women are affected much more often than men - diagnosis is based on history and physical exam; tx involves stretching and strengthening the thigh muscles in addition to avoiding activities that worsen the pain - risk factors include overuse, malalignment, and trauma - diagnostic test includes the PATELLAR GRIND TEST (patellofemoral compression test) and reproduction of pain w/ squatting - subacute to chronic pain, increased w/ squatting, running, prolonged sitting, using stairs

Answer 84

- primarily athletes ("jumper's knee") | - episodic pain and tenderness at inferior patella

Answer 85

- preadolescent/adolescent athletes; recent growth spurt | - increased pain w/ sports, relieved by rest; tenderness and swelling at tibial tubercle

Answer 86

- surgical EMERGENCY that requires emergent urethral imaging (retrograde urethrogram) and surgical repair - the most common cause is a crush injury of the erect penis, most commonly during intercourse where the female is on top of the male - often accompanied by snapping sensation or sound, followed by severe pain and swelling; due to tearing of the tunica albuginea, which invests the corpus cavernosum

Answer 87

- treatment of choice for phimosis, paraphimosis, and Zoon's balanitis - also associated w/ lower risk of squamous cell carcinoma of the penis

Answer 88

- can occur following cardiac surgery that is usually due to intra-op wound contamination and presents w/ fever, chest pain, leukocytosis, and mediastinal widening on chest x-ray - its a serious condition that requires drainage, surgical debridement, and prolonged antibiotic therapy - typically presents within 14 days post-op - clinical diagnosis and confirmed during surgery when pus is seen in mediastinum - high mortality rate even with appropriate treatment

Answer 89

- fever, leukocytosis, tachycardia, and chest pain - usually autoimmune and occurs a few weeks following a procedure with a pericardium incision - NSAIDS or steroids treat the inflammation, and pericardial puncture is indicated if tamponade occurs

Answer 90

- amputate parts should be wrapped in saline-moistened sterile gauze, sealed in a plastic bag, placed on a bed of ice and brought to the ED with the patient - younger pts w/ sharp amputations w/ no crush injury or avulsion are the best candidates for amputation reimplantation

Answer 91

- develop as a result of excessive fluid production by an inflamed synovium, as occurs in cases of RA, osteoarthritis, and cartilage tears - the excess fluid accumulates in the popliteal bursa which expands, creating a tender mass in the popliteal fossa - baker cysts occasionally burst and release their contents into the calf, resulting in an appearance similar to a DVT

Answer 92

- MCL is most commonly injured ligament of the knee - surgery is rarely necessary for MCL tears; bracing and early ambulation is the preferred treatment - MRI is the investigation of choice for defining soft tissue injuries of the knee

Answer 93

- Nasal septal perforation likely resulting from a septal hematoma - up to 25% of rhinoplasties need to be revised - common complications include patient dissatisfaction, nasal obstructions and epistaxis; those that involve the nasal septum are less common but more serious - additional conditions that can cause septal perforation are self-inflicted trauma (nose picking), syphilis, TB, intranasal cocaine use, sarcoidosis, and granulomatosis w/ polyantiitis (Wegener's)

Answer 94

- usually seen in pts w/ asthma and allergic disorders but may also occur in pts w/ other inflammatory conditions of the nasal mucosa - they may cause chronic nasal obstruction and should be surgically removed in symptomatic pts

Answer 95

- common in children - pts will have nasal obstruction and may have a foul odor, halitosis, and nasal bleeding - following surgery, a retained foreign body such as nasal packing most classically would cause toxic shock syndrome

Answer 96

- presents w/ rhinorrhea, nasal pruritis, cough and occasionally dyspnea - on exam, the nasal mucosa is edematous and pale, and polyps may be present

Answer 97

- results from staphylococcal folliculitis following nose picking or nasal hair plucking - potentially life threatening as it can spread to the cavernous sinus - pts may complain of pain, tenderness, and erythema in the nasal vestibule

Answer 98

- Retrograde urethrogram should be first step! - foley catheterization in the presence of a urethral injury will predispose the patient to abscess formation and worsening of the urethral damage - classic signs of posterior urethral injury include blood at the urethral meatus, inability to void and a high-riding prostate on digital rectal exam. Perineal or scrotal hematomas are also frequently seen and such an injury is most classically associated w/ pelvic fracture

Answer 99

- Retrograde urethrogram is almost always the first step - immediate surgical repair is occasionally done in cases of ANTERIOR urethral injury - most cases of urethral injury are treated w/ urinary diversion via a suprapubic catheter while the primary injury and associated hematomas are allowed to heal. After healing is complete, residual damage, such as urethral stricture, is assessed and repaired

Answer 100

- used for diagnosis of BLADDER INJURY - may occur following major trauma, especially pelvic fracture - pts typically complain of gross hematuria

Answer 101

-used to diagnose small bowel tumors and other pathology, which can cause intestinal obstruction

Answer 102

Chest x-ray to confirm proper placement of the catheter tip and absence of complications before administering drugs or other agents through the catheter - complications: arterial puncture, pneumothorax, hemothorax, thrombosis, air embolism, sepsis, vascular perforation, myocardial perforation leading to tamponade - catheter tip should be located proximal to either the cardiac silhouette or the angle between the trachea and the right mainstem bronchus; ideally in the superior vena cava

Answer 103

- most commonly occurs following instrumentation of the esophagus - less commonly, it may occur in pts w/ protracted vomiting who have been resisting the urge to vomit; rupture in these cases typically occurs into the mediastinum resulting in pneumomediastinum; rupture typically occurs a few centimeters above the gastroesophageal junction - retrosternal chest pain and crepitus in the suprasternal notch are common following rupture of esophagus within the mediastinum

Answer 104

-epigastric pain and air would be visualized under the diaphragm on upright abdominal x-ray, but pneumomediastinum is NOT associated w/ duodenal perforation

Answer 105

- an INCOMPLETE mucosal tear at the gastroesophageal junction usually resulting from protracted vomiting - the common presentation is self-limited hematemesis - pneumomediastinum does NOT occur in such tears because the rupture is incomplete

Answer 106

- most commonly caused by antibiotics (B-lactams and sulfa drugs) - symptoms arise 1-2 weeks after exposure and include fever, urticarial rash, arthralgia, and lymphadenopathy. the abnormalities should resolve within 48 hours w/ withdrawal of the offending agent. some cases may need steroid treatment - type III hypersensitivity reaction - lab findings: nonspecific hypocomplementemia and elevated ESR/CRP, which are consistent with any type III hypersensitivity reaction

Answer 107

- can follow untreated strep pharyngitis and may present w/ frank arthritis, erythema marginatum, and fever - ARF after appropriate antibiotic therapy is extremely rare and highly unlikely

Answer 108

- presents acutely w/ skin changes plus hypotension, respiratory distress, or GI symptoms - type 1 hypersensitivity reaction

Answer 109

- systemic IgA-mediated vasculitis occurring after an upper respiratory infection - presents w/ fever, arthralgia, and a palpable purpuric rash of the lower extremities

Answer 110

- presents as fever, cervical lymphadenopathy, pharyngitis, and malaise - those treated w/ an aminopenicillin can develop a MORBILLIFORM (measles-like) rash on the trunk; however, the rash typically spares the extremities and arthralgia does not occur

Answer 111

-presents w/ fever, and scarlatiniform "sandpaper" rash following strep pharyngitis

Answer 112

- severe mucocutaneous reaction most commonly triggered by medications (eg sulfa drugs, anticonvulsants). - affected pts develop acute high fever, vesicular or bullous lesions, and painful hemorrhagic oral erosions

Answer 113

- pts 30 are evaluated w/ mammogram and US - palpable breast masses should generally have an imaging evaluation even if the findings are relatively benign on physical exam - imaging evaluation is helpful both in characterizing the lesion as benign or malignant, and for guiding biopsy if needed

Answer 114

- can be due to spinal cord infarction as a potential complication of thoracic aortic aneurysm surgery - typically presents w/ spinal shock (abrupt onset of bilateral flaccid paralysis and loss of pain/temp sensation below the level of spinal injury) - upper motor neuron signs (spasticity and hyperreflexia) subsequently develop over days to weeks - vibration and proprioception are usually preserved - the anterior spinal artery (ASA) supplies the anterior 2/3 of the spinal cord, including motor tracts (eg anterior corticospinal tract) and sensory tracts involved in pain/temp sensation (eg spinothalamic tract); the ASA is particularly dependent on blood supply for the radicular arteries that originate from the thoracic aorta, such as the artery of Adamkiewicz

Answer 115

-peripheral neuropathy characterized by asymmetrical focal weakness, numbness, and paresthesias due to involvement of multiple adjacent nerve roots

Answer 116

- typically injured during forceful torsion of the knee with the foot planted - pts complain of a popping sound and severe pain at the time of injury; McMurray's sign is commonly positive on physical exam - a bucket handle tear of the medial meniscus leads to locking of the knee joint during terminal extension

Answer 117

- hx of forceful hyperextension injury to knee or a noncontact torsional injury of the knee during deceleration - effusion is seen rapidly following injury due to the ACL being well-perfused - Lachman's test, anterior drawer test and pivot shift test are used for clinical diagnosis

Answer 118

- classically seen in the "dashboard injury", which refers to forceful posterior-directed force on the tibia with the knee flexed at 90 degrees - the posterior drawer, reverse pivot shift and posterior sag tests will help w/ clinical diagnosis

Answer 119

- dilation of veins (capacitance vessels) and decrease in ventricular preload - it is unclear whether nitro significantly increases coronary blood flow in pts w/ obstructive coronary heart disease

Answer 120

- proportion of subjects with a positive test who actually have the disease out of all subjects who test positive for the disease - PPV = TP/TP+FP

Answer 121

- proportion of subjects with a negative test, and who actually do NOT have the disease out of the total number of people who test negative for the disease - NPV = TN/TN+FN

Answer 122

- Pseudogout - pseudogout tends to present as an acute onset, painful monoarthritis affecting the knee; rhomboid shaped, positively birefringent crystals are diagnostic of pseudogout - hyperparathyroidism causes elevated calcium levels and low phosphorus concentrations. Subsequently hypercalcemia can cause constipation, fatigue, excessive urination, abdominal pain, urinary stones, mental status changes, and osteoporosis

Answer 123

- needle shaped crystals w/ NEGATIVE birefringence | - presents as acute onset, painful monoarthropathy

Answer 124

-have the shape of coffin lids and are seen in nephrolithiasis caused by chronic UTI with urease-producing organisms

Answer 125

- topical antibiotics and corticosteroids are appropriate for otitis externa, but not for malignant otitis externa, which requires IV abx and possible debridement if no response to abx - the severity of pain, presence of granulation tissue, and elevated ESR are all clues that distinguish OE from MOE

Answer 126

- Anti-pseudomonal penicillins: Ticarcillin, Piperacillin - Cephalosporins: Ceftazidime (3rd gen), Cefepime (4th gen) - Aminoglycosides: Amikacin, Gentamicin, Tobramycin - Fluoroquinolones: Ciprofloxacin, Levofloxacin - Monobactams: Aztreonam - Carbapenems: Imipenem, Meropenem

Answer 127

- severe infection of the external auditory canal and skull base usually caused by Pseudomonas aeruginosa - its seen most frequently in elderly pts w/ diabetes or immunosuppression - presents as severe, unrelenting ear pain (especially prominent at night), purulent drainage w/ a sense of fullness, and conductive hearing loss on the affected side. Otoscopy shows granulation tissue and an edematous external auditory canal - as the infection spreads beyond the external auditory canal, osteomyelitis of the skull base or TMJ can develop and present w/ pain exacerbated by chewing - EMPIRIC TREATMENT WITH IV CIPROFLOXACIN

Answer 128

- proportions that indicate the chance of an event occurring in the treatment group compared to the chance of the event occurring in the control goup - when reviewing a drug advertisement, it is important to critically read all presented info - hazard ratios 1 signifies that an event is more likely to occur in the treatment group. A ratio close to 1 implies little difference between the two groups. In addition, if the 95% confidence interval contains the null value of 1, this indicates that there is no significant difference between the two groups.

Answer 129

- allows a study to eliminate bias in treatment assignments - an ideal randomization process minimizes selection bias, results in near-equal treatment and control group sizes, and achieves a low probability of confounding variables

Answer 130

- is always the statement of NO RELATIONSHIP between the exposure and the outcome - to state the null hypothesis correctly, you should recognize the study design first

Answer 131

-Insulin resistance typical for pts w/ central-type obesity!

Answer 132

- hypertension, impaired fasting glucose, and dyslipidemia - pts are also characteristically overweight w/ predominantly central (abdominal) fat distribution - Insulin resistance plays a central role in the pathogenesis of the metabolic syndrome - Diagnosis of the metabolic syndrome is based on at least 3 of the 5 following criteria: 1. abdominal obesity (men: waist circuference > 40 in; women: waist circumference > 35 in) 2. fasting glucose > 100 - 110 mg/dL 3. BP > 130/80 4. Triglycerides > 150 mg/dL 5. HDL (men:

Answer 133

-dyslipidemia, endothelial dysfunction, procoagulable state, increased sympathetic activity, increased markers of inflammation, decreased uric acid excretion, increased sodium absorption, disordered breathing and increased testosterone production from the ovaries

Answer 134

- Nitrofurantoin for 5 days (avoid in suspected pyelonephritis or creatinine clearance 20%) - Fosfomycin single dose - Fluoroquinolones only if above options cannot be used - Urine culture needed only if initial treatment fails

Answer 135

- Fluoroquinolones for 5-14 days (do NOT use in pregnancy; consider nitorfurantoin, amoxicillin, and cephalexin instead), extended spectrum abx (ampicillin/gentamicin) for more severe cases - obtain sample for urine culture prior to initiating therapy and adjust abx as needed - associated w/ diabetes, pregnancy, renal failure, urinary tract obstruction, indwelling catheter, urinary procedure (eg cystoscopy), immunosuppression and hospital-aquired

Answer 136

- Outpatient: fluoroquinolones (eg ciprofloxacin, levofloxacin) - Inpatient: IV abx (fluoroquinolone, aminoglycoside +/- ampicillin) - obtain sample for urine culture prior to initiating therapy and adjust abx as needed

Answer 137

- commonly occurs in otherwise healthy pts and has a low risk of tx failure - UA confirms diagnosis - Pts can be tx without a urine culture, which may be done later in those who fail initial therapy - oral TMP/SMX, nitrofurantoin, and fosfomycin are effective first-line tx options - presents w/ dysuria, urinary frequency, and suprapubic tenderness

Answer 138

- Tdap/Td: Tdap once as substitute for Td booster, then Td every 10 years - Influenza: annually - Pneumococcal vaccines: PPSV23 once, then revaccination w/ sequential PCV13 and PPSV23 at age 65 - Hepatitis A: 2 doses 6 months apart with initial negative serologies - Hepatitis B: 3 doses at 0 months, 1 month and at least 4 months w/ initial negative serologies

Answer 139

- the 13-valent pneumococcal conjugate vaccine (PCV13) is recommended initially for all adults age > 65 followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) after at least 6-12 months - for adults age

Answer 140

-Strep pneumoniae

Answer 141

- following splenectomy, the 13-valent pneumococcal conjugate vaccine (PCV13) should be given first, followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later. Pts need revaccination w/ PPSV23 fiver years later and again at age 65 - all pts should receive vaccines either >14 days before scheduled splenectomy or > 14 days after splenectomy

Answer 142

- seen in pts w/ severe liver cirrhosis secondary to systemic and renal hypoperfusion - pts have acute renal failure (creatinine > 1.5 mg/dL) w/ a very low urine sodium level, typically

Answer 143

- pts w/ severe liver cirrhosis have increased nitric oxide generation in the splanchnic circulation secondary to portal hypertension. This is thought to cause systemic vasodilation, which reduces peripheral vascular resistance and BP, causing renal hypoperfusion. Reduced renal perfusion would then activate compensatory pathways (the renin-angiotensin-aldosterone system, sympathetic nervous system, and antidiuretic hormone) that increase water and sodium retention and worsen volume overload. Any factor that may further reduce glomerular capillary pressure (such as hypotension from GI bleeding) causes an acute decline in glomerular filtration and can precipitate hepatorenal syndrome. - lab results are similar to those of prerenal azotemia: elevated serum creatinine (> 1.5 mg/dL) and a very low urine sodium level, typically

Answer 144

Membranoproliferative glomerulonephritis

Answer 145

-usually presents w/ eosinophils or leukocytes in the urine

Answer 146

- usually occurs in pts w/ a predisposing condition, such as hypercoagulability, trauma, nephrotic syndrome, or severe dehydration - acute renal vein thrombosis presents w/ abdominal pain and hematuria

Answer 147

- resembles alcohol-induced liver injury on histology but occurs in pts w/ minimal or no alcohol hx - most likely mechanism is insulin resistance leading to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acids - definition: hepatic steatosis on imaging or biopsy; exclusion of significant alcohol use; exclusion of other causes of fatty liver - features: mostly asymptomatic; metabolic syndrome; +/- steatohepatitis (AST/ALT ratio 35 - macrovesicular fat deposition and peripheral displacement of the nucleus

Answer 148

- begins w/ HYPERfiltration (increased GFR) and microalbuminuria (incipient nephropathy); if not treated adequately, microalbuminuria may progress to macroproteinuria, defined as urine protein excretion > 300 mg/24 hrs; this increase in urinary protein is accompanied by a progressive decline in GFR - the most beneficial therapy to reduce progression of diabetic nephropathy is STRICT BLOOD PRESSURE CONTROL; pts w/ diabetic nephropathy should be treated toward a target BP of 130/80 mmHg - ACE inhibitors or ARBs are first-line tx for pts w/ diabetes mellitus, but must be initiated carefully as they may induce an acute decline in GFR and hyperkalemia

Answer 149

-0.8g/kg/day protein

Answer 150

- causes: diuretic use, cirrhosis or CHF, renovascular HTN (renal artery stenosis or fibromuscular dysplasia), renin-secreting tumor, malignant HTN, coarctation of aorta - Increased plasma renin activity and plasma aldosterone concentration, but with a PAC/PRA ratio

Answer 151

- can diagnose Cushing's syndrome | - central obesity, purple striae, proximal muscle wasting, glucose intolerance, and HTN

Answer 152

- the ratio of plasma aldosterone concentration to plasma renin activity via early morning sampling; a PAC/PRA ratio > 20 with plasma aldosterone > 15 ng/dL suggests primary hyperaldosteronism - adrenal suppression testing is then used to confirm diagnosis, and positive tests requires adrenal imaging by CT. Adrenal vein sampling is the most SENSITIVE test for differentiating adrenal adenoma and bilateral adrenal hyperplasia in pts w/o discrete unilateral adrenal mass on imaging, can then be done to differentiate between hyperplasia and adenoma. Surgery for adenoma, medical therapy for hyperplasia.

Answer 153

- plasma free metanephrines would be elevated | - HTN and the classic triad of episodic headache, sweating, and palpitations w/ tachycardia

Answer 154

-therapy includes emergent administration of IV calcium gluconate to stabilize the cardiac membrane, then lowering serum potassium by driving potassium intracellularly with insulin and glucose, sodium bicarb, or beta-2 agonists such as albuterol; the final step would be to excrete excess potassium by elimination from the body.

Answer 155

-phenylephrine

Answer 156

-cause peripheral vasodilation, and are used in the tx of HTN and BPH

Answer 157

-commonly used in tx of HTN, heart failure, and atrial fibrillation

Answer 158

- can result in referred pain to the ear that is worsened with chewing - pts typically report a hx of nocturnal teeth grinding - pain is worsened w/ chewing; some hear audible clicks or crepitus w/ jaw movement, but not always - initial tx consists of conservate measure such as nighttime bite guard, but surgical intervention is sometimes necessary

Answer 159

- form of herpes zoster infection that causes Bell's palsy | - vesicles are typically seen on the outer ear

Answer 160

-pts experience intermittent, severe, stabbing pain in areas innervated by CN IX and X, which includes the ear.

Answer 161

-can result in ear pain, but it will usually cause erythema and/or limited mobility of the TM

Answer 162

-usually results in ear discharge and pain w/ pulling on the pinna

Answer 163

-usually causes conductive hearing loss as opposed to pain

Answer 164

- presents w/ metabolic acidosis, polyuria, dehydration, decreased level of consciousness, and diffuse abdominal pain, and is often precipitated by acute infection - DKA is characterized by an osmotic diuresis that reduces total body potassium stores even though serum potassium level may be elevated - occurs in type 1 DM - infection can precipitate DKA in type 1 DM due to systemic release of insulin couterregulatory horomes such as catecholamines and cortisol; the resultant excess of glucagon causes hyperglycemia, ketonemia, and an osmotic diuresis; this diuresis is accompanied by a net renal loss of potassium w/ depletion of total body potassium stores; despite reduction in TOTAL body potassium, the SERUM potassium concentration may be elevated due to acidemia and decreased insulin activity, causing redistribuation of potassium to ECF compartment - mild leukocytosis may also be seen - reduction in effective circulating blood volume, which activates the RAAS and accelerates renal potassium losses - increase in circulating free fatty acids due to underlying relative excess of glucagon to insulin and consequent increase in lipolysis - hyperglycemia in DKA contributes not only to osmotic diuresis and hypovolemia but also to serum HYPERosmolality, which will most likely promote pituitary vasopressin release - hepatic gluconeogenesis would be increased due to both the increased ratio of circulating glucagon to insulin and the increased circulating levels of catecholamines and cortisol - hyperglycemia and hyperketonemia in DKA cause an osmotic diuresis and increased urinary excretion of glucose, ketones, sodium, potassium, Mg, and phosphate

Answer 165

- pts w/ ETHYLENE GLYCOL (anti-freeze) poisoning | - Ethylene glycol, methanol and ethanol intoxication causes metabolic acidosis w/ both an anion gap and an osmolar gap

Answer 166

7.35 - 7.45

Answer 167

serum osmolality = [2Na + Glu/18 + BUN/2.8]

Answer 168

osmolar gap = observed osmolarity - calculated osmolarity normal is

Answer 169

-ARDS, heart failure, renal failure

Answer 170

-causes a MIXED anion gap metabolic acidosis and respiratory alkalosis with NO osmolar gap

Answer 171

-can cause visual changes ("snowfield vision") and acute pancreatitis

Answer 172

- rare condition characterized by the 3 P's: Precocious puberty, Pigmentation (cafe au lait spots), and Polyostotic fibrous dysplasia - responsible for 5% of cases of female precocious puberty and may be associated with other endocrine disorders - sporadic and has been attributed to defect in the G-protein cAMP-kinase function in affected tissue

Answer 173

- GI tract polyposis and mucocutaneous pigmentation | - may also involve the development of an estrogen-secreting tumor, leading to precocious puberty

Answer 174

-sporadic phakomatosis characterized by mental retardation, seizures, visual impairment and a characteristic port-wine stain over the territory of the trigeminal nerve

Answer 175

- classically presents w/ a pt complaining of severe pain in a single extremity - onset of pain is less acute than that seen in arterial occlusion due to EMBOLUS - the extremity typically exhibits coolness to touch, pallor, pulselessness, and paralysis on exam

Answer 176

- arterial spasm in response to cold or emotional stress causing discoloration and discomfort of the distal digits - may ultimately result in distal digital gangrene if severe

Answer 177

may cause tabes dorsalis, a lesion of the posterior spinal cord characterized by loss of proprioceptive sensation from the legs, ataxia, and paresthesias

Answer 178

-classically presents w/ central cord syndrome; weakness of upper extremities and loss of pain and temp sensation in a "cape-like" distribution over the neck, shoulders, upper arms and hands

Answer 179

- clinical features: chronic sinopulmonary disease (eg bronchiectasis), GI and nutritional abnormalities (eg pancreatic insufficiency, meconium ileus, failure to thrive), salt loss syndromes (eg acute salt depletion, chronic metabolic alkalosis), male urogenital abnormalities (eg obstructive azoospermia) - diagnosis: one or more clinical features OR hx of cystic fibrosis in a sibling OR positive newborn screening test PLUS increased sweat chloride concentration > 60 mmol/L on 2 or more occasions OR identification of 2 CF mutations OR abnormal nasal epithelial ion transport (potential difference) - recurrent respiratory infections, steatorrhea, and failure to thrive are hallmark features. Sweat chloride testing by QUANTITATIVE PILOCARPINE IONTOPHORESIS is the gold standard for diagnosis. Pilocarpine is a cholinergic drug that is applied to the patient's extremity to induce sweating. A chloride level of > 60 mmol/L on 2 separate occasions confirms the diagnosis. Abnormal or intermediate results should be followed by DNA analysis. Nasal potential difference measurement can be performed if sweat testing and DNA analysis are equivocal.

Answer 180

-Exhaled nasal nitric oxide test

Answer 181

- X-linked or autosomal recessive disorder characterized by recurrent respiratory infections and chronic diarrhea - affected pts have an absolute lymphocyte count

Answer 182

- classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications - maternal infection is acquired by exposure to feces from infected cats, or ingestion of infected raw meat or unpasteurized goat's milk - risk of transmission during pregnancy increases as pregnancy progresses, but severity of disease decreases - other complications include: hydrocephalus, microcephaly, hepatosplenomegaly, microphthalmia, microcephaly, diffuse lymphadenopathy, jaundice, diffuse petechiae - lab results show hyperbilirubinemia and thrombocytopenia

Answer 183

-intermittent fever, osteitis and osteochondritis, mucocutaneous lesions, lymphadenopathy, hepatomegaly, and persistent rhinitis

Answer 184

- microcephaly, microphthalmia, and meningoencephalitis; sensorineural deafness, cardiac anomalies (eg persistent ductus arteriosus, atrial septal defects), congenital glaucoma and cataract - classic triad: deafness, cataracts, and cardiac defects

Answer 185

-encephalitis, chorioretinitis, and disseminated disease

Answer 186

- fine motor: two-finger pincer grasp, turns several pages of a book at a time - gross motor: walks w/o assistance, waves bye, climbs up on furniture - language: says 2-3 words, says "mama" and "dada" - social: imitates actions, plays reciprocal games (peek-a-boo), indicates wants

Answer 187

- fine motor: builds tower of 6 cubes, turns individual pages of a book - gross motor: walks up and down stairs, jumps, throws a ball overhead - language: 200 word vocabulary, uses 2-word phrases, 2-quarters (50%) of speech intelligible - social: follows 2-step commands, remove clothes

Answer 188

- fine motor: copies a circle, uses utensils to feed self, stacks 9 blocks - gross motor: climbs stairs w/ alternative feet, rides a TRIcycle, kicks a ball - language: uses 3 word sentences, states first name, 3-quarters (75%) of speech intelligible - social: washes/dries hands, helps w/ simple household tasks, group play

Answer 189

- fine motor: copies a cross, draws a person, begins to use scissors, holds crayon w/ tripod grasp - gross motor: hops on one foot w/o losing balance, jumps over objects - language: counts to 10, tells stories, uses plurals and prepositions - social: cooperative play, has imaginary friends, imitates adult roles

Answer 190

- group of syndromes characterized by nonprogressive motor dysfunction; 3 primary subtypes- spastic, dyskinetic, and ataxic - the etiology is often multifactorial, with PREMATURITY as the leading risk factor - affected pts have uncoordinated and limited voluntary movements - risk factors: prematurity, IUG restriction, IU infection, antepartum hemorrhage, placental pathology, multiple gestation, maternal alcohol consumption, maternal tobacco use - managment: physical, occupational and speech therapies; Baclofen and botulinum toxin for spasticity - comorbidities: intellectual disability, epilepsy, strabismus, scoliosis

Answer 191

Magnesium sulfate

Answer 192

- Penicillin is treatment of choice - if patient is allergic to penicillin, the allergy should be confirmed w/ skin testing and the patient should then undergo desensitization using incremental doses of oral penicillin V so that she can safely take the medication

Answer 193

-harmful effect on teeth and bones of the fetus

Answer 194

-musculoskeletal system risks to fetus

Answer 195

- UTERINE ATONY - its important to make a quick diagnosis by checking the firmness and location of the uterus fundus; if bleeding persists despite treatment, other causes should be ruled out - a soft, "boggy", poorly contracted uterus is characteristic - risk factors: uterine overdistention (eg multiple gestation, polyhydramnios, macrosomia) and uterine fatigue (prolonged labor)

Answer 196

- Uterine atony - Initial tx includes bimanual uterine massage (resolves hemorrhage in most cases), fluid resuscitation (SBP > 90), uterotonic agents (eg oxytocin, methylergonovine, carboprost), and blood transfusion as needed

Answer 197

-abnormally adherent placenta (eg placenta accreta), or when all other attempts to control bleeding are unsuccessful or a rupture uterus cannot be repaired

Answer 198

-when suspected retained placental tissue; this can be determined by an echogenic mass on US, absence of the normal endometrial stripe on US, or a nonintact placenta on exam

Answer 199

- commonly occurs following a tonic-clonic seizure - its a transient anion gap metabolic acidosis that resolves without treatment within 60 to 90 minutes following resolution of seizure activity

Answer 200

- 2nd most common form of non-melanoma skin cancer (after basal cell carcinoma) - the single most important risk factor for the development of squamous cell carcinoma is exposure to sunlight - polygonal cells with atypical nuclei at all levels of the epidermis with zones of keratinization - SCC is more aggressive than basal cell carcinoma because it metastasizes frequently

Answer 201

CT scan of the brain - note that you could also perform a sedate MRI if stable and asymptomatic to spare child from radiation exposure - US is most useful in infants under 6 months of age - Tx of hydrocephalus consists of a shunt that is placed from the ventricle to the peritoneum, pleura, or right atrium

Answer 202

- medical: emergency care, STIs, substance abuse, prenatal care - emancipated minor: homeless, parent, married, military, financially independent, high school graduate

Answer 203

- insulin and glucose - sodium bicarb - beta 2 agonists

Answer 204

- ALL pts should receive DMARDs as early as possible in the disease course - Methotrexate is the initial DMARD of choice in most pts w/ active RA - NSAIDS and glucocorticoids should be used for initial temporary symptomatic relief while awaiting response to DMARD therapy; they do NOT alter disease progression however - nonbiologics: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, azathioprine - biologics: etanercept, infliximab, adalimumab, tocilizumab, rituximab - pts should be tested for hep B and C and TB before starting therapy! - if pts do not respond after 6 months, they may require biologic DMARDs such as TNF-a inhibitors (etanercept, infliximab) as step-up therapy

Answer 205

- form of primary herpes simplex virus infection associated w/ atopic dermatitis - numerous vesicles over the area of atopic dermatitis are typical - the infection can be life-threatening in infants; thus, prompt tx with acyclovir should be initiated

Answer 206

-vesicular eruption that is not localized, but tends to spread over the head and to the trunk

Answer 207

-manifests as thick-crusted facial lesions that are frequently honey-colored

Answer 208

- usually causes an asymptomatic or minor respiratory illness in healthy pts, but immunocompromised pts can develop severe pulmonary or disseminated disease - the most rapid and sensitive test to diagnose disseminated histoplasmosis in immunocompromised pts is urine or serum assay for Histoplasma antigen - disseminated disease typically presents w/ systemic symptoms and involves the reticuloendothelial system, resutling in cytopenias, lymphadenopathy, and hepatosplenomegaly.

Answer 209

- mild to moderate: no treatment or oral itraconazole | - severe: amphotericin B (switche to oral itraconazole once initial response is documented

Answer 210

-anti-fungal effective against Cryptococcus and Candida

Answer 211

-effective against amebiasis and other anaerobic bacterial infections

Answer 212

Itraconazole

Answer 213

- 6 or more inattentive and/or 6 or more hyperactive/impulsive symptoms for 6 or more months - several symptoms present before age 12 - symptoms occur in at least 2 settings - functional impairment (social, academic) - subtypes: predominantly inattentive, predominantly hyperactive/impulsive, combined type

Answer 214

- weight should triple; height should increase by 50% - developmental milestones include walking independently, using a 2-finger pincer grasp, saying a few words other than "mama" and "dada", and imitating the actions of others.

Answer 215

- recommended: nitrofurantoin, amoxicillin, amoxicillin-clavulanate, cephalexin - contraindicated: tetracylines (interfere with fetal bone and tooth development), fluoroquinolones (bone deformities and arthropathy), TMP-SMX (contraindicated in first trimester as it interferes w/ folic acid metabolism, should be avoided during third trimester as it increases the risk of kernicterus in the newborn) - pregnant women w/ asymptomatic bacteriuria should be treated w/ antibiotics to decrease the risk of pyelonephritis, preterm birth, low birth weight, and perinatal mortality.

Answer 216

-CHF due to left ventricular systolic dysfunction is characterized by decreased cardiac output/index, increased systemic vascular resistance (SVR), and an increase in left ventricular end-diastolic volume (LVEDV)

Answer 217

-Cardiac index is reduced due to myocardial dysfunction, while SVR is increased to maintain vital organ perfusion; LVEDV remains relatively normal in the early phase before LV remodeling and/or dilatation occurs over the following several weeks

Answer 218

-increased LVEDV, decreased SVR, normal/increased CI

Answer 219

- laboring pts w/ placental abruption at term may be allowed to deliver vaginally if the woman and fetus are stable - Cesarean delivery is indicated if the mother is hypotensive w/ severe bleeding or if the condition of the fetus deteriorates - presents as vaginal bleeding and hyperactive and tender uterus - bleeding between the decidua and placenta interface causes placental detachment, which can compromise the fetus - US should be performed to rule out placenta previa (contraindication to vaginal delivery), but it detects only 25% of cases of abruption - laboring patients > 34 WEEKS GESTATION CAN PROCEED TOWARD VAGINAL DELIVERY

Answer 220

- risk factors: maternal HTN or preeclampsia/eclampsia, abdominal trauma, prior placental abruption, cocaine and tobacco use - presenation: sudden-onset vaginal bleeding, abdominal or back pain, high-frequency and low-intensity contractions, hypertonic tender uterus - diagnosis: clinical presentation, US (not required for diagnosis) to rule out placenta previa - Tx: unstable maternal VS or nonreassuring fetal heart tracing at any gestational age means emergent C-section; stable maternal VS, reassuring fetal heart tracing, no placenta previa and >34 wks gestation means a trial of vaginal delivery

Answer 221

> 37 weeks

Answer 222

- used to measure the amount of fetal hemoglobin transferred into the maternal bloodstream - it should be performed on an Rh-negative woman w/ an Rh-positive fetus to determine the dose of Rh immune globulin to prevent Rh sensitization

Answer 223

- empiric abx must NOT be delayed while awaiting results of CT scan or performing LP to diagnose bacterial meningitis - VANCOMYCIN plus AMPICILLIN plus CEFEPIME is the drug regimen of choice for immunocompromised pts w/ suspected bacterial meningitis - Corticosteroids must be started at the same time as abx and should be discontinued if cultures show an organism other than Strep pneumoniae

Answer 224

- head CT, blood cultures, LP - indications for head CT: immunocompromised, previous CNS disease, new onset seizure, papilledema, altered mental status, focal neuro deficits

Answer 225

- most commonly N. meningitidis, S. pneumoniae | - give Vancomycin plus a 3rd generation cephalosporin

Answer 226

- S. pneumoniae, N. meningitidis, Listeria | - Vancomycin plus ampicillin plus a 3rd gen cephalosporin

Answer 227

- gram negative rods, S. aureus, and coagulase-negative Staph - Vancomycin plus cefepime

Answer 228

- Pneumococcus, N. meningitidis, Listeria, gram negative rods - Vancomycin plus ampicillin plus cefepime

Answer 229

- S. aureus, coagulase-negative Staph, and gram negative rods - Vancomycin plus cefepime

Answer 230

lead 1 lead aVF -if up in 1 and up in aVF, then its a normal axis -axis deviation can be a sign of ventricular hypertrophy or bundle branch block

Answer 231

-rate, rhythm, axis, intervals, ischemia, and hypertrophy

Answer 232

- PR interval: 120-200 msec; in AV block PR interval > 200 msec or there will be no QRS after a P wave - QRS interval: 120msec; LBBB has deep S wave and no R wave in V1, and a wide/tall R waves in 1, V5, V6; RBBB has RSR' ("rabbit ears") complex w/ wide R wave in V1 and wide S wave in V5, V6. - QT interval: 440 msec, and predispose to ventricular tachyarrhythmias

Answer 233

V1 and V5/V6 | -WiLLiaM MaRRoW

Answer 234

- T wave inversion --> ST segment changes (elevation or depression) -- Q waves (> 40 msec or more than 1/3 the QRS amplitude; note that Q waves signify either an acute or prior ischemic event and do NOT give info on when the event occurred - poor R wave progression; on normal ECG, R waves increase in size from V1 through V5

Answer 235

- Right atrial hypertrophy: tall P wave in lead II (>2.5 mm) - Left atrial hypertrophy: wide P wave in lead II (>120 msec); notched P waves are frequently seen (cameL has Left atrial enlargement) - LVH: S wave amplitude in V1 + R wave amplitude in V5/V6 = > 35 mm; alternatively, amplitude of R in aVL + S in V3 is > 28 mm in men or > 20 mm in women - RVH: Right axis deviation and an R wave in V1 > 7 mm

Answer 236

- Cardiac tamponade and constrictive pericarditis | - Increase in JVP w/ inspiration is Kussmaul sign

Answer 237

aortic stenosis

Answer 238

mitral regurgitation

Answer 239

mitral valve prolapse

Answer 240

-aortic regurgitation

Answer 241

-mitral stenosis

Answer 242

- sign of fluid overload | - often normal in younger pts and in high-output states (eg pregnancy)

Answer 243

- sign of decreased compliance (ie HTN, diastolic dysfunction) - usually pathologic but can be normal in younger pts and athletes

Answer 244

-right heart failure, biventricular failure, nephrotic syndrome, hepatic disease, lymphedema, hypoalbuminemia, and drugs

Answer 245

- decreased SBP w/ inspiration - possible sign of Pericardial tamponade; also seen in obstructive lung disease, tension pneumothorax, and foreign body in airway

Answer 246

-compensated aortic regurgitation (bounding pulses), coaractation (greater in arms than legs), PDA

Answer 247

- alternating weak and strong pulses | - cardiac tamponade, impaired left ventricular systolic function; poor prognosis

Answer 248

- weak and delayed pulse | - aortic stenosis!

Answer 249

ABCD - anticoagulate - B blockers for rate control!! - cardiovert/calcium channel blockers - Digoxin (in refractory cases)

Answer 250

mitral stenosis

Answer 251

- used to estimate stroke risk in pt w/ atrial fibrillation; anticoagulate if score is > 2 - CHF (1 point) - HTN (1 point) - Age > 75 (2 points) - Diabetes (1 point) - Stroke or TIA hx (2 points) - Vascular disease (1 point) - Age 65-74 (1 point) - Sex category (female; 1 point)

Answer 252

- can occur in normal individuals; associated w/ increased vagal tone and w/ B-blocker or CCB use - asymptomatic - PR interval > 200 msec - no treatment necessary

Answer 253

- drug effects (digoxin, B-blockers, CCBs) or increased vagal tone; right coronary ischemia or infarction - usually asymptomatic - progressive PR lengthening until a dropped beat occurs; the PR interval then resets - Tx: stop offending drug; Atropine as indicated

Answer 254

- results from fibrotic disease of the conduction system or from acute, subacute, or prior MI - occasonally syncope; frequent progression to third-degree AV block!!!! - unexpected dropped beat(s) without a change in PR interval - Tx is PACEMAKER PLACEMENT

Answer 255

- no electrical communication between the atria and ventricles - syncope, dizziness, acute heart failure, hypotension, cannon A waves - no relationship between P waves and QRS complexes - Tx is PACEMAKER PLACEMENT

Answer 256

- a heterogeneous disorder that leads to intermittent supraventricular tachyarrhythmias and bradyarrhythmias - secondary to tachycardia or bradycardia; may include syncope, palpitations, dyspnea, chest pain, TIA, and stroke - this is the MOST COMMON INDICATION FOR PACEMAKER PLACEMENT

Answer 257

Procainamide

Answer 258

- acute AF: PIRATES: Pulmonary disease, Ischemia, Rheumatic heart disease, Anemia/Atrial myxoma, Thyrotoxicosis, Ethanol, Sepsis. - chronic AF: HTN, CHF - often asymptomatic but may present w/ SOB, chest pain, or palpitations; physical exam shows an IRREGULARLY IRREGULAR pulse - no discernable P waves w/ variable and irregular QRS response - for chronic AF, initial therapy: RATE CONTROL WITH B-BLOCKERS, CCB, or Digoxin; Anticoagulate w/ warfarin for pts w/ CHADS-VASc > 2; for unstable AF, or new-onset AF ( 2 days or unclear duration, must get TEE to rule out atrial clot!!!!

Answer 259

- circular movement of electrical activity around the atrium at a rate of approx. 300 times per minute - usually asymptomatic but can present w/ palpitations, syncope, and lightheadedness - regular rhythm; "SAWTOOTH" APPEARANCE OF P WAVES; atrial rate is usually between 240-320 bpm and ventricular rate is about 150 bpm. - Tx: anticoagulation, rate control, and cardioversion as in atrial fibrillation

Answer 260

- multiple atrial pacemakers or reentrant pathways; COPD, hypoxemia - may be asymptomatic; at least 3 DIFFERENT P WAVE MORPHOLOGIES - three or more unique P waves, rate > 100 bpm - treat the underlying disorder; verapamil or B-blockers for rate control and suppression of atrial pacemakers (not very effective)

Answer 261

- a reentry circuit in the AV node depolarizes the atrium and ventricle nearly simultaneously - occurs at AV junction - rate 150-250 bpm; P WAVE IS OFTEN BURIED in QRS or shortly after - Tx: cardiovert if hemodynamically unstable; carotid massage, valsalva, or adenosine can stop the arrhythmia

Answer 262

- occurs at AV junction - an ectopic connection between the atrium and ventricle that causes a reentry circuit; seen in WPW - a retrograde P wave is often seen after a normal QRS; PREEXCITATION DELTA WAVE IS CHARACTERISTICALLY SEEN IN WPW - cardiovert, valgal maneuvers, adenosine

Answer 263

- rapid ectopic pacemaker in the atrium (not sinus node) - rate > 100 bpm; P wve w/ an unusual axis BEFORE each normal QRS - Tx: adenosine can be used to unmask underlying atrial activity by slowing down the rate

Answer 264

- ectopic beats arise from ventricular foci; associated w/ hypoxia, electrolyte abnormalities, and hyperthyroidism - early, wide QRS not preceded by a P wave; PVCs are usually followed by a compensatory pause - Treat the underlying cause; if symptomatic, give B-blockers

Answer 265

- abnormal fast accessory pathway from atria to ventricle - characteristic DELTA WAVE w/ widened QRS complex and shortened PR interval - tx is observation for asymptomatic pts

Answer 266

- can be associated w/ CAD, MI, and structural heart disease - can progress to VF and death - 3 or more consecutive PVCs; wide QRS complexes in a regular rapid rhythm; may see AV dissociation - cardioversion if unstable; antiarrhythmics (amiodarone, lidocaine, procainamide)

Answer 267

- totally erratic wide-complex tracing | - immediate electrical defibrillation and ACLS protocol!

Answer 268

- associated w/ long QT syndrome, proarrhythmic response to meds, hypokalemia, congenital deafness, and alcoholism - polymorphous QRS; VT w/ rates between 150 - 250 bpm - give MAGNESIUM initially and cardiovert if unstable; correct underlying disorder

Answer 269

-used for symptomatic relief only and confer NO mortality benefit

Answer 270

-exertional dyspnea

Answer 271

- brain natriuretic peptide (BNP) > 500 pg/mL | - decreased EF

Answer 272

- Loop diuretics (most commonly; Lasix)for aggressive diuresis - Morphine - Nitrates - Oxygen - Position (upright) - LMNOP - AVOID B-BLOCKERS IN DECOMPENSATED CHF, but resume once euvolemic

Answer 273

- lifestlye: limit dietary sodium and fluid intake - meds: b-blockers and ACEIs/ARBs (help prevent remodeling of the heart and decrease mortality; avoid CCBs!). Diuretics prevent volume overload. Low-dose spironolactone has been shown to decrease mortality w/ advanced heart failure. Daily aspirin and a statin if underlying cause was prior MI - advanced tx: implantable cardiac defibrillator if EF

Answer 274

- decreased ventricular compliance w/ normal systolic function - ventricle either has IMPAIRED ACTIVE RELAXATION or IMPAIRED PASSIVE FILLING - LVEDP is increased, cardiac output remain normal, and EF IS NORMAL OR INCREASED

Answer 275

- Furosemide (Lasix), ethacrynic acid, bumetanide, torsemide | - side effects: ototoxicity, HYPOKALEMIA, HYPOCALCEMIA, dehydration, gout

Answer 276

- HYDROCHLOROTHIAZIDE, chlorothiazide, chlorthalidone - side effects: hypokalemic metabolic alkalosis, hyponatremia, and hyperGLUC (hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia)

Answer 277

- SPIRONOLACTONE, triamterene, amiloride | - side effects: hyperkalemia, gynecomastia, sexual dysfunction

Answer 278

- Acetazolamide | - side effects: hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy

Answer 279

- Mannitol | - side effects: pulmonary edema, dehydration; contraindicated in anuria and CHF

Answer 280

- left ventricular dilation and decreased EF must be present - most cases are idiopathic; most common secondary causes are ischemia and long-standing HTN; also coxsackievirus, Chagas disease are rare - ECHO is diagnostic - an S3 gallop signifies rapid ventricular filling in the setting of fluid overload and is associated with dilated cardiomyopathy

Answer 281

- Dilated: impaired contractility, increase LVEDV, increased LVESV, decreased EF, and usually decreased wall thickness - Hypertrophic: impaired relaxation, decreased LVEDV, decreased LVESV, increased or normal EF, markedly increased wall thickness - Restrictive: impaired elasticity, increased LVEDV, increased LVESV, decreased or normal EF, usually increased wall thickness

Answer 282

hypertrophic obstructive cardiomyopathy - inherited as an autosomal dominant trait - key finding is a systolic ejection crescendo-decrescendo murmur that increases with decreased preload - Echo is diagnostic and shows an asymmetrically thickened septum and dynamic obstruction of blood flow - Tx: B-blockers are initial therapy; CCB are second-line; avoid intense athletic competition and training

Answer 283

- decreased elasticity of myocardium leading to impaired diastolic filling w/o significant systolic dysfunction; caused by INFILTRATIVE DISEASE (amyloidosis, sarcoidosis, hemochromatosis) or by scarring and fibrosis - right sided heart failure symptoms often predominate - echo is diagnostic, w/ rapid early filling and a near-normal EF - ECG frequently shows LBBB; low voltages are seen in amyloidosis - Tx: generally palliative only; cautious use of diuretics for fluid overload and vasodilators to decrease filling pressure

Answer 284

-mimics angina pectoris but is caused by vasospasm of coronary vessels; classically affects young women at rest in the early morning and is associated w/ ST segment elevation in the absence of cardiac enzyme elevation

Answer 285

- substernal chest pain secondary to myocardial ischemia - classic triad: substernal chest pain, precipitated by stress, relieved by rest - pain can radiate to neck or arm or associated with SOB, N/V, diaphoresis, or lightheadedness; pain is usually dull and pressure-like - ECG is best initial test for any type of chest pain (ECG stress test is contraindicated for pts w/ abnormal baseline ECGs)

Answer 286

- cardiac origin - GERD (hx of hoarseness and worse after meals; relief w/ PPIs) - MSK/costochondritis (pain is tender to palpation and movement) - Pneumonia/pleuritis (worsening w/ breathing (pleuritic)) - Anxiety (hx of panic disorder or anxiety attacks)

Answer 287

- aspirin, b-blockers, and nitroglycerin | - risk factor reduction (smoking, cholesterol, HTN)

Answer 288

- unstable angina: new onset, accelerating, or occurring at rest; signals impending infarction based on plaque instability - NSTEMI: myocardial necrosis marked by elevations in troponin I and CKMB - Unstable angina is NOT associated w/ elevated cardiac enzymes; NSTEMI is diagnosed by serial cardiac enzymes (elevated) and ECG - Tx: aspirin, oxygen, IV nitro, IV morphine, B-blockers - admit to hospital and monitor until acute MI has been ruled out by serial cardiac enzymes - Pts w/ refractory chest pain, a TIMI score of > 3, a troponin elevation, or ST changes > 1 mm should be given IV heparin and scheduled for angiography and possible PCI or CABG

Answer 289

- age > 65 (1 point) - 3 or more CAD risk factors (premature family hx, DM, smoking, HTN, increased cholesterol) (1 point) - known CAD (stenosis > 50 %) (1 point) - ASA use in past 7 days (1 point) - severe angina (2 or more episodes within 24 hours) (1 point) - ST deviation > 0.5 mm (1 point) - + cardiac marker (1 point) - scale from 0-7; pts at higher risk 3 or more points benefit from enoxaparin, glycoprotein IIb/IIIa inhibitors, and early angiography

Answer 290

LV ejection fraction

Answer 291

- MOAN - Morphine - Oxygen - ASA - Nitro

Answer 292

- Troponin I | - stays elevated longer than CK-MB

Answer 293

- Inferior MI: involving RCA/PDA, ST elevation in leads II, III, and aVF; obtain a right-sided ECG to look for ST elevation in right ventricle! - Anterior MI: involving LAD and diagonal branches; ST elevation in leads V1-V4 - Lateral MI: involving LCA; ST elevation in leads I, aVL, and V5-V6 - Posterior MI: ST depression in V1-V2 (anterior leads); obtain posterior ECG leads V7-V9

Answer 294

- ASA, b-blockers (unless in heart failure or cardiogenic shock; instead give ACEIs if not hypotensive), clopidogrel, morphine, nitrates, and oxygen - in inferior wall MI, avoid nitrates due to risk of severe hypotension

Answer 295

-If PCI cannot be performed within 90 minutes, AND there are no contraindications to thrombolysis (eg a hx of hemorrhagic stroke, or recent ischemic stroke, severe heart failure, or cardiogenic shock), AND the pt presents within 3 hrs of chest pain onset, thrombolysis w/ tPA, reteplase, or streptokinase should be performed instead of PCI

Answer 296

- first day: heart failure - 2-4 days: arrhythmia, pericarditis - 5-10 days: left ventricular wall rupture (acute pericardial tamponade causing electrical alternans, pulseless electrical activity), papillary muscle rupture (severe mitral regurgitation) - weeks to months: ventricular aneurysm (CHF, arrhythmia, persistent ST segment elevation, mitral regurgitation, thrombus formation) - Dressler syndrome: an autoimmune process occurring 2-10 wks post-MI, presents w/ fever, pericarditis, pleural effusion, leukocytosis, and elevated ESR

Answer 297

- total cholesterol > 200 mg/dL - LDL > 130 mg/dL - Triglycerides > 150 mg/dL - HDL 35 years of age or > 20 w/ CAD risk factors, then every 5 yrs. - Tx: hx of CAD, CVA, or PAD --> high intensity statin; LDL between 70-189 WITHOUT diabetes (>7.5% 10 yr risk--> high intensity statin; between 5-7.5% 10 yr risk--> moderate intensity statin; no statin); LDL between 70-189 WITH diabetes (>7.5% 10 yr risk--> high intensity statin; moderate intensity statin); for pts w/ LDL > 190--> high intensity statin - high intensity therapy is a goal reduction of > 50% LDL; moderate intensity is reduction of 30-50% LDL - first intervention should be a 12 week trial of diet and exercise

Answer 298

- decrease LDL | - decrease triglycerides

Answer 299

- decrease triglycerides | - increase HDL

Answer 300

-decrease LDL

Answer 301

- increase HDL - decrease LDL - causes skin flushing which can be prevented with aspirin ingestion

Answer 302

- decrease LDL | - can decrease absorption of other drugs in GI tract

Answer 303

- SBP > 140, and/or DBP > 90 on 3 measurements separated in time in pts 60, SBP > 150 and/or DBP > 90 (if no hx of CKD, DM) - pts > 18 yrs w/ CKD or DM, SBP > 140 and/or DBP > 90 - you will initiate treatment above any of these variables for these populations

Answer 304

ABCD - ACEIs/ARBs - B-blockers - CCBs - Diuretics (typically thiazides)

Answer 305

-b-blockers (typically labetalol), hydralazine

Answer 306

ACEIs, ARBs

Answer 307

-elevated BP with MILD TO MODERATE SYMPTOMS (headache, chest pain) WITHOUT end-organ damage

Answer 308

- elevated BP w/ signs or symptoms of impending end-organ damage such as acute kidney injury, intracranial hemorrhage, papilledema, or ECG changes suggestive of ischemia or pulmonary edema - tx w/ IV meds (labetalol, nitroprusside, nicardipine) w/ goal of lowering MAP by no more than 25% over the fist 2 hours to prevent cerebral hypoperfusion or coronary insufficiency

Answer 309

- Diagnose w/ urinary metanephrines and catecholamine levels or plasma metanephrine - surgical removal of tumor after treatment with BOTH A-BLOCKERS AND B-BLOCKERS

Answer 310

- most often secondary to an aldosterone-producing adrenal adenoma - causes the triad of HTN, unexplained hypokalemia, and metabolic alkalosis - metabolic workup w/ plasma aldosterone and renin levels; increase aldosterone and decreased renin levels suggest primary hyperaldosteronism; surgical removal of tumor

Answer 311

- due to ACTH producing pituitary tumor, an ectopic ACTH secreting tumor, or cortisol secretion by an adrenal adenoma or carcinoma; also due to exogenous steroid exposure - tx is surgical removal of tumor; removal of exogenous steroids

Answer 312

CARDIAC RIND - Collagen vascular disease - Aortic dissection - Radiation - Drugs - Infections - Acute renal failure - Cardiac (MI) - Rheumatic fever - Injury - Neoplasma - Dressler syndrome - viral infection, TB, SLE, uremia, drugs, radiation, neoplasms, post-MI or Dressler's

Answer 313

- pleuritic chest pain, dyspnea, cough, fever - chest pain tends to WORSEN IN THE SUPINE POSITION, and with inspiration; classic patient is SEEN SITTING UP AND BENDING FORWARD - may hear pericardial friction rub on exam, elevated JVP, pulsus paradoxus (a decrease in SBP > 10mmHg on inspiration) if tamponade present - ECG will show DIFFUSE ST-SEGMENT ELEVATION AND PR-SEGMENT DEPRESSIONS, followed by T wave inversions

Answer 314

- decrease cardiac contractility and renin release | - side effects: bronchospasm (in severe active asthma), bradycardia, CHF exacerbation, impotence, fatigue, depression

Answer 315

- block aldosterone formation, reducing peripheral resistance and salt/water retention - side effects: cough, angioedema, rahes, leukopenia, hyperkalemia

Answer 316

- sartan - block aldosterone EFFECTS, reducing peripheral resistance and salt/water retention - side effects: rashes, leukopenia, and hyperkalemia but NO COUGH

Answer 317

- Dihydropyridines (nifedipine, felodipine, amlodipine), and Nondihydropyridines (diltiazem, verapamil) - decrease smooth muscle tone and cause vasodilation; may also decrease cardiac output - Dihydropyridines: headache, flushing, peripheral edema - Nondihydropyridines: decreased contractility

Answer 318

- Hydralazine: headache, lupus-like syndrome - Minoxidil: orthostasis, hirsutism - decrease peripheral resistance by dilating arteries/arterioles

Answer 319

- prazosin, terazosin, phenoxybenzamine - cause vasodilation by blocking actions of norepinephrine on vascular smooth muscle - side effects: orthostatic hypotension

Answer 320

- methyldopa, clonidine - inhibit the sympathetic nervous system via central a2 adrenergic receptors - side effects: somnolence, orthostatic hypotension, impotence, rebound HTN

Answer 321

- Beck triad (hypotension, distant heart sounds, JVD), a narrow pulse pressure, pulsus paradoxus, and Kussmaul sign (increased JVD on inspiration) - CXR will show enlarged, globular, water-bottle shaped heart - ECG could show ELECTRICAL ALTERNANS, which is diagnostic

Answer 322

Pulmonary embolism

Answer 323

> 5 cm--> surgical repair | monitoring

Answer 324

-screen all men 65-75 years of age w/ a hx of smoking once by US

Answer 325

Pulsus parvus et tardus (weak, delayed carotid upstroke) | -also, systolic murmur radiating to the carotids

Answer 326

- blowing diastolic murmur at left sternal border, mid-diastolic rumble (Austin Flint murmur), and midsystolic apical murmur - WIDENED PULSE PRESSURE causes de Musset sign (head bob w/ heartbeat), Corrigan sign (water-hammer pulse), and Duroziez sign (femoral bruit)

Answer 327

- hemostasis - trauma (endothelial damage) - hypercoagulability

Answer 328

anticoagulate w/ IV unfractionated heparin or subcutaneous LMWH followed by PO warfarin for a total of 3-6 months

Answer 329

-get and ABI; if

Answer 330

-drop in SBP > 20 mmHg when moving from lying down to standing and is typically preceded by a lightheaded or presyncopal sensation

Answer 331

- causes pneumomediastinum and pleural effusion | - diagnosis confirmed w/ water-soluble contrast esophagography

Answer 332

-pneumothorax that does not resolve w/ chest tube placement, pneumomediastinum and subcutaneous emphysema

Answer 333

- pts w/ WPW who develop atrial fibrillation w/ a rapid ventricular rate should be treated w/ cardioversion if hemodynamically unstable, or antiarrhythmics such as PROCAINAMIDE or ibutilide if stable. AV nodal blockers such as beta blockers, calcium channel blockers, digoxin, and adenosine should be avoided as they can cause increased conduction through the accessory pathway!! - accessory pathway conducts depolarization directly from atria to ventricles w/o traversing the AV node

Answer 334

- type A involves the ascending aorta and is a SURGICAL EMERGENCY; all other locations are type B - type A can extend into the pericardial space, causing hemopericardium and rapidly progressing to cardiac tamponade and cardiogenic shock - bedside TEE is typically performed in the ED for rapid diagnosis and early treatment!!

Answer 335

- risk factors: HTN (most common), Marfan syndrome, cocaine use - features: severe, sharp, tearing chest or back pain; > 20 mmHg variation in SBP between arms - complications (involved structure): Stroke (carotids), acute aortic regurgitation (aortic valves), Horner's syndrome (superior cervical sympathetic ganglion), acute MI (coronary artery), pericardial effusion/tamponade (pericardial cavity), hemothorax (pleural cavity), lower extremity weakness (spinal or common iliac arteries), abdominal pain (mesenteric artery)

Answer 336

- aspirin (75-325 mg/day) - beta-blockers - ACE inhibitors - lipid lowering statin drugs -in addition, CLOPIDOGREL should be given to all pts w/ unstable angina/NSTEMI, as well as pts who are post percutaneous coronary intervention (PCI)

Answer 337

- should be given to all pts w/ unstable angina/NSTEMI, as well as those having had a PCI - belongs to drug class called Thienopyridines, and has an anti-platelet effect by antagonizing ADP - for pts who need to be on aspirin but cannot tolerate it, clopidogrel is an appropriate alternative because it is as effective - for pts who are post UA/NSTEMI, clopidogrel + aspirin has been shown to be more effective in terms of mortality than aspirin alone. Clopidogrel should be taken for 12 months, aspirin indefinitely. - clopidogrel + aspirin is more effective than aspirin alone for the first 30 days following PCI as it helps prevent subacute stent thrombosis - basically, clopidogrel should be prescribed for at least 12 months following UA/NSTEMI, 30 days for bare metal stents, and up to 1 year for drug eluting stents following PCI

Answer 338

- class III antiarrhythmic agent, well known for causing pulmonary fibrosis - thyroid dysfunction (hypo and hyper), hepatotoxicity, corneal deposits and skin discoloration (blue-gray) are other potential side effects - excellent drug for BOTH atrial and ventricular arrhythmias

Answer 339

- used to treat atrial AND ventricular arrhythmias | - side effects: nausea, drug-induced lupus, agranulocytosis, and QT prolongation

Answer 340

- class IB anti-arrhythmic agent use to treat VENTRICULAR arrhythmias - high doses can cause confusion, seizures and respiratory depression

Answer 341

- class IA anti-arrhythmic used to treat ATRIAL arrhythmias | - side effects: diarrhea, tinnitus, QT prolongation, torsades de pointes, hemolytic anemia and thrombocytopenia

Answer 342

- inotrope used to treat ATRIAL arrhythmias | - can cause nausea, anorexia, AV block, and ventricular and supraventricular arrhythmias

Answer 343

- chronic disease that can cause megaesophagus, megacolon, and/or cardiac dysfunction - the PROTOZOAN Trypanosoma cruzi, endemic to Latin America, is responsible

Answer 344

- presents w/ hypotension, elevated JVP, and clear lung fields in the setting of acute inferior MI - pts require increased RV preload to maintain cardiac output and may need IV fluid support - Nitrates, diuretics, and opioids can reduce RV preload and should be avoided!

Answer 345

- should be considered in differential of syncopal episodes - the typical scenario would be a middle age or older male, who loses his consciousness immediately after urination, or a man who loses his consciousness during coughing fits

Answer 346

- estimation of left ventricular end diastolic pressure - elevated in pts w/ left ventricular systolic and/or diastolic dysfunction - elevation typically causes signs of pulmonary edema

Answer 347

- impaired function of the right ventricle due to PULMONARY HYPERTENSION that usually occurs due to chronic lung disease - signs of right ventricular failure: elevated JVP, right ventricular 3rd heart sound, tricuspid regurgitation murmur, hepatomegaly w/ pulsatile liver, lower-extremity edema, ascites, and/or pleural effusions - echo will shows signs of increased right heart pressures, and right heart catheterization will show pulmonary systolic pressure > 25 mmHg

Answer 348

- dihydropyridine: amlodipine, nimodipine, nifedipine - non-dihydropyridine: diltiazem, verapamil - mechanism: block voltage dependent L-type calcium channels of cardiac and smooth muscle, thereby reduce muscle contractility; - Verapamil is most effective in cardiac muscle (Verapamil = Ventricle) - DHPs (except nimodipine) are used for HTN, angina, Raynaud's - Non-DHPs are used for HTN, angina, ATRIAL FIBRILLATION/FLUTTER - Nimodipine: subarachnoid hemorrhage (prevents cerebral vasospasm) - side effects: cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia, and constipation

Answer 349

- cardiac glycoside - mechanism: direct inhibition of Na/K ATPase leads to indirect inhibition of Na/Ca exchanger/antiport. Increased Ca conduction leads to positive inotropy. Stimulates vagus nerve which decreases HR. - used to increase contractility in CHF, and to slow conduction at AV node and SA node in ATRIAL fibrillation - can cause change in color vision, hyperkalema, AV block - antidote is to slowly normalize potassium, cardiac pacer, anti-digoxin Fab fragments, Mg

Answer 350

- Na channel blockers (class 1) - B-blockers (class 2) - potassium channel blockers (class 3) - Calcium channel blockers (class 4) "Some Blokes Possess Cardio"

Answer 351

- slow or block conduction (esp in depolarized cells); decrease slope of phase 0 depolarization and increase threshold for firing in abnormal pacemaker cells; they are state dependent (selectively depress tissue that's frequently depolarized; hyperkalemia causes increased toxicity for all class 1 drugs - Class 1A: Quinidine, Procainamide, Disopyramide ("the Queen Proclaims Diso's Pyramid"); increase AP duration, increase refractory period, increase QT interval; used for BOTH ATRIAL AND VENTRICULAR ARRHYTHMIAS, esp re-entrant and ectopic SVT and VT BOTH ATRIA AND VENTRICLES - Class 1B: Lidocaine, Mexiletine; decrease AP duration; preferentially affect ischemic or depolarized Purkinje and ventricular tissue; used for ACUTE VENTRICULAR ARRHYTHMIAS (esp post-MI), digitalis induced arrhythmias (1B is Best post-MI) VENTRICLES - Class 1C: Flecainide, Propafenone ("Can I have Fries, Please"); significantly prolongs refractory period in AV NODE; minimal effect on AP duration; used for SVTs, INCLUDING ATRIAL FIBRILLATION; contraindicated post-MI!!!!! ATRIA

Answer 352

- Metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol - decrease SA and AV nodal activity by decreasing cAMP, decreasing Ca currents; suppress abnormal pacemakers by decreasing slope of phase 4 - used for SVT, slowing VENTRICULAR rate during a. fib and a. flutter - treat overdose with glucagon

Answer 353

- Amiodarone, Ibutilide, Dofetilide, Sotalol ("AIDS") - increase AP duration, increase effective refractory period, increase QT interval (all the same as class 1 anti-arrhythmics) - used for ATRIAL FIBRILLATION, ATRIAL FLUTTER, VENTRICULAR TACHYCARDIA (amiodarone, sotalol) - know that amiodarone can cause PULMONARY FIBROSIS, hepatotoxicity, hypo/hyperthyroidism, corneal deposits, skin deposits, etc.; must check PFTs, LFTs, and TFTs when using amiodarone; it also has class I,II,III, and IV effects and alters the LIPID MEMBRANE

Answer 354

- Verapamil, diltiazem - decrease conduction velocity, increase effective refractory period, increase PR interval - used for prevent NODAL ARRHYTHMIAS (eg SVT), rate control in ATRIAL FIBRILLATION - can cause flushing, constipation, edema, AV block, CHF

Answer 355

- increase potassium out of cells leads to hyperpolarizing the cell and decrease Ca conductance - drug of choice in DIAGNOSING/ABOLISHING SUPRAVENTRICULAR TACHYCARDIA; very short acting (~15 sec) - may cause flushing, hypotension, chest pain; effects blocked by theophylline and caffeine

Answer 356

-effective in torsades de pointes and DIGOXIN toxicity

Answer 357

Class 1a, 1b (sodium blockers), and class 3 (potassium blockers)

Answer 358

-class 1a, 1c (sodium blockers), class 2, class 3

Answer 359

-inhibits L-type calcium channels, decreasing conduction velocity in the AV node; this can lead to a transient AN nodal block and is used in the tx of AV node-dependent reentrant tachycardia

Answer 360

- type 3 AV block - temporal dissociation of P waves and QRS complexes (AV dissociation) - pts w/ symptomatic 3rd degree AV block should be managed w/ temporary pacemaker insertion while undergoing further evaluation to identify and correct reversible causes - a permanent pacemaker is indicated if no reversible causes of heart block are found.

Answer 361

- should be tailored to the specific organism as soon as they are identified (start empiric IV vancomycin first) - most viridans group strep are highly susceptible to penicillin and should be treated w/ IV aqueous penicillin G or IV ceftriaxone for 4 weeks

Answer 362

-peripheral edema

Answer 363

age-dependent idiopathic sclerocalcific changes | -these changes are common and usually have minimal hemodynamic significance, but sometimes may be severe

Answer 364

-shortened PR interval, delta waves, and widening of the QRS complex

Answer 365

- holosystolic murmur heard best at the apex w/ radiation to the axilla - exertional dyspnea, fatigue, atrial fibrillation, and signs of heart failure

Answer 366

-fixed, split S2 in addition to systolic ejection murmur at the left upper sternal border

Answer 367

- associated w/ Turner syndrome | - diminished or absent lower extremity pulses and upper extremity HTN

Answer 368

- continuous machine-like murmur | - strongly associated w/ congenital rubella syndrome

Answer 369

-cyanosis, a single second heart sound, and a harsh crescendo-decrescendo murmur caused by right ventricular outflow tract obstruction

Answer 370

-strongly associated w/ DiGeorge syndrome

Answer 371

- failure of endocardial cushion fusion results in AV septal defects - Complete AV septal defects causes heart failure in early infancy (~6 wks) and require surgical repair - Complete AV septal defects > Ventricular septal defect > Atrial septal defect

Answer 372

-important cause of right heart failure and is characterized by progressive peripheral edema, ascites, elevated JVP, pericardial knock (middiastolic sound), and pericardial calcifications on chest x-ray

Answer 373

- echo will show increased ventricular wall thickness w/ a normal or nondilated left ventricular cavity - pts w/ amyloidosis may also have heavy proteinuria, periorbital purpura, and hepatomegaly

Answer 374

- classically presents during pregnancy | - its most often due to rheumatic fever and occurs much more often in countries w/ limited access to abx

Answer 375

- can occur within days or months after cardiac surgery and is referred to as postpericardiotomy syndrome - life-threatening fluid accumulation is characterized by distant heart sounds, hypotension, and distended jugular veins (Beck's triad) and requires drainage

Answer 376

-fever, new murmur, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots

Answer 377

- used to treat lipid abnormalities, but frequently produces cutaneous flushing and pruritis - prostaglandin-induced peripheral vasodilatation and can be reduced by low-dose aspirin

Answer 378

- sudden onset, regular, and narrow-complex tachycardia | - Adenosine and vagal maneuvers can terminate PSVT by transiently slowing SA and AV node conduction

Answer 379

- common in pts post-MI and can be recognized by their widened QRS (> 120msec), bizarre morphology, and compensatory pause - even though they may indicate a worse prognosis, tx is NOT indicated unless the patient is symptomatic (then give beta blockers)

Answer 380

- VSD - RVH - pulmonary stenosis - overriding aorta

Answer 381

- presents w/ varying degrees of cyanosis depending on the severity of right ventricular outflow tract obstruction - "Tet" spells result from sudden spasm of the right ventricular outflow tract during exertion - the murmur is typically a harsh crescendo-decrescendo systolic murmur over the left upper sternal border, reflecting turbulence at the stenotic pulmonary artery

Answer 382

- can present w/ several nonspecific symptoms and physical exam findings due to immunologic and/or vascular phenomena - early recognition is important to avoid a missed or late diagnosis in such pts - definitive diagnosis is based on Duke Criteria and requires a more comprehensive evaluation

Answer 383

- inflammatory disorder characterized by recurrent high fevers (>39C), rash, and arthritis - the rash is often maculopapular and nonpruritic, affecting the trunk and extremities during febrile episodes

Answer 384

- vasospastic disorder that typically occurs in young female smokers - chest pain usually occurs in the middle of the night, and episodes are associated w/ transient ST elevations on ECG - treatment is with CCB or nitrates

Answer 385

- causes chest pain that is classically described as sudden, tearing, and radiating to the back - HTN is the most common predisposing factor

Answer 386

- mutation of the FIBRILLIN gene, which results in "weakened" connective tissue - pts are at increased risk for aortic dissection

Answer 387

-connective tissue disease involving collagen that can predispose to aortic dissection

Answer 388

-low frequency sound heard at the end of diastole just before S1 that is commonly associated w/ LVH from prolonged HTN

Answer 389

- can be seen following viral myocarditis, particularly after a Coxsackievirus B infection - diagnosis made by Echo, which typically shows dilated ventricles and diffuse hypokinesia resulting in systolic dysfunction (low ejection fraction) - tx is largely supportive, involving mainly the management of CHF symptoms

Answer 390

- hypertrophic cardiomyopathy | - young pts; athletes; sudden cardiac death

Answer 391

- follows chronic pressure overload, such as w/ valvular aortic stenosis or untreated HTN - only develops in CHRONIC conditions

Answer 392

- follows chronic volume overload, as seen in valvular regurgitation - develops slowly over time in response to ventricular volume overload

Answer 393

-mid-diastolic murmur and an opening snap, ECG can show left atrial hypertrophy (camel hump, wide P wave in lead II)

Answer 394

- defined as a body temp > 40C (104F) WITH CNS dysfunction or end-organ damage - most commonly induced by strenuous exercise during hot and humid weather - dehydration, hypotension, and tachycardia are common - systemic effects such as seizures, ARDS, DIC, and hepatic/renal failure may also occur - Tx consists of rapid cooling by ice-water immersion and supportive managment

Answer 395

- occurs in absence of strenuous activity and typically affects elderly pts w/ significant underlying comorbidities that limit their ability to escape or cope w/ excessive heat - management involves EVAPORATIVE COOLING, rather than ice-water immersion which is used in exertional heat stroke; this is due to increased mortality with that method in this population

Answer 396

- serotonin syndrome: typically seen in pts taking SSRI - malignant hyperthermia: usually triggered by certain anesthetic agents - both conditions cause MUSCULAR RIGIDITY, serotonin syndrome has significant HTN

Answer 397

- electrical cardioversion is indicated for SMVT pts who are hemodynamically unstable, pulseless, or severely symptomatic - hemodynamically stable pts can first be given anti-arrhythmics (IV amiodarone) as these may lead to sinus rhythm and avoidance of the need for cardioversion

Answer 398

-useful vagal maneuver to terminate paroxysmal supraventricular tachycardia (PSVT), a regular, narrow-complex tachycardia

Answer 399

- used for rate control in SUPRAVENTRICULAR ARRHYTHMIAS (a. flutter, fibrillation, atrial tachycardia), esp in pts w/ hypotension and/or heart failure who are unable to tolerate beta blockers or calcium channel blockers!!!! - can potentially worsen ventricular arrhythmias!

Answer 400

- presents w/ bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, and cardiogenic shock - IV fluids and atropine are the first-line treatment options - IV glucagon should be administered in pts w/ profound or refractory hypotension

Answer 401

-methylxanthine which acts by blocking phosphodiesterase, thereby increasing levels of cAMP; causes bronchodilation and has positve inotropic/chronotropic effects

Answer 402

-antidote to digoxin toxicity, which usually presents w/ fatigue, anorexia, nausea, blurred vision, disturbed COLOR PERCEPTION, and cardiac arrhythmias

Answer 403

-inotropic agent that can cause significant vasodilation and worsen hypotension

Answer 404

- causes increased ectopy and increased vagal tone - atrial tachycardia w/ AV block occurs from the combination of these two digitalis effects, and is relatively specific for digitalis toxicity

Answer 405

Pulmonary disease

Answer 406

- best heard along the left sternal border at the 3rd and 4th interspaces - may be heard in some pts only by applying firm pressure w/ the diaphragm of the stethoscope while the patient is sitting up, leaning forward, and holding breath in full expiration - congenital bicuspid aortic valve is the most common cause of AR in young adults in developed countries - Rheumatic heart disease is the most common cause in developing countries

Answer 407

- result from normal blood flow from a structurally normal heart - the intensity is typically grade 1 or 2 and DECREASES with maneuvers that decrease venous blood return, such as standing. - benign murmurs are also early or mid-systolic in timing - management consists of observation and reassurance

Answer 408

- Beta blockers, calcium channel blockers, and nitrates are anti-anginal agents and should be withheld for at least 48 hrs prior to cardiac stress testing - however, these meds should be continued in pts w/ known CAD undergoing stress testing to assess the efficacy of antianginal therapy

Answer 409

- progressive prolongation of PR interval leading to a non-conduction P wave and a dropped QRS complex - the PR interval prolongation is best appreciated by measuring the PR intervals just before and after the dropped QRS complex - constant PP interval, decreasing RR interval

Answer 410

- indicate depolarization of the atria originating in a focus outside the SA node - they are seen on ECG as a P wave w/ abnormal morphology, often occurring earlier in the cardiac cycle than a normal P wave

Answer 411

- leads to sick sinus syndrome, which is often due to degeneration and/or fibrosis of the SA node and surrounding atrial myocardium - pts may present w/ fatigue, lightheadedness, palpitations, presyncope, or syncope - ECG often shows bradycardia, sinus pauses/arrest, SA exit block, or alternating bradycardia and atrial tachyarrhythmias (tachy-brady syndrome)

Answer 412

- ventricular preexcitation that is due to an accessory conduction pathway that directly connects the atria and ventricle, bypassing the AV node - the ECG shows a characteristic pattern of short PR interval (

Answer 413

- extremely common due to their shorter esophagus, incomplete closure of the lower esophageal sphincter, and greater time spent in the supine position - parents should be reassured about adequate weight gain and advised to hold the infant upright after feeds

Answer 414

-include normal to increased PCO2 values, speech difficulties, diaphoresis, altered sensorium, cyanosis, and "silent" lungs

Answer 415

-local osteolytic metastasis, secretion of parathyroid hormone-related protein (PTHrP), and increased formation of 1,25-dihydroxyvitamin D

Answer 416

- should be suspected in any ill pts, esp. those w/ a hx of febrile paroxysms, who have traveled to an endemic-tropical region - thick and thin blood smears should be ordered for parasite detection and quantification - nonimmune children are at highest risk of death, but the sickle cell trait confers some protection from severe complications - Plasmodium falciparum, P. vivax, P. ovale, or P. malariae transmitted by bite of infected Anopheles mosquito - antimalarial drugs: atovaquone-proguanil, doxycycline, mefloquine, chloroquine, hydroxychloroquine

Answer 417

- urinary incontinence in children age >5 - urinalysis, urologic imaging for children w/ significant daytime sx and hx of recurrent UTI - avoid sugary/caffeinated beverages, void regularly during the day and immediately before bed, drink ample fluids in the morning and early afternoon; minimize fluid intake before bed, reward system - ENURESIS ALARM: 1st line intervention when behavior modifications fail; best long-term outcome - meds: DESMOPRESSION (1st line), TCAs (2nd line)

Answer 418

- blocked vessel is LAD | - some or all of leads V1-V6 involved

Answer 419

- RCA or L circumflex artery | - ST elevation in leads II, III, and aVF

Answer 420

- L circumflex or RCA - ST depression in leads V1-V3 - ST elevation in leads I and aVL (LCX) - ST depression in leads I and aVL (RCA)

Answer 421

- L circumflex, or diagonal artery - ST elevation in leads I, aVL, V5 and V6 - ST depression in leads II, III, and aVF

Answer 422

- RCA | - ST elevation in leads V4-V6R

Answer 423

- can cause acute inferior and posterior wall MIs - inferior wall MI presents w/ ST segment elevations in the inferior leads (II, III, and aVF) - ST segment depression in leads V1 and V2 in this setting usually suggests a posterior wall MI - Inferior MI is also associated w/ hypotension, bradycardia, and AV block

Answer 424

-diffuse PR segment depression and diffuse ST segment elevation across multiple limb and precordial leads

Answer 425

- LAD usually supplies the anterior walls of the left ventricle as well as the anterior 2/3rds of the septum - occlusion of this vessel can cause ST segment elevation in all precordial leads, but most commonly in V1-V4 - second degree AV block can be seen

Answer 426

- supplies the posterolateral wall of the left ventricle | - occlusion can cause ST segment elevation in leads I, II, III, and aVL

Answer 427

- usually a catastrophic event and presents as sudden cardiac death in the majority of pts - occlusion of both LCX and LAD causes ST segment elevations in anterior and lateral leads (I aVL, V1-V6)

Answer 428

- APLASTIC CRISIS - this is an acute drop in Hgb and is known complication of sickle cell disease - alternative things that can cause an acute drop in Hgb: hyperhemolytic crisis, splenic sequestration, or an aplastic crisis - aplastic crisis is a transient arrest of erythropoiesis that results in a severe drop in Hgb and virtual absence of reticulocytes on peripheral smear (reticulocytes

Answer 429

- rare complication of sickle cell disease that is characterized by a sudden, severe anemia accompanied by an APPROPRIATE RETICULOCYTOSIS (in contrast to aplastic crisis) - etiology unknown

Answer 430

- occurs in sickle cell pts who have not yet developed auto-splenectomy - caused by vasoocclusion and pooling of red cells within the spleen, which may lead to severe hypotensive shock - characterized by a dramatic drop in Hgb concentration that is accompanied by persistent reticulocytosis - physical exam shows a rapidly enlarging spleen - mortality rate of 10-15% and 50% chance of recurrence, so splenectomy is usually recommended after the first episode

Answer 431

- characterized by the presence of fever, chest pain, and an infiltrate on chest x-ray - multifactorial and related to pulmonary infarction and infection

Answer 432

- acute onset of pain and caused by vasoocclusion secondary to the sickling of RBCs - these crises may be precipitated by changes in weather, dehydration, or infection

Answer 433

- pre-renal failure from hypovolemia most likely, though urinary catheter obstruction should first be ruled out - the next step in diagnosis/management of acute renal failure manifesting as oliguria or anuria is an IV fluid challenge

Answer 434

-elevated BUN/Cr ratio > 10:1 and FENa 1 is intrinsic renal

Answer 435

- women age 21-24 yrs: repeat cytology in 1 year - women age >25 yrs: HPV DNA test; those who test positive for HPV require colposcopy; pts w/ a negative HPV test can be followed w/ repeat Pap smear and HPV test in 3 yrs

Answer 436

- cytology every 3 yrs or a combo of cytology and HPV DNA test every 5 yrs in women age >30 yrs - for women age 21-29 yrs, cytology every 3 yrs is recommended

Answer 437

- ophthalmologic emergency! - treated w/ an ocular massage and high-flow oxygen! - painless loss of monocular vision - risk factors: carotid artery disease, endocarditis, cardiac valvular disease, long bone fx, hypercoagulable states, vasculitis, atrial myxoma - amaurosis fugax

Answer 438

- topical pilocarpine and beta-blockers | - sudden, painful loss of vision w/ red eye

Answer 439

-difficulty w/ initiating swallowing associated w/ coughing, choking, or nasal regurgitation

Answer 440

- can initiate swallowing but have difficulty passing the food down the esophagus - dysphagia which is initially w/ solids but eventually liquids favors a mechanical obstruction - progressive dysphagia suggests esophageal stricture or cancer - nonprogressive dysphagia favors esophageal rings - upper GI endoscopy is initially recommended except in pts w/ hx of prior radiation, caustic injury, complex stricture, or surgery for esophageal/laryngeal cancer; these pts have increased risk of perforation w/ endoscopy and can benefit from having a barium swallow first; pts w/ negative endoscopy should then have barium swallow for further evaluation - pts w/ dysphagia to liquids and solids at onset favor a motility disorder; intermittent dysphagia suggest a primary esophageal motility disorder; progressive dysphagia indicates secondary causes such as achalasia or systemic sclerosis (scleroderma); barium swallow is recommended initially for these pts as its more effective than endoscopy in evaluating motlity disorders; pts who have a barium swallow suggesting a motility disorder then undergo esophageal motility studies (manometry) to confirm the diagnosis

Answer 441

-might be helpful to confirm diagnosis of gatroesophageal reflux

Answer 442

- wrist immobilization for 6-10 wks - if x-rays are negative but suspicion is high, immobilize wrist and re-image in 7-10 days or proceed immediately w/ CT scan

Answer 443

-done on hemodynamically UNSTABLE pts w/ BLUNT abdominal trauma and INCONCLUSIVE FAST exam

Answer 444

- Pneumonia hospitalization criteria, 2-3 = consider inpatient tx; > 4 = admission - Confusion - Uremia (BUN > 19) - Respiratory rate ( > 30 breaths/min) - Blood pressure (SBP 65 yrs

Answer 445

- neonates: GBS, E. coli, Listeria - children: Viruses, S. pneumo, Mycoplasma, Chlamydia pneumoniae, S. aureus - adults (18-40): Mycoplasma, S. pneumo, Viruses, C. pneumoniae - adults (40-65): S. pneumo, H. influenza, Mycoplasma, Viruses, Anaerobes - elderly: S. pneumo, H. influenza, Viruses, S. aureus, gram - rods, anaerobes

Answer 446

-MCL (mycoplasma, chlamydophila, legionella)

Answer 447

-GNRs, Staph, anaerobes, Pseudomonas (intubated pts)

Answer 448

-Staph, gram + rods, fungi, viruses, Pneumocystis jirovecii (w/ HIV), mycobacteria

Answer 449

-S. pneumo, Klebsiella, Staph

Answer 450

-staph, Pseudomonas, Burkholderia, mycobacteria

Answer 451

-H. influenza, Moraxella catarrhalis, S. pneumo

Answer 452

-Staph, S. pneumo, H. influenza

Answer 453

-obstruction, bronchogenic carcinoma, lymphoma, Wegener granulomatosis, immunodeficiency, unusual organisms (Nocardia, Coxiella burnetii, Aspergillus, Pseudomonas)

Answer 454

macrolide or doxycycline

Answer 455

Fluoroquinolone or B-lactam + macrolide

Answer 456

antipneumococcal B-lactam + either azithromycin or fluoroquinolone

Answer 457

- extended spectrum cephalosporin or carbapenem w/ antipseudomonal activity - add an aminoglycoside or a fluoroquinolone for coverage of resistant organisms (Pseudomonas) until lab sensitivities are back

Answer 458

- Rifampin turns body fluids red/orange - Ethambutol can cause optic neuritis - INH causes peripheral neuropathy and hepatitis

Answer 459

- active: sputum culture or gram stain for acid-fast bacilli; chest x-ray - latent: PPD and chest x-ray

Answer 460

active disease: directly observe tx w/ 4 drug regimen (INH, pyrazinamide, rifampin, ethambutol) x 2 months followed by INH and rifampin for 4 months; must give vitamin B6 w/ INH! latent disease: + PPD w/o symptoms needs INH x 9 months or INH x 6 months or rifampin x 4 months

Answer 461

>5 mm: HIV or risk factors, close TB contacts, CXR evidence of TB >10 mm: indigent/homeless, residents of developing nations, IV drug use, chronic illness, prisoners, healthcare workers > 15 mm: everyone else, including those w/ no known risk factors -note that a negative test w/ negative controls implies anergy from immunosuppression, old age, or malnutritions and does NOT rule out TB

Answer 462

-thrombophlebitis of the jugular vein due to Fusobacterium, an oral anaerobe

Answer 463

- used to determine tx plan for acute pharyngitis - Fever 1 point - tonsillar exudate 1 point - tender anterior cervical lymphadenopathy 1 point - lack of cough 1 point - 3-14 yrs of age 1 point - 15-45 yrs of age 0 point - > 45 yrs of age -1 point - if 4-5 points, treat empirically; if 2-3 points, perform rapid antigen test. if + test, treat w/ abx. if - test, perform throat culture; if 0-1 point, no testing or abx required, symptomatic tx only

Answer 464

-amoxicillin/clavulanate for 10 days or clarithromycin, azithromycin, TMP-SMP, a fluoroquinolone, or a second-generation cephalosporin for 10 days

Answer 465

- GBS - E. coli/GNRs - Listeria

Answer 466

- S. pneumo - N. meningitidis - H. influenza serotype b - Enteroviruses

Answer 467

- N. meningitidis (#1 in teens) - S. pneumo - Enteroviruses - HSV

Answer 468

- S. pneumo - GNRs - Listeria - N. meningitidis

Answer 469

- petechial or purpuric rash - waterhouse-friderichsen syndrome (adrenal insufficiency due to bleeding into the adrenal gland) is characterized by profound hypotension and has high mortality

Answer 470

GB has high protein levels in CSF; MS has high gamma globulin in CSF

Answer 471

Give abx as soon as possible! - close contacts w/ meningococcal meningitis should receive Rifampin, Ciprofloxacin, or ceftriaxone - Dexamethasone decreases complications in S. pneumo meningitis only! - if immunocompromised, elderly, or neonate, add ampicillin for Listeria - 60 yrs/alcoholism/chronic illness: Ampicillin + vancomycin + cefotaxime or ceftriaxone

Answer 472

- HSV encephalitis | - subarachnoid hemorrhage

Answer 473

-HSV and arboviruses

Answer 474

trypanosomes

Answer 475

- HSV encephalitis: IV acyclovir - CMV encephalitis: IV ganciclovir +/- foscarnet - Doxycycline for Ricketsia such as Rocky Mountain spotted fever or ehrlichiosis - Lyme encephalitis: Ceftriaxone

Answer 476

headache, fever, and a focal neurologic deficit

Answer 477

-broad spectrum IV antibiotics and surgical drainage; lesions

Answer 478

- Esophageal candidiasis - CMV retinitis - Kaposi sarcoma (HHV-8) - CNS lymphoma, toxoplasmosis, PML - P. jirovecii pneumonia or recurrent bacterial pneumonia - HIV encephalopathy - Disseminated mycobacterial or fungal infection - invasive cervical cancer

Answer 479

-combo of 2 nucleoside/nucleotide reverse transcriptase inhibitors (RTIs), plus either one non-nucleoside RTI or one protease inhibitor or one integrase inhibitor

Answer 480

- Protease inhibitors: hyperglycemia, hyperlipidemia, lipodystrophy - Nucleoside RTIs: bone marrow suppression, neuropathy - Indinavir: crystal induced nephropathy, nephrolithiasis - Didanosine: pancreatitis - Abacavir: hypersensitivity rxn - Nevirapine: liver failure - Efavirenz: vivid dreams, hallucinations

Answer 481

MMR and varicella

Answer 482

P. jirovecii: CD4 5mm or high risk; INH x 9mo (+pyridoxine) or rifampin x 4 mo Candida: fluconazole or fluconazole or nystatin mouth wash HSV: daily suppressive acyclovir, famciclovir, or valacyclovir S. pneumo: Pneumovax every 5 yrs if CD4 > 200 Influenza: annual vaccine

Answer 483

- 45 degree angle branching septate hyphae (think of the capital letter "A" and how it's angle is 45 degrees) - rare fruiting bodies

Answer 484

- yeasts w/ wide capsular halo | - narrow-based buds

Answer 485

-irregular broad nonseptate hyphae, wide-angle branching

Answer 486

thrush can be easily rubbed off, hairy leukoplakia cannot

Answer 487

-IV amphotericin B + flucytosine x 2 wks; then fluconazole x 8 wks

Answer 488

CXR: diffuse nodular densities, focal infiltrate, cavity, or hilar lymphadenopathy Urine and serum polysaccharide antigen test is most sensitive.

Answer 489

- mild: supportive or itraconazole - moderate: itraconazole for > 1 year - severe: liposomal amphotericin B followed by itraconazole for 1 yr or greater

Answer 490

-histiocyte macrophage containing numerous yeast cells

Answer 491

- partially acid-fast, gram +, branching rod found in soil that is a common cause of lung and CNS infection in immunocompromised - TMP-SMX is treatment

Answer 492

- most commonly (80%) due to parathyroid hormone-related peptide (PTHrP) production - other mechanisms include excess vitamin D production, bone metastasis w/ local cytokine release to induce bone resorption, and ectopic PTH production - breast cancer most commonly causes hyper calcemia by producing PTHrP, either systemically or locally by bone metastases

Answer 493

- IL-6 - IL-3 - RANK-L - TNF-a - macrophage inflammatory factor 1-a

Answer 494

- manifests as a pulsatile mass that can compress adjacent structures (nerves, veins) and can result in thrombosis and ischemia - popliteal and femoral artery aneurysms are the most common peripheral artery aneurysms - they are frequently associated w/ AAA

Answer 495

diabetic neuropathy and prevention of migraine headaches

Answer 496

effective antidepressant; however, weight gain is fairly common

Answer 497

- if due to ectopic ACTH production, it causes rapid onset of HTN, metabolic alkalosis, hyperglycemia, hypokalemia, and proximal muscle weakness - in contrast to Cushing's DISEASE (ACTH-producing pituitary adenoma), administration of high-dose dexamethasone does NOT suppress plasma cortisol levels in most pts w/ ectopic ACTH syndrome - ACTH independent: usually due to exogenous steroids, adrenal adenoma, or primary pigmented nodular adrenocortical hyperplasia; get an adrenal CT to exlude adrenal adenoma - ACTH dependent: most commonly due to Cushing's disease (ACTH-producing pituitary adenoma), ectopic ACTH production, or ectopic CRD production; due a high-dose dexamethasone suppression test; failure to suppress serum cortisol levels by 50% makes ectopic ACTH most likely

Answer 498

-retrograde urethrogram (helps determine urethral injury and location for repair)

Answer 499

- gardener's disease - the initial lesion, a reddish nodule that later ulcerates, appears at the site of the thorn prick or other skin injury - from the site of inoculation, the fungus spreads along the lymphatics forming subcutaenous nodules and ulcers

Answer 500

- prokinetic agent used to treat nausea, vomiting, and gastroparesis - pts taking this med should be monitored closely for the development of drug-induced extrapyramidal symptoms (dystonic rxn most commonly; tx involves stopping the drug and giving benztropine or diphenhydramine)

Answer 501

1. Is it an inflammatory process? 2. Is it monarticular or polyarticular? 3. Is it symmetric or asymmetric? 4. What is the duration of symptoms?

Answer 502

- can preset w/ symmetric small joint inflammatory arthritis - distinguished from other causes of symmetric inflammatory arthritis by the fact that it tends to resolve within two months - positive inflammatory markers such as ANA and rheumatoid factor may occur - tx involves NSAIDs for resolution of symptoms - antiviral therapy is unnecessary as the symptoms are self-limited - causative agents include: parvovirus, hepatitis, HIV, mumps, and rubella among many others

Answer 503

- include ankylosing spondylitis, reactive arthritis, and psoriatic arthritis - asymmetric arthritis and inflammatory back pain w/ a negative rheumatoid factor

Answer 504

- occurs most commonly in pts over 50 - inflammatory condition which presents w/ sore and stiff muscles, particularly in the neck and shoulders - ESR typically > 40, while the ANA is normal

Answer 505

- variable presentation from no symptoms to light vaginal bleeding - pregnancy symptoms may decrease - CLOSED cervix - Nonviable fetus on US

Answer 506

- vaginal bleeding, uterine cramps - possible intrauterine fetus w/ heartbeat - OPEN cervix; fetus w/ possible heartbeat on US

Answer 507

- vaginal bleeding w/ passage of large clots or tissue - uterine cramps - products of conception often visualized in dilated cervical os - OPEN cervix; products of conception often in cervix

Answer 508

- variable amount of vaginal bleeding - pregnancy can proceed to viable birth - CLOSED cervix; viable pregnancy on US

Answer 509

- fever, malaise, signs of sepsis - foul smelling vaginal discharge, cervical motion and uterine tenderness - rarely occurs after spontaneous abortion - usually w/ induced abortions, can be life-threatening - USUALLY OPEN cervix; usually retained products of conception on US

Answer 510

- form of spontaneous abortion (defined as intrauterine fetal death before 20 wks gestational age) w/ complete retained products of conception and a closed cervix - pts often develop loss of pregnancy symptoms and scant to light vaginal discharge - pelvic US is necessary for diagnosis

Answer 511

- x linked mutation of androgen receptor - breast development present - absent uterus and upper 1/3 of vagina; cryptorchid testes - minimal to absent pubic and axillary hair - 46 XY

Answer 512

- Hypoplastic or absent mullerian ductal system - breast development present - absent or rudimentary uterus and upper 1/3 of vagina; normal ovaries - normal pubic and axillary hair - 46 XX

Answer 513

- malformation of urogenital sinus and Mullerian ducts - breast development present - normal uterus, abnormal vagina; normal ovaries - normal pubic and axillary hair - 46 XX

Answer 514

- complete/partial absence of 1 X chromosome - variable breast development depending on ovarian function - normal uterus and vagina; streak ovaries - normal axillary and pubic hair - 45 X

Answer 515

-absence of menses by age 15 in someone who has normal growth and secondary sexual characteristics

Answer 516

- caused by mutated androgen receptor that results in end-organ resistance to androgens - 46 XY pts have testicular secretion of anti-Mullerian hormone, resulting in primary amenorrhea - in addition, testosterone secreted from the testes is converted to estrogen, resulting in breast development

Answer 517

- cannot convert testosterone to DHT | - ambiguous genitalia at birth (undervirilization) and a male internal urogenital tract (due to AMH)

Answer 518

- presents w/ abrupt onset of fever, sore throat, dysphagia, and drooling - airway obstruction is the most concerning potential complication, and often requires nasotracheal intubation - in unimmunized children, H. influenza type b is a likely cause

Answer 519

- fever, sore throat, muffled voice, and occasionally drooling - unilateral tonsillar swelling w/ uvular deviation

Answer 520

-rare congenital anomaly where aortic arch remnants encircle and compress the trachea or esophagus

Answer 521

- most commonly caused by parainfluenza virus type 1 - fever, TRIDOR, and barking cough - drooling is UNCOMMON - Corticosteroids or nebulized epinephrine may be used in tx

Answer 522

- common cause of respiratory distress in children - pts w/ a laryngeal foreign body present w/ wheezing and in severe cases, cyanosis - diagnosis typically confirmed radiographically - rigid bronchoscopy is used to remove foreign body

Answer 523

- typically presents w/ epigastric pain that improves w/ eating (alkali solution is injected into duodenum w/ food ingestion; this is in contrast to GASTRIC ulcers, which get worse w/ food ingestion due to acid increase in stomach) - over 90% of pts w/ duodenal ulcer disease are infected w/ H. pylori - tx is acid suppression w/ PPI and amoxicillin plus clarithromycin

Answer 524

- multiple motor and one or more vocal tics that present before the age of 18; grimacing, eye blinking, nose twitching, head jerking, and shoulder shrugging, barking, grunting, squeaking, coughing, throat clearing, coprolalia - sx exacerbated by stress and tend to subside during sleep - comorbid conditions: ADHD, OCD

Answer 525

- helpful in assessing the STATUS of a neonate and RESPONSE to neonatal resuscitation - routinely measured at 1 and 5 minutes; most infants score 7-9/10 - scores

Answer 526

- Appearance/color: completely blue/pale 0 points, body pink and extremities blue 1 point, completely pink 2 points - Pulse: absent 0 points, 100/min 2 points - Grimace/reaction: absent 0 points, grimace/whimper 1 point, cough/sneeze/cry 2 points - Activity/muscle tone: limp 0 points, some flexion 1 point, active/spontaneous 2 points - Respiratory effort: absent 0 points, slow/weak cry 1 point, regular good cry 2 points

Answer 527

-typical presentation is a moderately obese middle-aged man complaining of daytime somnolence, morning headaches, increased fatigability, and who is noted to snore loudly. Try weight reduction, avoidance of sedatives and alcohol, and avoidance of supine posture during sleep as a first step

Answer 528

- common AUTOSOMAL RECESSIVE disease characterized by recurrent sinopulmonary infections - bilateral nasal polyps exacerbate nasal obstruction and chronic rhinosinusitis - Quantitative pilocarpine iontophoresis is the gold standard for diagnosis!

Answer 529

- most common cause of childhood cancer - numerous infections and weight loss - Hepatosplenomegaly, lymphadenopathy, and petechiae are often seen

Answer 530

- autosomal recessive disorder of mucociliary clearance | - recurrent sinopulmonary infections, nasal polyposis, and digital clubbing

Answer 531

- can develop in pts who have persistent or recurrent tachyarrhythmia w/ prolonged periods of rapid ventricular rate - initial tx is aimed at restoration of sinus rhythm or aggressive control of ventricular rate and can lead to significant improvement in left ventricular function

Answer 532

- leading cause of end stage renal disease in US - increased extracellular matrix, BM thickening, mesangial expansion, and fibrosis - within the first year: glomerular HYPERFUSION and renal HYPERTROPHY w/ INCREASED GFR - first five years: glomerular BM thickening, glomerular hypertrophy, and mesangial volume expansion w/ GFR returning to normal - within 5-10 yrs: microalbuminuria, which later progresses to overt nephropathy

Answer 533

Vasospasm | -vasospasm can best be prevented w/ initiation of NIMODIPINE

Answer 534

- multisystem disorder w/ a varied presentation caused by infection w/ the gram-positive bacillus Tropheryma whippelii - chronic malabsorptive diarrhea, weight loss, migratory non-deforming arthritis, lymphadenopathy and a low-grade fever are the most common presenting symptoms - diagnosis made by small intestinal biopsy and PCR; shows PAS-positive macrophages in the lamina propria containing non-acid fast gram positive bacilli

Answer 535

- occurs following an infection - HLA-B27 associated reactive arthropathy characterized by conjunctivitis, urethritis, and arthritis - typically follows infections by Chlamydia, Shigella, Salmonella, Yersinia, Campylobacter, and C. diff

Answer 536

Sarcoidosis

Answer 537

- autoimmune disease causing malabsorptive diarrhea | - anti-endomysial and anti-transglutaminase antibodies and histopath shows effacement of small intestinal villi

Answer 538

- abdominal pain, weight loss, N/V, distention, and occult blood in stool - diffuse infiltrate by atypical lymphocytes

Answer 539

-affects pts over 60; mature-appearing small lymphocytes and "smudge" cells are seen

Answer 540

- may occur in association w/ an inflammatory arthritis - ankylosing spondylitis and IBD are both associated w/ HLA-B27 and may occur in association w/ one another - Both conditions may also be associated w/ a positive p-ANCA despite the absence of vasculitis in both conditions.

Answer 541

- may follow infectious diarrhea caused by Shigella, Salmonella, Yersinia, Campylobacter, or C. diff - urethritis, conjunctivitis/uveitis, arthritis, malaise and skin findings (keratoderma blennorrhagica and balanitis circinata)

Answer 542

Dermatitis herpetiformis

Answer 543

erythema nodosum, pyoderma gangrenosum

Answer 544

- presents w/ fever and occipital or posterior cervical lymphadenopathy followed by a blanching, erythematous maculopapular rash that spreads in a cranial-caudal pattern (starts on face and spreads to trunk) and SPARES THE PALMS AND SOLES - affected adult women also suffer from arthritis that can last up to a month after resolution of other symptoms - can be contagious for up to 3 wks during incubation period prior to symptomatic manifestation - postinfectious encephalitis is a rare complication that can occur within a week of the exanthem - congenital disease: sensorineural hearing loss, intellectual disability, cardiac anomalies (PDA), cataracts/glaucoma - children: low grade fever, conjunctivitis, coryza, cervical lymphadenopathy, Forschheimer spots, maculopapular rash - diagnosis: PCR, acute and convalescent serology for anti-rubella IgM and IgG - prevention: live attenuated rubella vaccine - tx: supportive

Answer 545

- same rash as rubella - high fever (> 104F) and cranial-caudal spread of rash takes days vs less than 24 hrs in rubella - arthritis does not occur

Answer 546

- triad of tenosynovitis, dermatitis, and migratory asymmetric polyarthralgias - vesiculopustular, few in number, and rarely involves the face

Answer 547

-febrile prodrome followed by an erythematous macular rash that starts over the wrists and ankles, involves the palms and soles, and spreads centrally

Answer 548

- fever and maculopapular rash involving the entire trunk and extremities - INCLUDES the palms and soles

Answer 549

-Topical retinoids

Answer 550

- tx w/ topical retinoids and benzoyl peroxide - moderate to severe inflammatory acne benefits from the addition of topical antibiotics - oral antibiotics and isotretinoin are usually reserved for severe or recalcitrant acne (nodular/cystic acne; severe inflammatory)

Answer 551

- presents w/ headache, vision changes (blurry or double vision), papilledema, and/or cranial nerve palsies (usually CN VI) - CSF shows increased opening pressure >250 mmHg! and normal studies - most common in young obese women - GH, tetracyclines, and excessive vitamin A and its derivatives can cause it - withdrawal of these meds is tx; also weight loss and acetazolamide for idiopathic causes

Answer 552

- usually presents w/ 2 or more distinctive episodes of CNS dysfunction w/ at least some resolution - optic neuritis, Lhermitte's sign, Uhthoff's phenomenon (worse symptoms w/ increased body temp), motor and sensory deficits, and bowel or bladder dysfunction

Answer 553

impaired absorption of CSF

Answer 554

- autosomal dominant; mutation in adenomatous polyposis coli (APC) gene - affects both sexes equally - pts have hundreds of adenomas in the colon and have a 100% risk of cancer, if not treated appropriately w/ elective proctocolectomy at time of diagnosis

Answer 555

- fragmented erythrocytes - occur in microangiopathic hemolytic anemias (DIC, HUS, TTP) and due to RBC destruction by prosthetic cardiac valves - Hemolytic anemias are characterized by a decreased serum haptoglobin level, increased LDH and indirect bilirubin, increased urinary urobilinogen

Answer 556

- Endometriosis: pain w/ menses, dyspareunia, infertility - Fibroids: heavy menses w/ clots, constipation and pelvic pain/heaviness, enlarged uterus - Adenomyosis: dysmenorrhea and pelvic pain, menorrhagia, bulky/globular/tender uterus - Endometrial cancer/hyperplpasia: hx of obesity, nulliparity, or chronic anovulation; irregular, intermenstrual, or postmenopausal bleeding, small, nontender uterus - endometritis: recent instrumentation of the uterus, foul smelling discharge, fever

Answer 557

- occurs most frequently in parous women age > 40 and typically presents w/ dysmenorrhea, menorrhagia, and pelvic pain - uterus is symmetrically enlarged, globular, and boggy (due to retained blood in uterine musculature) but is usually

Answer 558

- often present w/ irregular menstrual bleeding or postmenopausal bleeding - women age > 45 w/ irregular bleeding require an endometrial biopsy to exclude malignancy

Answer 559

- infertility, pain w/ intercourse, and dysmenorrhea - symptoms begin in 20's/30's - does NOT cause uterine enlargement as foci of endometrial glands are outside the uterus

Answer 560

- benign smooth muscle tumors of the uterus - dysmenorrhea, menorrhagia, and an enlarged uterus, frequently coexist w/ adenomyosis - firm, irregularly enlarged uterus that can vary in size from normal to the size of a full-term gestation - symptoms of mass effect

Answer 561

- inherited bleeding disorder that causes easy bruising, bleeding, heavy menses, nosebleeds, and excessive bleeding after surgery or delivery - platelet count is normal

Answer 562

- Gardnerella vaginalis - thin, off-white discharge w/ fishy odor, no inflammation - pH > 4.5, CLUE CELLS, positive whiff test (amine odor w/ KOH) - Metronidazole is tx

Answer 563

- Trichomonas vaginalis - thin, yellow-green, malodorous, frothy discharge; VAGINAL INFLAMMATION - pH > 4.5, motile trichomonads - Tx: Metronidazole, treat sexual partner also

Answer 564

- Candida albicans - thick "cottage cheese" discharge, vaginal inflammation - normal pH (3.8-4.2), pseudohyphae - Tx: fluconazole

Answer 565

- causes vaginal discharge, pruritis, dysuria, and dyspareunia, although it is sometimes asymptomatic - Pts and their sexual partners should be treated w/ oral metronidazole and abstain from sex until tx has been completed to prevent recurrence

Answer 566

-Metronidazole and tinidazole

Answer 567

- common form of acute cholecystitis in elderly diabetic males - arises due to infection of the gallbladder wall w/ gas-forming bacteria - pts typically males 50-70 - predisposing factors: vascular compromise, immunosuppression, gallstones, infection w/ gas-forming bacteria - crepitus in the abdominal wall adjacent to gallbladder is occasionally detectable - abdominal radiograph will show air fluid levels in gallbladder or US shows curvilinear gas shadowing in gallbladder - Tx: immediate fluid and electrolyte resuscitation, early cholecystectomy, and IV abx against gram-positive Clostridium sp (ampicillin-sulbactam, piperacillin-tazobactam, or combo of aminoglycoside or quinolone w/ clindamycin or metronidazole)

Answer 568

- infection of the biliary tree; high fever, jaundice, and RUQ pain (Charcot's triad) - arises due to biliary tract obstruction and a resultant bacterial contamination of the bile - causes: choledocholithiasis, biliary tract manipulations/stenting, and hepatobiliary malignancies - alk phos and WBC are often markedly elevated

Answer 569

1. off-loading 2. debridement 3. wound dressings 4. Abx 5. Revascularization 6. Amputation

Answer 570

- normal: 0-5 WBC, 40-70 glucose, 1000 WBC, 250 protein - Tuberculosis meningitis: 5-1000 WBC, 250 protein - Viral meningitis: 100-1000 WBC, 40-70 glucose,

Answer 571

- IV amphotericin (plus flucytosine) is induction therapy - subacute meningitis, that presents after weeks of symptoms - usually immunocompromised - increased ICP w/ ELEVATED OPENING PRESSURE on spinal tap

Answer 572

-used to treat alcohol withdrawal in hospitalized pts

Answer 573

- CSF findings of elevated WBC counts w/ lymphocytic predominance, normal glucose, and elevated protein concentration - start IV acyclovir

Answer 574

- extremely contagious; spread by droplets from repiratory secretions; virus can remain airborne for several hours - fever, cough, coryza, non-purulent conjunctivitis, and Koplik spots (pathognomonic for measles!; bluish-white lesions) which appear on buccal mucosa and sometimes in conjunctivae and vaginal mucosa - on days 3-5 of ilness, the erythematous, macular exanthem is sometimes pruritic; begins on the face; and spreads in a cephalocaudal and centrifugal pattern to the rest of the body; the rash persists for a week, coalesces, and darkens to a reddish-brown color - diagnosis: 4-fold rise in antibody titers and confirmed by PCR - Tx: symptomatic relief w/ antipyretics and hydration; VITAMIN A can be given to pts who are deficient in this vitamin or hospitalized children at high risk of complications - complications: otitis media, pneumonia, neruologic (encephalitis, acute disseminated encephalomyelitis, subacute sclerosing panencephalitis), gastroenteritis

Answer 575

- caused by human parvovirus B19 | - children develop fever and an erythematous malar rash ("slapped cheeks")

Answer 576

-fever for 5 or more days, mucous membrane changes, extremity changes, nonexudative conjunctivitis, cervical lymph node > 1.5cm, and a polymorphous rash

Answer 577

- caused by human herpes virus 6 | - maculopapular rash appears as the fever resolves

Answer 578

- rubella is similar to measles but is relatively mild and shorter in duration - the rubella rash spreads cephalocaudally but does not darken as does measles - the fever is also lower and no Koplik spots are seen

Answer 579

- results from the transmission of the spirochete Borrelia burgdorferi from Ixodes tick bites to humans - Pts traveling to tick-infested areas should be advised to wear permethrin-treated pants and long-sleeved shirts, to apply insect repellents to the skin, and to check the entire body for ticks

Answer 580

-positive psychotic symptoms lasting at least 1 day but less than 1 month

Answer 581

- involves one or more delusions and the absence of other psychotic symptoms in an otherwise high-functioning individual - > 1 month duration

Answer 582

- palpation of the vertex at the fundus indicates fetus is breech - a breech diagnosed before the 37th week of gestation does NOT require any intervention, as they often convert to vertex before the 37th week - external cephalic version is indicated if breech presentation is persistent after 37 weeks, and if this fails, then planned C-section is indicated

Answer 583

- corticosteroids - beta-interferon or glatiramer acetate is used to decrease the frequency of exacerbations in pts w/ relapsing-remitting or secondary progressive form of MS; however, they have no proven role in the tx of acute exacerbations

Answer 584

Nocturnal polysomnography

Answer 585

- associated w/ neurodevelopmental injury if not recognized and treated early - decreased activity, hoarse cry, and jaundice are commonly associated w/ congenital hypothyroidism, but the majority of infants w/ congenital hypothyroidsim are asymptomatic - thyroid dysgenesis is the most common cause worldwise - tx: levothyroxine immediately to prevent neurodevelopmental injury

Answer 586

Syphylis, HIV, and hepatitis B

Answer 587

- pain and stiffness of pelvis and shoulders | - markedly elevated ESR

Answer 588

- chronic, diffuse MSK pain syndrome most common in females - often accompanied by fatigue, mood disorders, insomnia, abdominal pain, and IBS - diagnosis depends on tenderness in at least 11 of 18 defined trigger sites

Answer 589

- should be considered in pts w/ a liver abscess who have lived or traveled in an endemic area for Entamoeba histolytica - initial evaluation includes imaging, serologic testing, and empiric tx w/ metronidazole (to treat the abscess) and a luminal agent (to eradicate intestinal colonization). - cyst drainage is not recommended routinely

Answer 590

- almost always benign and do not require further evaluation - features concerning for malignant renal mass: multilocular mass, irregular walls, thickened septae, and contrast enhancement

Answer 591

- causes nausea and vomiting after eating rice | - symptom onset is within one to six hours

Answer 592

- present in foods such as dairy, salad, meat, and eggs - N/V/D and abdominal pain - rapid onset of symptoms due to preformed toxin

Answer 593

- spore forming organism - spores germinate in foods such as meats, poultry, or gravy - watery diarrhea due to production of toxin in gut - symptom onset is later than with preformed toxin (8-14 hrs after ingestion)

Answer 594

painless hematuria is most common; may also develop isosthenuria (impairment in concentrating ability); increased risk of UTI in pregnancy; splenic infarct possible at high altitudes

Answer 595

- presents w/ episodic flushing, secretory diarrhea, wheezing, and murmur of tricuspid regurgitation - elevated 24 hr urinary 5-HIAA can confirm the diagnosis in most pts

Answer 596

- responsible for facial movement, taste in the anterior 2/3 of the tongue, lacrimation (via the greater petrosal/vidian nerves), salivation (via chorda tympani), and eyelid closure - also carries sensory fibers supplying sensation to parts of the external ear and the nasopharynx

Answer 597

-responsible for the majority of eye movement (adduction via the medial rectus, elevation via the superior rectus and inferior oblique, and depression via the inferior rectus), eyelid opening, and pupillary constriction

Answer 598

-carries visual info to the brain as well as mediates the afferent limb of the pupillary light reflex pathway

Answer 599

- swallowing, palate elevation, phonation, and parasympathetic outflow to the thoracoabdominal viscera, including monitoring the aortic arch baro- and chemoreceptors - also responsible for taste in the epiglottis and sensation from parts of the external ear; also mediates the afferent limb of the cough reflex and efferent limb of gag reflex

Answer 600

- important cause of HTN in elderly pts, and its caused by decreased elasticity of the arterial wall - should always be treated due to its association w/ an increased risk for cardiovascular events - initial tx involves monotherapy w/ a low-dose thiazide, an ACE inhibitor, or a long-acting calcium channel blocker

Answer 601

- form of non-cardiogenic pulmonary edema caused by leaky alveolar capillaries - causes include: sepsis, severe infection, severe bleeding, toxic ingestions and burns - mechanical ventilation w/ low tidal volumes (6 ml/kg) and PEEP can improve oxygenation - potential complications of PEEP include barotrauma and tension pneumothorax

Answer 602

- Saline unresponsive (> 20 mEq/L): can have expanded ECF w/ hypervolemia (primary hyperaldosteronism, Cushing syndrome, excessive black licorice ingestion, ectopic ACTH production) or appear hypo/euvolemic (Bartter syndrome, Gitelman syndrome) - Saline responsive (

Answer 603

-increases urinary H+ and K+ excretion to cause metabolic alkalosis. Pts also typically develop HTN, expanded ECF volume, and hypokalemia. Urine Cl- is usually > 20 mEq/L as there is no stimulus for renal NaCl retention.

Answer 604

- decreased risk of developing otitis media, respiratory, GI, and UTIs; and necrotizing enterocolitis - lower rates of type 1 DM and childhood cancer - the only absolute infant contraindication to breastfeeding is galactosemia

Answer 605

- supportive care, tx the precipitating cause (volume depletion, electrolyte abnormalities), and lowering serum ammonia - Disaccharides (lactulose, lactitol) are initially preferred for lowering serum ammonia - Rifaximin can be added to lactulose in pts w/o improvement after 48 hrs or used as monotherapy in those unable to take lactulose

Answer 606

- Lung, breast, unknown primary, melanoma, colon, and renal cell carcinoma - Lung cancer is most common cause of brain metastasis in pts w/ a hx of smoking and no prior incidence of cancer - tumors that RARELY metastasize to the brain include prostate cancer, esophageal cancer, oropharyngeal carcinoma, hepatocellular carcinoma, and non-melanoma skin cancers - Brain mets from breast, colon, and renal cell usually have SOLITARY brain mets - Lung cancer and malignant melanoma can present w/ multiple brain mets

Answer 607

- primary CNS tumor arising within the brain parenchyma | - usually presents as solitary mass w/ central necrosis and extensive vasogenic edema

Answer 608

- occurs most often in adults aged 20-30 years - Pts suffer from limited spine mobility and progressive back pain of greater than 3 months duration - the pain and stiffness are worse in the morning and improve w/ exercise - Bilateral sacroiliitis on plain film of a pt w/ suspected symptoms is diagnostic - the most prominent extraarticular manifestation of AS is ANTERIOR UVEITIS

Answer 609

-associated w/ Marfan syndrome, Ehlers-Danlos syndrome, and syphilis; also inflammatory arthritides

Answer 610

Rheumatoid arthritis and inflammatory bowel disease

Answer 611

SLE, Crohn's, Behcet's

Answer 612

- common complication of small cell lung cancer | - initial tx is fluid restriction to

Answer 613

- most often due to acute viral hepatitis, acetaminophen toxicity, and ischemic hepatopathy - acute onset of markedly elevated transaminases (often in the thousands), reduced hepatic synthetic function, and encephalopathy

Answer 614

most often due to breast cancer, small cell lung cancer, and lymphoma

Answer 615

- most commonly caused by the Epstein-Barr virus and presents w/ fever, fatigue, exudative pharyngitis, and diffuse cervical lymphadenopathy - a polymorphous, maculopapular rash frequently develops after administration of amoxicillin - pts should avoid sports for >3 wks due to risk of splenic rupture

Answer 616

- frequent causes of upper respiratory infections and typically present w/ coryza, pharyngitis, tonsillitis, and conjunctivitis - other manifestations: fever, malaise, headache, and abdominal pain

Answer 617

-can cause hand-foot-mouth disease and herpangina (vesicles on the hard palate)

Answer 618

- responsible for 15-30% of cases of pharyngitis in children | - fever, exudative pharyngitis, and enlarged anterior cervical lymph nodes

Answer 619

- mosqutio-borne viral illness (Aedes mosquito) that typically presents w/ flulike illness, symmetric polyarthralgias, macular or maculopapular rash on the limbs and trunk, peripheral edema, and cervical lymphadenopathy - tx is supportive, lasts 7-10 days - lymphopenia and thrombocytopenia

Answer 620

-usually presents 1-4 wks after a GI or GU infection w/ asymmetric oligoarthritis, conjunctivits, and oral lesions

Answer 621

- can develop after a prolonged surgery characterized by hypotension, extensive blood loss into tissues, and massive blood replacement - bilirubin and alk phos are elevated

Answer 622

- requires histopathologic exam because there is a risk for an underlying sebaceous (meibomian gland) carcinoma - additionally, basal cell carcinoma is the most common malignancy of the lid margin, and may appear clinically similar to a chalazion

Answer 623

1. Venous thromboembolism or recurrent early miscarriages 2. presence of an antiphospholipid antibody such as the lupus anticoagulant, anticardiolipin antibody, or beta 2 glycoprotein 1 antibody

Answer 624

- hypercoagulability disorder presenting w/ recurrent and migratory superficial thrombophlebitis at unusual sites (eg arm, chest area) - usually associated w/ an occult VISCERAL malignancy such as pancreatic (most common), stomach, lung, or prostate carcinoma

Answer 625

- HTN in the upper part of the body and relative hypoperfusion in the lower part of the body - a mild, continuous murmur heard all over the chest is due to the development of collaterals between the hypertensive and hypoperfused vessels - RIB NOTCHING, caused by the dilatation of the collateral chest wall vessels, is specific for coarctation

Answer 626

-surgical emergency that requires emergent urethral imaging and surgical repair

Answer 627

- refers to polymorphic ventricular tachycardia that occurs in the setting of a congenital or acquired prolonged QT interval - immediate defibrillation is indicated in hemodynamically unstable pts w/ TdP, while IV magnesium is first-line for stable pts w/ recurrent episodes of TdP

Answer 628

- acute termination of paroxysmal SUPRAventricular tachycardia (PSVT) - NOT recommended for tx of ventricular tachycardia

Answer 629

- class III anti-arrhythmic (K+ blocker) - used for BOTH atrial and ventricular tachycardia - used occasionally in pts w/ polymorphic VT (and normal baseline QT interval) due to myocardial ischemia or infarction

Answer 630

-used in tx of symptomatic SINUS BRADYCARDIA or AV NODAL BLOCK

Answer 631

- useful for pts w/ cardiotoxicity due to hyperkalemia - occasionally used in pts w/ beta-blocker and/or calcium channel blocker overdose - ECG of pts w/ hyperkalemia shows peaked T waves, followed by lengthening of the PR and QRS intervals, eventually resulting in a sine wave

Answer 632

useful in management of pts w/ TdP due to quinidine use; also those in cardiac arrest from metabolic acidosis, hyperkalemia, or TCA overdose

Answer 633

- class III antiarrhythmic | - causes QT prolongation and TdP

Answer 634

- nonspecific and highly variable - suspect in any pt who presents w/ some comb of sudden-onset SOB, pleuritic chest pain, low-grade fever, and hemoptysis - tachypnea, tachycardia, and hypoxemia are common exam findings - calf swelling and Virchow's triad (stasis, endothelial injury, and hypercoagulable state) are not always present in PE - ECG: S1Q3T3 - CXR: Hampton's hump, Westermark's sign)

Answer 635

- Painful: Herpes simplex virus (MULTIPLE small, grouped ulcers w/ erythematous base; shallow; tender lymph nodes; most common in US; recurrence is common) and Haemophilus ducreyi (chancroid)(single or multiple deep ulcers, often w/ irregular/ragged border; base may be friable and have gray/yellow exudate; matted lymph nodes which can suppurate/rupture) - Painless: Treponema pallidum (syphilis)(single, indurated, well-circumscribed painless ulcer known as CHANCRE; clean base; nontender lymph nodes), Chlamydia trachomatis serovars L1-3 (LGV)(small and shallow ulcers often absent; matted lymph nodes; large, painful, fluctuant BUBOES; sinus tracts), and Klebsiella granulomatis (granuloma inguinale)(extensive and progressive nodules--> ulcers/beefy-appearing lesions w/ bleeding; base may have granulation like tissue)

Answer 636

- should be administered to any Rh D-negative mother who delivers an Rh D-positive baby - the standard dose is usually adequate at 28 wks gestation - after delivery or procedures, the Kleihauer-Betke test is used to determine whether a higher dose is needed due to the increased risk of fetal blood cells entering the maternal circulation

Answer 637

-Glucose-6-phosphate dehydrogenase deficiency

Answer 638

Spherocytes

Answer 639

- assessing ABCs - contaminated clothing should be removed promptly - upper GI endoscopy is the diagnostic study of choice to evaluate the extent of injury and should be done within 24 hrs - attempting to neutralize the alkali w/ vinegar or lavage is dangerous as these interventions may trigger vomiting, which may cause further mucosal damage - all pts w/ persistent dysphagia or significant esophageal burns on endoscopy should undergo barium contrast studies 2-3 weeks after ingestion to assess for ESOPHAGEAL STRICTURES or PYLORIC STENOSIS

Answer 640

-often confused w/ osteomyelitis; however, x-ray findings of lamellated appearance or "onion-skin" periosteal rxn; lytic, central lesion accompanied by endosteal scalloping; often followed w/ a "moth-eaten" or mottled appearance and extension into soft tissue

Answer 641

- fever, malaise, local joint pain, and swelling | - chronic osteomyelitis: central lytic bone defect w/ surrounding sclerosis termed as Brodie's abscess

Answer 642

- measure of random error - the tighter the confidence interval, the more precise the result - increasing the sample size increases precision

Answer 643

- measures of systematic error (bias) - accuracy is reduced if the result does not reflect the true value of the paramater measured - increasing the sample size increases the precision of the study, but does not affect accuracy

Answer 644

- common and usually benign; resolve on its own by age 1-2 weeks - the indirect hyperbilirubinemia is due to increased bilirubin production, decreased bilirubin clearance, and increased enterohepatic recycling - phototherapy is the gold standard tx for rapidly rising hyperbilirubinemia to prevent kernicterus

Answer 645

- jaundice is usually the first sign - the neonatal liver can conjugate bilirubin, but the obstructed biliary tract cannot transport bile to the intestine, resulting in hepatic bile retention (cholestasis), direct hyperbilirubinemia, and jaundice - direct hyperbilirubinemia is defined as conjugated bilirubin > 2mg/dL or > 20% of total bilirubin

Answer 646

- Toxoplasmosis - TMP-SMX is used for PROPHYLAXIS - Sulfadiazine and pyrimethamine are used for TREATMENT purposes

Answer 647

- TMP-SMP - Nitrofurantoin - Fosfomycin

Answer 648

-oral fluoroquinolones, IV ceftriaxone if more severe

Answer 649

- stable: oral fluoroquinolones | - severe: IV ceftriaxone

Answer 650

contraindicated in pts w eating disorders as it can provoke seizures

Answer 651

Olanzapine | -can be considered in pts who fail to gain weight despite initial nutritional rehab and CBT

Answer 652

- mixed agonist/antagonist of estrogen receptors - in breast and vaginal tissue, its an ANTAGONIST; whereas in bone, its an AGONIST - first line agent for prevention of osteoporosis, and it DECREASES breast cancer risk - INCREASES risk of thromboemolism

Answer 653

Endometrial cancer

Answer 654

- most common cause of glomerulonephritis in adults - pts have recurrent episodes of gross hematuria, usually within 5 days after a URI (SYNPHARYNGITIC) - differentiated from postinfectious glomerulonephritis based on earlier onset of URI-related GN and normal serum complement levels - kidney biopys can also help differentiate (IgA deposits in mesangial cells vs subepithelial humps of C3 complement)

Answer 655

- acute inflammatory process involving the renal tubules and interstitium following exposure to a drug (abx, NSAIDs, PPIs). - other findings: fever, skin rash, eosinophilia, eosinophiluria, or WBC casts

Answer 656

- X-linked defect in collagen-IV (basement membranes) formation and present w/ hearing loss, ocular abnormalities, hematuria, and progressive renal insufficiency - thinning of glomerular BMs

Answer 657

- anti-GBM antibodies against collagen IV (alpha-5 chain) damaging the glomeruli and alveolar lining - can be renal limited process (rapidly progressive GN) or alveolar hemorrhage (pulmonary renal syndrome) - Goodpasture's syndrome refers to pulmonary-renal syndrome that is a manifestation of anti-GBM disease

Answer 658

- thin BM nephropathy | - benign familial condition that presents as isolated microscopic hematuria

Answer 659

- systemic form of IgA involvement of the glomeruli, skin, joints, and intestines - more common in children and presents as erythematous and papular skin rash invovling the dorsal aspect of lower extremities, abdominal pain, arthralgia/arthritis, and microscopic hematuria/proteinuria

Answer 660

- nephritis syndrome, nephrotic syndrome, RPGN, or pulmonary-renal syndrome - low complement levels (C3 and C4) and positive lupus antibodies (ANA, anti-dsDNA, anti-Smith)

Answer 661

- usually associated w/ Parkinsonian symptoms - gradually progressive dementia w/ fluctuations in cognitive function, persistent and well-formed visual hallucinations, and EPS

Answer 662

- autosomal dominant; affects caudate and putamen - mean onset age 35-44 - choreoathetoid movements, behavioral disturbances, and dementia

Answer 663

probable uterine rupture | -risk factors include a pre-existing uterine scar or abdominal trauma

Answer 664

- small, rubbery lymph nodes are rarely pathologic; nodes les than 1 cm are almost always benign - nodes > 2 cm are associated w/ greater likelihood of malignancy or granulomatous disease

Answer 665

-produces an early diastolic murmur and can be associated w/ several physical signs caused by a hyperdynamic pulse, including bounding or "water hammer" peripheral pulses

Answer 666

- may lead to tubo-ovarian abscess, abscess rupture, pelvic peritonitis, and sepsis if left untreated - inability to take oral meds due to nausea and vomiting is an indication for inpatient tx of PID

Answer 667

lactulose, rifaximin, and laxatives

Answer 668

-may be measured in pts w/ suspected gastrinoma and Zollinger-Ellison syndrome (recurrent duodenal ulcers, gastroesophageal reflux, diarrhea)

Answer 669

Renal artery stenosis

Answer 670

- main precipitating factor is omission of insulin w/ or w/o infections or other stressors - affects type 1 diabetics - diagnosis: blood glucose > 250 mg/dL, pH

Answer 671

- depolarizing neuromuscular blocker that can cause life-threatening hyperkalemia! - it should NOT be used in pts w/ or at high risk for hyperkalemia, such as burn and crush injury pts and pts w/ prolonged demyelination!

Answer 672

- inflammation of the lung parenchyma caused by antigen exposure - acute episodes present w/ cough, breathlessness, fever, and malaise that occur within 4-6 hours of antigenic exposure - chronic exposure may cause weight loss, clubbing, and honeycombing of the lung - cornerstone of management is avoidance of the responsible antigen - may develop to pulmonary fibrosis and a RESTRICTIVE pattern on lung spirometry - eg "bird fancier's lung" and "farmer's lung"

Answer 673

- more common on the left side because of the right side tends to be protected by the liver - pts have respiratory distress and can have deviation of the mediastinal contents to the opposite side - elevation of the hemidiaphragm on the CXR might be the only abnormal finding - CXR showing NG tube in pulmonary cavity is diagnostic

Answer 674

- more common in pts w/ psych conditions, possible due to a central defect in thirst regulation - pts typically develop hyponatremia and dilute urine w/ urine osmolality

Answer 675

- fluid collection within the processus or tunica vaginalis (the peritoneal projection that accompanies the testis during its descent into the scrotum) - when processus vaginalis fails to obliterate, peritoneal fluid may accumulate within the processus causing a COMMUNICATING hydrocele - a collection of fluid within the tunica vaginalis that has properly obliterated its communication w/ the peritoneum is a NON-COMMUNICATING hydrocele - hydroceles will transilluminate, while other masses will note - most will resolve spontaneously by age of 12 months and can be safely observed during that period - hydroceles that do not resolve spontaneously should be removed surgically due to risk of inguinal hernia

Answer 676

- should NOT be performed in low-risk pts as they frequently have false-positive test results - Pts w/ intermediate probability of CAD should receive appropriate stress testing based on ECG findings and their ability to exercise - high-risk pts should be started on appropriate medical therapy, w/ expert evaluation to consider coronary angiography

Answer 677

- most common nutritional deficiency in children, often caused by excessive intake of cow's milk (> 24 oz a day) and results in a microcytic anemia - can be differenitiated from thalassemia by an elevated RDW, which is typically > 20% in iron deficiency

Answer 678

- Oral amoxicillin - Oral doxycycline, amoxicillin, and cefuroxime have equivalent efficacy. Doxy is usually used because it can also treat possible co-infection w/ Anaplasma phagocytophilum in Ixodes tick bites, but should not be used in children

Answer 679

-IV ceftriaxone

Answer 680

a preceding viral upper respiratory infection | -tx: amoxicillin plus clavulanic acid

Answer 681

-excessive anxiety and preoccupation w/ 1 or more unexplained symptoms

Answer 682

-fear of having a serious illness despite few or no symptoms and consistently negative evaluations

Answer 683

- neurologic symptom incompatible w/ any known neurologic disease; often acute onset associated w/ stress - symptoms NOT PRODUCED INTENTIONALLY - severe enough to cause social and functional impairment, although pts may appear indifferent ("la belle indifference")

Answer 684

-intentional falsification or inducement of symptoms w/ goal to assume SICK ROLE

Answer 685

-falsification or exaggeration of symptoms to obtain external incentives (SECONDARY GAIN)

Answer 686

- inovles one or more somatic complaints (including pain) that are distressing or result in significant disruption of daily life, w/ excessive thoughts, feelings, or behaviors related to these symptoms and lasting 6 or more months - pts may have concurrent medical illness, or the symptoms may represent normal bodily function

Answer 687

-fluctuating cognitive impairment, recurrent visual hallucinations and motor features of Parkinsonism

Answer 688

- high mortality rate and requires rapid diagnosis - effective and less invasive modalities for rapid diagnosis include TEE, and CT; TEE is preferred over CT scan in pts w/ kidney disease due to risk of contrast-induced nephropathy

Answer 689

- transient spike in Cr within 24 hrs of contrast administration, w/ a return to normal renal function within 5-7 days - Pts w/ diabetes and elevated baseline Cr are at especially high risk - adequate IV hydration w/ isotonic bicarb or normal saline and administration of N-acetylcysteine help to minimize the risk of contrast-induced nephropathy

Answer 690

- normal inhabitant of the GI tract, and S. bovis bacteremia is associated w/ colon cancer - colonoscopy should be performed when this organism is isolated from blood cultures

Answer 691

-DM, carcinoma, alcoholism, hepatic failure, elective abortion, and IV drug use

Answer 692

- Large aneurysm diameter, rapid rate of expansion, and current cigarette smoking - current indiations for operative or endovascular repair include aneurysm size > 5.5 cm, rapid rate of aneurysm expansion (> 0.5cm in 6 months or > 1 cm per year), and presence of symptoms (abdominal, back, or flank pain; lim ischemia) regardless of aneurysm size

Answer 693

-can produce infertility by suppressing the production of GnRH, LH, and FSH

Answer 694

- XXY (seminiferous tubule dysgenesis) - inherited disorder characterized by testicular fibrosis (primary hypogonadism), azoospermia, gynecomastia, decreased intelligence, increased axial skeletal growth, and high FSH and LH levels

Answer 695

-testicular atrophy as well as widespread muscular atrophy, weakness, lower-than-normal testosterone levels, and high FSH and LH levels

Answer 696

-"bag of worms" sensation on palpation

Answer 697

-probability of observing a given (or more extreme) result due to chance alone, assuming the null hypothesis is true

Answer 698

- caused by recognition of host major and minor HLA-antigens by donor T-cells and consequent cell-mediated immune response - organs typically affected include the skin, intestine, and liver

Answer 699

- type 1: primary hyperParathyroidism, enteroPancreatic tumors, Pituitary tumors (PPP); due to mutations in then MEN 1 tumor suppressor gene - type 2A: Medullary thyroid cancer, Pheochromocytoma, Parathyroid hyperplasia (MPP) - type 2B: Medullary thyroid cancer, Pheochromocytoma, Marfanoid habitus/Mucosal and intestinal neuromas (MMMP) - MEN 2A/2B: autosomal dominant; germline mutations involving RET proto-oncogene on chromosome 10

Answer 700

Tuberous sclerosis

Answer 701

- can cause hyperkalemia due to blockade of the epithelial sodium channel in the collecting tubule - TMP also competitevely inhibits renal tubular creatinine secretion and may cause an artificial increased in serum creatinine w/o affecting the GFR

Answer 702

- useful tool to evaluate for CAD and indicates inducible ischemia when a reversible defect is noted on stress and rest images - antiplatelet therapy is the preferred tx to prevent CAD in these pts

Answer 703

-decrease in movement of ipsilateral chest wall, dullness to percussion, and DECREASED breath sounds

Answer 704

dullness to percussion, bronchial breath sounds (assuming patent airways), and egophony

Answer 705

- extreme fatigue, malaise, sore throat, fever, and generalized maculopapular rash - posterior cervical lymphadenopathy and palatal petechiae can be present - Splenomegaly is common - Heterophile antibodies are very sensitive and specific, but may be negative early in the illness; repeat testing may be helpful

Answer 706

- used to classify pleural fluid as an exudate or transudate - must have at least one of the following to be conisdered an exudate: 1. pleural fluid protein/serum protein ratio > 0.5 2. pleural fluid LDH/serum LDH ratio > 0.6 3. pleural fluid LDH > 2/3 of the upper limit of normal for serum LDH - exudative pleural effusion, along w/ pleural fluid acidosis (pH

Answer 707

- may present w/ epigastric pain, nausea, and/or early satiety in associated w/ food - symptoms of duodenal ulcer classically occur in the absence of a food buffer (eg 2-5 hrs after meals, on an empty stomach, or at night). - melena is a manifestation of upper GI bleeding, w/ PUD being one of the most common causes

Answer 708

-should be give at age 11-12 followed by a booster dose at age 16 due to the risk of college outbreaks

Answer 709

-given at age 2-8 months

Answer 710

- abx used to treat serious gram-negative infections | - potentially nephrotoxic and drug levels and renal function must be monitored closely during therapy

Answer 711

Proteus species - P. mirabilis secretes urease to alkalinize the urine (pH >7), leading to formation of struvite stones; the stone becomes a permanent source of bacteria to perpetuate the cycle; staghorn calculi - other urease producing bacteria: Morganella morganii, Pseudomonas species, Providencia species, Staph species, and Ureaplasma urealyticum

Answer 712

- Staph aureus - gram negative rods - anaerobes

Answer 713

- Coagulase negative staph - Propionibacterium species - Enterococci

Answer 714

- should be suspected in any ill pt, especially those w/ a hx of FEBRILE PAROXYSMS, who have traveled to an endemic-tropical region. - THICK AND THIN BLOOD SMEARS should be ordered for parasite detection and quantification - Nonimmune children are at highest risk of death, but the sickle cell trait confers some protection from severe complications like cerebral malaria

Answer 715

- typically develops in 45 days | - multifocal diffuse patchy infiltrates, upper and lower GI ulcers, arthralgias, myalgias, esophagitis

Answer 716

THE SKIN - skin rash is almost always seen - other organs commonly involved include the intestine, liver, and lung (bronchiolitis obliterans)

Answer 717

- dry cough and dyspnea | - CXR usually demonstrates bilateral diffuse infiltrates

Answer 718

- Streptococcus pneumoniae | - also the most common cause of community-acquired pneumonia in adults

Answer 719

- Staph aureus is the most common cause of bacterial pneumonia in young children w/ CF!, esp. those w/ coexisting influenza infection - Pseudomonas is most common above the age of 20

Answer 720

- should be suspected in an inadequately vaccinated pt w/ severe, paroxysmal cough, inspiratory whoop, or posttussive emesis - during the first month of illness, the diagnosis is confirmed by cultures and/or PCR of nasopharyngeal secretions - MACROLIDE ABX are the preferred tx of prevent spread of infection - will have LYMPHOCYTE-PREDOMINANT LEUKOCYTOSIS

Answer 721

- should be considered in pts w/ presumed hx of IV drug use - empiric abx tx of native-valve endocarditis should be geared toward methicillin-resistant Staph aureus, streptococci, and enterococci - Vancomycin is the most appropriate empiric abx

Answer 722

- Zidovudine should be administered to the neonate for >6 wks - 3 drug regimine should be used for mother

Answer 723

- Strep pneumo - nontypeable H. flu - Moraxella catarrhalis - Due to increasing beta-lactamase resistance, the tx of choice is amoxicillin-clavulanic acid

Answer 724

- causative agent of amebiasis - found mostly in Southeast Asia, Africa, and central and south america - abdominal pain and bloody diarrhea

Answer 725

- common bacterial cause of acute diarrhea | - fever, abdominal pain, and bloody diarrhea

Answer 726

- parasite found primarily in tropical and subtropical regions and can cause skin, GI, and pulmonary manifestations - N/V/ abdominal pain

Answer 727

- emerging and important cause of traveler's diarrhea | - consider in pts w/ persistent, nonbloody, watery diarrhea for > 2 wks

Answer 728

- Pyrazinamide w/ Rifampin or Rifabutin for 2 months | - Rifampin alone for 4 months

Answer 729

- Gardener's disease - the initial lesion, a reddish nodule that later ulcerates, appears at the site of the thorn prick or other skin injury - from the site of inoculation, the fungus spreads along the lymphatics forming subcutaneous nodules and ulcers - adenopathy and systemic signs of infection are usually absent

Answer 730

- most common cause of bacterial meningitis in children and young adults - typically presents w/ fever, headache, neck stiffness, AMS, and a PETECHIAL OR PURPURIC RASH - prompt diagnosis and tx are critical given that it has a high morbidity and mortality rate even w/ appropriate tx

Answer 731

- causes Lyme disease - usually acquired in late summer months after and Ixodes tick bite - rash (erythema chronicum migrans), headaches, fever, chills, and malaise

Answer 732

-can cause infectious mononucleosis like illness, which presents w/ high fevers, fatigue, malaise, splenomegaly, and pharyngitis

Answer 733

-may cause meningitis, rhinorrhea, fever, epiglottitis, and ear infections

Answer 734

-causes temporal lobe encephalitis in neonates and infants and typically presents w/ seizures

Answer 735

- transmitted vaginally, is 1 of the 3 most common causes of meningitis in newborns - also transmitted through unpasteurized milk or cheese from infected cows

Answer 736

- sudden onset of a sharply-demarcated, erythematous, edematous, tender skin lesion w/ raised borders in a febrile patient suggests erysipelas - most frequently implicated organism is group A beta-hemolytic streptococcus - specific type of cellulitis; inflammation of the superficial dermis - abrupt onset, and usually systemic signs, including fever and chills

Answer 737

causative organism of gas gangrene

Answer 738

- INR > 1.6: inherited deficiency of single clotting factors; prevent active bleeding in pt on anticoagulant therapy before a procedure; active bleeding - emergent reversal of warfarin: major or intracranial hemorrhage; prophylactic transfusion in a surgical procedure that cannot be delayed - acute DIC: w/ active bleeding and correction of underlying condition - microvascular bleeding during massive transfusion: > 1 blood volume (5L in adults) - replacement fluid for apheresis in thrombotic microangiopathies: TTP; HUS

Answer 739

- 100,000 (rarely): surgery w/ active bleeding | - 100.4 or undergoing invasive procedure

Answer 740

- 20,000: always transfuse - 20-30,000: consider transfusion; transfuse for clinical reasons (active bleeding, LP) - 30-50,000: transfuse if any of the following exist: - first week of life w/ birth weight

Answer 741

- acute sickle cell crisis to prevent stroke - acute blood loss > 1500mL (30% of blood volume) - symptomatic anemia (fatigue, weakness, dizziness, reduced exercise tolerance, SOB, changes in mental status, muscle cramps, angina, severe CHF) if they cannot function w/o treating the anemia - Hgb

Answer 742

-carbamazepine, phenobarbital, phenytoin, rifampin

Answer 743

-phenothiazines, TCAs, cimetidine

Answer 744

-follow WHO algorithm. Basically, start w/ non-opiods such as acetaminophen, NSAIDs, aspirin, COX inhibitors. If that doesn't work, then progress to weak opiods like vicodin, and possibly add non-opiods to regimen. Finally, progress to pure opioid regimen for sever pain. You can titrate pure opioids until pain relief, and you are only limited by patient side effects. From here you can switch to a different opiod due to low cross-tolerance between meds of this class.

Answer 745

- blocks retinal vein, causing walls of vein to leak blood and excess fluid into retina. When fluid collects in the macula (area of retina responsible for central vision), vision becomes blurry. - "floaters" in your vision are another symptom from clotted blood in vitreous - in severe cases, the blocked vein causes painful pressure in the eye - commonly occurs w/ glaucoma, diabetes, age-related vascular disease, HTN, and blood disorders - no cure - look for DILATED TORTUOUS RETINAL VEINS ON EXAM

Answer 746

- ages 50-70 usually - most common medical problem associated with it is ARTERIOSCLEROSIS (carotid disease is found in 50%) - most common cause is THROMBOSIS, and less likely, embolus - first sign is SUDDEN and PAINLESS loss of vision that leaves you barely able to count fingers or determine light from dark - irreversible damage occurs after 90 minutes--> EMERGENCY - AFFERENT pupillary defect will be present - affected portion of retina (ischemic) will appear white and the foveal center (center of macula) appears red (cherry red spot)

Answer 747

TRIGLYCERIDES - this is the 3rd most common cause of pancreatitis behind alcohol and gallstones - Tg >1000 (normal is

Answer 748

- adhesions - malignancy - Crohn disease - hernias

Answer 749

- nausea - vomiting (associated w/ more proximal obstructions) - diarrhea (early finding) - constipation (late finding, as evidenced by the absence of flatus or bowel movements) - fever and tachycardia (occur late and may be associated w/ strangulation) - previous abdominal or pelvic surgery, inflammatory bowel disease, previous radiation therapy, may be part of the patient's medical hx - hx of malignancy (particularly ovarian and colonic)

Answer 750

- inhibit conversion of angiotensin-I to angiotensin-II - angiotensin-II is a potent vasoconstrictor and promotes production of aldosterone. Aldosterone promotes sodium and water retention. By inhibiting angiotensin-II production, ACE-i cause vasodilation and indirectly inhibit fluid volume increases that result from the actions of aldosterone

Answer 751

- Clomiphene citrate | - lifestyle modification such as diet and exercise also help

Answer 752

- unvaccinated person who got exposed: hepatitis B vaccine series and hepatits B immune globulin - vaccinated person who got exposed: Only the hepatitis B vaccine booster! No need for HBIG if you already have circulating antibodies - if the source has an unknown HBsAg status, then administer hep B vaccine in unvaccinated person; no treatment for those already vaccinated

Answer 753

23 - 34 weeks | -before 23 weeks the fetus is unable to benefit, and after 34 weeks the lungs are already developed

Answer 754

- terbutaline - magnesium sulfate - nifedipine - indomethacin

Answer 755

occurring before 37 weeks

Answer 756

37 - 42 weeks | -measured from first day of last menstrual period

Answer 757

- placement of stitches in cervix to hold it closed | - used to keep a weak cervix from opening early

Answer 758

viral: CMV, rubella, HSV bacterial: GBS, Listeria, E. coli

Answer 759

- viral: RSV, Parainfluenza virus, Influenza virus, Adenovirus - bacterial: S. pneumo, Chlamydia trachomatic, Bordetella pertussis

Answer 760

- viral: RSV, parainfluenza virus, adenovirus, human metapnuemovirus, influenza type A - bacterial: S. pneumo, Chlamydia pneumoniae, Mycoplasma pneumoniae

Answer 761

- viral: adenovirus, EBV, parainfluenza, influenza, rhinovirus - bacterial: S. pneumo, S. aureus, Atypical pneumonia (Mycoplasma, Chlamydia)

Answer 762

- viral: parainfluenza virus, adenovirus, influenza virus | - bacterial: S. pneumo, atypical pneumonia (Mycoplasma, Chlamydia)

Answer 763

- viral - bacterial: S. pneumo, respiratory viruses, Haemophilus influenzae, gram negative bacilli, S. aureus (moraxella and Legionella are less common)

Answer 764

- S. pneumo - Haemophilus influenzae - Moraxella catarrhalis - Legionella pneumonia

Answer 765

- S. pneumo - Anaerobes - Klebsiella

Answer 766

- early disease: S. aureus | - late disease: Pseudomonas aeruginosa

Answer 767

- birds: Psittacosis - rabbits: tularemia - livestock or cats: Coxiella burnetii

Answer 768

Hyperparathyroidism! | -everyone must be tested for parathyroid gland malignancy or problem

Answer 769

ANAPHYLACTIC

Answer 770

- type 2 hypersensitivity reaction - Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs) - fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinemia (intravascular), jaundice (extravascular)

Answer 771

- type 1 hypersensitivity reaction against plasma proteins in transfused blood - urticaria, pruritis, wheezing, fever - treat with antihistamines

Answer 772

- severe allergic reaction - IgA deficient individuals must receive blood products that lack IgA - Dyspnea, bronchospasm, hypotension, respiratory arrest, shock

Answer 773

- type 2 hypersensitivity raction - host antibodies against donor HLA antigens and leukocytes - fever, headaches, chills, flushing

Answer 774

- can occur 1-4 wks after transfusion - usually extravascular hemolysis - mild symptoms; unexplained fatigue, jaundice, fever - direct coombs positive

Answer 775

Beta blockers! Then possible nitroprusside, followed by surgical correction if indicated

Answer 776

-hypothyroidism, depression, anemia

Answer 777

- methyldopa - labetalol - nifedipine

Answer 778

Hydralazine

Answer 779

- sudden onset of a sharply-demarcated, erythematous, edematous, tender skin lesion w/ raised borders in a febrile patient - group A beta-hemolytic strep most frequent

Answer 780

- most common parasitic infection of the brain | - most prevalent in rural areas w/ poorer sanitary conditions and where pigs are raised

Answer 781

- Creutzfeldt-Jacob disease and Kuru - spongiform encephalopathy - intracytoplasmic vacuoles diffusely throughout gray matter on microscopy

Answer 782

- caused by Echinococcus species - usually seen in the liver and lungs - more common in SHEEP BREEDERS

Answer 783

- bright red, firm, friable, exophytic nodules in an HIV infected patient usually - caused by Bartonella, a gram negative bacillus - oral erythromycin is tx

Answer 784

- caused by poxvirus | - centrally-umbilicated, dome-shaped papules that are non-pruritic

Answer 785

- usually on trunk, face, and extremities - papules that become plaques or nodules - color changes from light brown, to pink, to dark violet

Answer 786

- can present w/ a mononucleosis-like syndrome consisting of fever, night sweats, lymphadenopathy, arthralgias, and diarrhea - making the diagnosis at an early stage can be beneficial both to the individual patient and from a public health standpoint

Answer 787

- in humans, hepatic hydatid cysts are due to infection by this organism - dogs are the definitive host - a cystic hepatic lesion w/ eggshell calcification is highly suggestive of infection w/ this organism - may or may not be a hx of sheep breeding - surgical resection under cover of albendazole

Answer 788

-common opportunistic infection in AIDS pts w/ CD4 35 to minimize pulmonary complications!

Answer 789

- recent hospitalization, advanced age, or antibiotic use (most commonly fluoroquinolones, penicillins, cephalosporins, and clindamycin) - C. diff colitis can range from mild colitis (watery diarrhea, low-grade fever, abdominal pain, and leukocytosis) to fulminant colitis w/ toxic megacolon - diagnosis is usually confirmed w/ stool studies for C. diff toxin (PCR or enzyme immunoassay)

Answer 790

Metronidazole or ORAL vancomycin

Answer 791

- endemic in southwestern U.S., as well as Central and South America - primary pulmonary infection: fever, fatigue, dry cough, weight loss, pleuritic chest pain - cutaneous findings: erythema multiforme, erythema nodosum, arthralgias

Answer 792

- southeastern, mid-atlantic, and central U.S. | - acute pneumonia; cough, fever, and malaise

Answer 793

- south-central and north-central U.S. - affects lungs, skin, bones, joints, and prostate - infection in immunocompetent hosts is uncommon - primary pulmonary infection is asymptomatic or presents w/ flu-like symptoms

Answer 794

- immunocompromised pts (those w/ neutropenia, taking cytotoxic drugs such as cyclosporine, high doses of steroids) - fever, cough, dyspnea, or hemoptysis - CXR may show cavitary lesions - CT: pulmonary nodules w/ THE HALO SIGN or lesions w/ an AIR CRESCENT

Answer 795

-meningoencephalitis in HIV pts whose CD4 count is

Answer 796

initial: Amphotericin B w/ flucytosine maintenance: fluconazole

Answer 797

- ear discharge and severe ear pain that worsens despite the use of topical antibiotics - pain often radiates to TMJ - presence of granulation tissue in the external auditory meatus - DM and immunosuppressive conditions are important risk factors - Pseudomonas aeruginosa most frequently!

Answer 798

- presents w/ painful swelling of the parotid gland that is aggravated by chewing - high fever and a tender, swollen, and erythematous parotid gland are common - this post-op complications can be prevented w/ adequate fluid hydration and oral hygiene - most common infectious agent is Staph aureus!

Answer 799

- Tendinopathy and tendon rupture (Achilles most common) - Pts can develop tendon pain within 24 hrs w/ a median of 8 days after starting the drug - Pts should stop the drug at onset of symptoms, avoid exercise and/or use of the affected area, and seek medical care for symptom evaluation and changing to a non-fluoroquinolone antibiotic

Answer 800

- non-opportunistic infections: Salmonella, campylobacter, entamoeba, chlamydia, shigella, giardia - opportunistic infections: CMV, cryptosporidium, isopora belli, blastocystis, MAC, Herpes simplex virus, adenovirus, HIV itself - non-infectious: Kaposi sarcoma, lymphoma of GI tract - Hematochezia and lower abdominal cramps are usually due to colonic infection w/ CMV, C. diff, Shigella, Entamoeba, or campylobacter

Answer 801

- suspect in HIV positive pt w/ bloody diarrhea and a normal stool exam; they should have a colonoscopy w/ biopsy - bloody diarrhea w/ abdominal pain - colonoscopy shows multiple ulcers and mucosal erosions - biopsy demonstrates large cells w/ eosinophilic intranuclear and basophilic intracytoplasmic inclusions (owl's eye effect) - tx is GANCICLOVIR; Foscarnet is used in cases of ganciclovir failure

Answer 802

- parasite that cause bloody diarrhea, but can usually be diagnosed by visualization of trophozoites on stool exam - colonoscopy shows presence of "flask-shaped" colonic ulcers

Answer 803

- Pneumocystis jirovecii | - Toxoplasma gondii

Answer 804

- most commonly caused by EBV - presents w/ fever, fatigue, exudative pharyngitis, and diffuse cervical lymphadenopathy - a polymorphous, maculopapular rash frequently develops after administration of amoxicillin! - pts should avoid sports for 3 or more wks due to risk of splenic rupture

Answer 805

- frequent causes of URI; coryza, pharyngitis, tonsillitis, conjunctivitis - fever, malaise, headache, and abdominal pain

Answer 806

-cause hand-foot-mouth disease and herpangina (vesicles on hard palate)

Answer 807

- chronic liver disease (including HBV and HCV) - men who have sex with men - IV drug users

Answer 808

-all pts w/o documented immunity to HBV

Answer 809

-men and women age 9-26

Answer 810

-annually for all pts

Answer 811

- all pts age 11-18 - large groups living in close proximity (college students, military recruits, incarcerated pts) - asplenia or complement deficiency

Answer 812

- PCV13 once | - PPSV23 8 weeks later, then every 5 years

Answer 813

- Tdap once - repeat Tdap for women during each pregnancy - Td every 10 years following Tdap

Answer 814

- occurs in immunocompromised pts, who may present w/ fever, cough, dyspnea, or hemoptysis - CXR may show a cavitary lesion, and CT scan shows pulmonary nodules w/ a halo sign or lesions w/ an air crescent

Answer 815

- can cause parotitis and orchitis - most common in postpubertal young men, ages 15-29 - infertility is a rare complication - tx is supportive w/ application of cold compresses to parotid area or testes - most common complications are aseptic meningitis and encephalitis

Answer 816

-likely in pts w/ HIV who have a nonproductive cough, exertional dyspnea, fever, severe hypoxia, bilateral interstitial infiltrates on CXR, and a normal white count, especially if their CD4 35 on room air

Answer 817

-should be suspected in children who present w/ fever, dysphagia, inability to extend the neck, muffled voice, and lateral x-ray showing a widened prevertebral space

Answer 818

- brachial artery injury (most common) - median nerve injury (most common) - cubitus varus deformity - compartment syndrome/Volkmann ischemic contracture

Answer 819

- associated w/ a high risk of neurovascular injury - radial and brachial pulses must be assessed before and after reduction as the brachial artery can be impinged - motor and sensory function should also be assessed due to risk of median nerve injury

Answer 820

- typically occurs at 5-14 days of life and presents w/ eyelid swelling, chemosis, and watery or mucopurulent discharge - blood-stained eye discharge is highly characteristic of chlamydial conjunctivitis - first line tx is oral erythromycin

Answer 821

- IV or IM ceftriaxone or cefotaxime - ceftriaxone should be avoided in infants w/ hyperbilirubinemia as it results in displacement of bilirubin from albumin-binding sites, increasing the risk of kernicterus

Answer 822

-topical erythromycin (note that once it has occured, it is treated w/ IM or IV ceftriaxone/cefotaxime)

Answer 823

-unilateral subacute hip pain in a male child coupled w/ a progressive antalgic gait, thigh muscle atrophy, decreased hip range of motion, and collapse of the ipsilateral femoral head on plain pelvic x-rays

Answer 824

- the metaphysis and proximal femur slip relative to the epiphysis at the epiphyseal plate - the capital femoral epiphysis remains structurally intact within the acetabulum - classic presentation is obese adolescent w/ complainst of pain

Answer 825

-S. aureus due to hematogenous seeding to the metaphysis

Answer 826

- most common childhood myopathy | - causes proximal muscle weakness and calf pseudohypertrophy

Answer 827

- primary bone cancer that produces Codman's triangle in the metaphysis of long bones - note that Ewing sarcoma tends to affect the diaphysis of long bones

Answer 828

- progressive cervical changes are absent! - contractions are usually irregular and discomfort is readily relieved by sedation! - all such pts need reassurance only

Answer 829

- contractions that occur at regular intervals w/ a progressively shortening interval and increasing intensity - pain is in the back and upper abdomen and is NOT relieved by sedation - cervical changes are typically observed

Answer 830

- every case of leukocoria is considered retinoblastoma, until proven otherwise!!! such cases should be promptly referred to an ophthalmologist - inactivation of the Rb suppressor gene, may be familial or sporadic - highly malignant - other manifestations: strabismus, decreased vision, ocular inflammation, eye pain, glaucoma, orbital cellulits - mass w/ calcifications on US or CT is highly suggestive

Answer 831

-covering the normal eye

Answer 832

- autosomal dominant - should be suspected in a patient w/ persistent jaundice, hemolytic anemia, splenomegaly, positive family hx, and spherocytes on peripheral blood smear - RBC fragility on acidified glycerol lysis and eosin-5-maleimide binding tests confirm the diagnosis - mutation in ankyrin gene causes deficiency in SPECTRIN - increased mean corpuscular hemoglobin concentration

Answer 833

- autosomal dominant, northern european - hemolytic anemia, jaundice, splenomegaly - increased MCH concentration, spherocytes, negative coombs test, increased osmotic fragility on acidified glycerol lysis test, abnormal eosin-5-maleimide binding test - tx: folic acid, blood transfusions, splenomegaly - complications: pigment gallstones, aplastic crises from parvovirus B19 infection

Answer 834

- cholinesterase inhibitors (donepezil, galantamine, rivastigmine) effective in mild to moderate dementia; may improve quality of life, cognitive functions, memory, language, thought, and reasoning; they slow the cognitive decline - Donepezil is approved for all stages of Alzheimer's dementia - Memantine, an N-methyl-D-aspartate receptor antagonist, is approved for moderate to severe dementia

Answer 835

- increased risk of impaired fertility or infertility due to chronic inflammation and adhesion formation - endometriosis is diagnosed in 25-50% of women being evaluated for infertility, and almost half of women w/ endometriosis have impaired fertility

Answer 836

-advanced age, HTN, preeclampsia, renal disease, cocaine or tobacco use

Answer 837

-positive family hx, genetic mutations (BRCA1, BRCA2, p53), early menarche, late menopause, prolonged hormone replacement therapy, and nulliparity

Answer 838

-advancing age, unopposed estrogen or prolonged use of TAMOXIFEN, obesity, nulliparity, and anovulatory conditions (PCOS)

Answer 839

- aka pinworms - highly contagious and manifests as nocturnal perianal pruritus - albendazole and pyrantel pamoate (for pregnant pts!) are first-line tx options - diagnosed by scotch tape test

Answer 840

- aka Chagas disease - primarily affects the heart (cardiomyopathy, right bundle branch block) and GI tract (megacolon, megaesophagus) - Benznidazole is first-line anti-trypanosomal tx!

Answer 841

- urticaria, abdominal pain, respiratory symptoms (eg dry cough, dyspnea, wheezing) - tx w/ IVERMECTIN

Answer 842

- aka river blindness - causes ocular lesions and dermatitis - tx w/ ivermectin

Answer 843

-used for protozoan infections such as amebiasis (acute dysentery, liver abscess) and trichomonas vaginitis (green-yellow, frothy, malodorous discharge) as well as anaerobic intra-abdominal infections (diverticulitis, peritonitis, cholangitis, abscess)

Answer 844

- seronegative spondyloarthropathy that presents w/ progressive inflammatory back pain and stiffness - in the setting of suggestive findings on history and physical, AS is confirmed by plain film x-ray demonstrating fused sacroiliac joints and/or bamboo spine - presents in second or third decade of life usually; male:female ratio 2:1 - progressive low back pain and spinal stiffness of > 3 months duration usually - morning stiffness > 30 min and back pain improves w/ exercise - decreased lumbar spinal mobility and tenderness over SI joints is common - AP x-ray of SI joints; fusion of SI joints and/or bamboo spine is diagnostic

Answer 845

- PaO2 55%) | - evidence of cor pulmonale

Answer 846

- symptoms: nausea, vomiting, cramps, diarrhea, dysphoria, restlessness, rhinorrhea, lacrimation, myalgias, arthralgias - physical exam: mydriasis, piloerection, hyperactive bowel sounds - oral or IM methadone is the tx of choice

Answer 847

- 2/3 have an antecedent respiratory or GI infection - Campylobacter jejuni is most common precipitant; others include human herpes virus, Mycoplasma, H. influenza - more common in pts w/ lymphoma, sarcoidosis, and SLE - Recent HIV infection and immunization have also been associated

Answer 848

-in pts who have resistant HTN (requiring > 3 meds from different classes) and in young (

Answer 849

- usually present in 40s or 50s w/ chorea and/or behavioral disturbance - atrophy of the CAUDATE nucleus is a characteristic feature.

Answer 850

Alzheimer's disease

Answer 851

Wilson's disease

Answer 852

Pick's disease

Answer 853

- most important factor is the history, because physical symptoms can be vauge - suspect in cases of smoke inhalation and when multiple people from the same confined quarters present w/ headache, nausea, and abdominal discomfort - pinkish-red skin hue is noted on exam and diagnosis is confirmed by carboxyhemoglobin levels

Answer 854

-bitter almond breath

Answer 855

- foreign body aspiration - CXR is of limited help as most objects are radiolucent - a hx of choking, if witnessed, is very helpful in diagnosis - immediate bronchoscopy is indicated to remove the foreign body

Answer 856

-nebulized racemic epinephrine

Answer 857

- 70% of cases are caused by drugs such as cephalosporins, penicillins, sulfonamides, sulfonamide containing diuretics, NSAIDs, rifampin, phenytoin, and allopurinol - discontinuing the offending agent is the tx of drug-induced interstitial nephritis - clinical features include fever, rash, and arthralgias - peripheral eosinophilia, hematuria, sterile pyuria, eosinophiluria, and WBC casts

Answer 858

- characterized by proteinuria and a progressive decline in GFR - hallmark is nodular glomerulosclerosis (w/ Kimmelstiel-Wilson nodules) but diffuse glomerulosclerosis is more common - progression can be slowed w/ strict glycemic control, tx of HTN, and angiotensin axis blockade

Answer 859

-oropharyngeal thrush (oral candidiasis)

Answer 860

- diagnostic: 2 of 3 of the following: androgen excess, oligo- or anovulation, polycystic ovaries on US; AND exculsion of other hyperandrogenic conditions - tx: weight loss; combined hormonal contraceptives for hyperandrogenism and menstrual dysfunction; Clomiphene citrate for ovulation induction; metformin for coexisting type 2 DM - comorbidities: overweight/obesity,glucose intolerance/DM, dyslipidemia, OSA, endometrial hyperplasia/cancer

Answer 861

clomiphene citrate

Answer 862

-migraine w/ aura -> 15 cigarettes/day and age > 35 -stage 2 HTN (> 160/100) -Hx of venous thromboembolic disease -Hx of stroke or ischemic heart disease -breast cancer -cirrhosis and liver cancer -major surgery w/ prolonged immobilization -

Answer 863

- weakness in the proximal limb and torso muscles; ocular muscles may or may not be involved - diplopia, ptosis, facial weakness, and dysphagia - 10-15% also have a thymoma - ocular involvement is painless - antibodies against post-synaptic Ach receptor

Answer 864

-GI tract, lung, breast

Answer 865

-can be used in diagnosis of hepatocellular carcinoma

Answer 866

- usually caused by cephalosporins, penicillins, sulfonamides, NSAIDs, rifampin, phenytoin, and allopurinol - pts present w/ arthralgias, rash, renal failure and the UA will show WBC casts and eosinophiluria

Answer 867

- autoimmune condition characterized by areas of depigmentation completely lacking melanocytes - sometimes associated w/ other autoimmune conditions such as pernicious anemia, autoimmune thyroid disease, type 1 DM, primary adrenal insufficiency, hypopituitarism, and alopecia areata

Answer 868

- AIDS defining malignancy due to human herpesvirus 8 - cutaneous KS develops most commonly on the lower extremities, face, oral mucosa, and genitalia - the lesions usually appear as multiple violaceous papules - diagnosis is made clinically, but may require biopsy

Answer 869

- due to human papillomavirus - pts develop skin-colored, whitish, or grayish verrucous and filiform papules in the anal/perianal area (more often in men), penile shaft, or vulvovaginal and cervical areas

Answer 870

- can be due to infections, medications, inflammatory conditions, or malignancy - typically presents as non-blanching, 1-3 mm violaceous papules that can cluster/coalesce into plaques - older lesions appear brownish-red; newer ones are more violaceous

Answer 871

- should be suspected in a newborn w/ feeding intolerance, abdominal distension, and bloody stools - risk factors: prematurity, hypotension, congenital heart disease - hallmark x-ray finding is PNEUMATOSIS INTESTINALIS - can result in strictures, short bowel syndrome, or death

Answer 872

-benign suprasellar tumors that present w/ visual defects, headache, and symptoms of pituitary hormonal deficiency

Answer 873

-causes GRADUAL loss of peripheral vision in both eyes, leading to tunnel vision

Answer 874

- inflammatory demyelinating disease usually associated with MS - pts typically develop acute or subacute PAINFUL vision loss w/ ABNORMAL PUPILLARY RESPONSE to light in the affected eye

Answer 875

-most common in obese women age

Answer 876

-suspect in non-smoking adults

Answer 877

- decreased FEV1/FVC ratio - increased TLC - Decreased DLCO

Answer 878

1. subacute painless thyroiditis 2. subacute granulomatous (De Quervain's; painful) thyroiditis 3. iodine-induced thyroid toxicosis 4. levothyroxine overdose 5. struma ovarii

Answer 879

-ovarian teratoma which produces thyroid hormones, thereby causing thyrotoxicosis

Answer 880

- suspect in young obese female w/ a headache that is suggestive of a brain tumor, but w/ normal neuroimaging and elevated CSF pressure - papilledema, visual field defects, 6th nerve palsy - glucocorticoids, vitamin A, and OCPs can provoke - impaired absorption of CSF by arachnoid villi - tx: weight reduction and acetazolamide; possibly shunting or optic nerve sheath fenestration to prevent blindness

Answer 881

- should be suspected in an older adult patient (between 50-70) w/ rapidly progressive dementia, myoclonus, sharp wave complexes on EEG, and/or elevated 14-3-3 proteins in CSF - a rapidly progressive course and prominent myoclonus differentiate CJD from other causes of dementia - can also test for PRNP gene

Answer 882

-primary biliary cirrhosis (bear holding a mitochondria)

Answer 883

- occurs as a late complication of acute ST segment elevation or transmural myocardial infarction - ECG shows persistent ST segment elevation along w/ deep Q waves in the same leads - progressive left ventricular enlargement causing heart failure may occur in addition to refractory angina, ventricular arrhythmias, or mural thrombus - echo is diagnostic

Answer 884

- complication of acute MI that typically occurs 2-7 days after infarct - acute severe mitral regurgitation leading to hypotension and pulmonary edema

Answer 885

- mixed agonist and antagonist activity on estrogen receptors - estrogenic effects of tamoxifen increase the risk of endometrial cancer and venous thrombosis

Answer 886

- not uncommon after high-speed car accidents | - symptoms usually develop in the first 24 hrs and a patchy alveolar infiltrate on CXR is typical

Answer 887

amoxicillin (doxycycline can cause tooth discoloration and skeletal problems in children and fetusus)

Answer 888

- anaphylaxis to vaccine ingredients - hx of intussusception - hx of uncontrolled congenital malformation of the GI tract (eg Meckel's diverticulum) - SCID

Answer 889

- smoking cessation | - home oxygen therapy

Answer 890

-in all pts w/ syncope due to suspected STRUCTURAL HEART DISEASE

Answer 891

HTN, proteinuria, edema

Answer 892

abducted and externally rotated

Answer 893

-adducted and internally rotated

Answer 894

-N/V/D, muscle weakness, and DECREASED or ABSENT DTRs@

Answer 895

- delivery at 18 hours - GBS bacteriuria in any concentration during the current pregnancy - prior hx of delivery of an infant w/ GBS sepsis

Answer 896

- should be administered in pregnant females w/ PPROM before 32 wks gestation to reduce risks of respiratory distress syndrome, necrotizing enterocolitis, neonatal intraventricular hemorrhage, and neonatal death - beyond 32 wks, its unclear if steroids are efficacious w/ rupture of membranes, though many places continue to administer betamethasone between 32-34 wks for pts w/ PPROM; - steroids are typically not given after 34 wks gestation

Answer 897

- copper IUD (most effective; 99%; can be used up to 5 days after) - Levonorgestrel pill (85%; used up to 3 days after) - Ulipristal pill (> 85%; used up to 5 days after) - OCPs (75%; used up to 3 days after)

Answer 898

- can cause developmental delay - sensorineural deafness - blindness - jaundice - hepatosplenomegaly - petechiae

Answer 899

- due to pregnant women on phenytoin | - hypoplastic fingers/nails and cleft lip/palate

Answer 900

- developmental delay - sensorineural deafness - cataracts - hepatosplenomegaly - purpura

Answer 901

- cough, coryza, conjunctivitis, and Koplik spots followed by a maculopapular rash that spreads in a cranial-caudal pattern - prevention is best through live attenuated measles vaccine

Answer 902

- fear of a specific object or situation | - behavioral therapy using exposure techniques is the preferred treatment

Answer 903

- group of syndromes characterized by nonprogressive motor dysfunction - etiology is multifactorial, w/ prematurity as the leading risk factor - affected pts have uncoordinated and limited voluntary movements

Answer 904

prematurity

Answer 905

- recommended in pts w/ sustained BP > 135/80 mmHg and may be considered in all pts over age 45, as well as those w/ additional risk factors for diabetes - screening options include fasting plasma glucose, 2 hr oral glucose tolerance test and hemoglobin A1c

Answer 906

- caused by Chlamydia trachomatis serotype A-C - major cause of blindness worldwide - presents w/ follicular conjunctivitis and pannus (neovascularization) formation in the cornea - diagnosed by Giemsa stain exam of conjunctival scrapings - topical tetracycline or oral azithromycin should be started immediately

Answer 907

- pain, photophobia, and decreased vision | - dendritic ulcer is most common presentation, may also have minute clear vesicles on corneal epithelium

Answer 908

- acquired through contact w/ infected genital secretions, and occurs 2-3 days after birth - presents as copious, purulent eye discharge w/ swollen eyelids and chemosis

Answer 909

- conjunctiva is red w/ copious, watery discharge - children more commonly infected through contaminated swimming pools - mostly caused by adenovirus type 3

Answer 910

- increased extracellular pH (eg respiratory alkalosis) causes dissociation of hydrogen ions from albumin, allowing increased binding of calcium and a drop in unbound (ionized) calcium - ionized calcium is the physiologically active form, and decreased levels can result in clinical manifestations of hypocalcemia (crampy pain, paresthesias, carpopedal spasm)

Answer 911

-commonly present w/ microcephaly, prominent occiput, micrognathia, closed fists w/ index finger overlapping the 3rd digit and the 5th digit overlapping the 4th, and rocker bottom feet

Answer 912

-cleft lip, flexed fingers w/ polydactyly, ocular hypotelorism, bulbous nose, low-set malformed ears, small abnormal skull, cerebral malformation, microphthalmia, cardiac malformations, scalp defects, etc.

Answer 913

- due to Staph aureus; associated w/ menstruation (tampons), nasal packing, and post-surgery infections - pts usually develop fever, myalgias, marked hypotension, and diffuse erythematous macular rash (erythroderma) that can progress to multiorgan involvement

Answer 914

- primarily seen in children - group A strep infection occurs earlier at another site (tonsillitis, pharyngitis) - skin findings are preceded by prodrome of fever, headache, vomiting, and sore throat - 12-48 hrs later, fine pink blanching papules appear on the neck and upper trunk and quickly generalize w/ flexural accentuation (rough, sandpaper-like texture)

Answer 915

-HPV and tobacco

Answer 916

- plasma cell disorder | - presents w/ lytic lesions, hypercalcemia, and renal failure

Answer 917

- usually present w/ HTN, hematuria, proteinuria, palpable renal masses, or progressive renal insufficiency - may also have flank pain due to renal calculi, cyst rupture or hemorrhage, or upper UTI - HTN is a common early finding in pts w/ ADPKD and usually precedes the decline in renal function

Answer 918

- benign nodule containing normal epidermis that produces keratin - pts usually develop a dome-shaped, firm, freely movable cyst or nodule w/ a small central punctum - the lesion can remain stable or gradual increase in size but usually resolves spontaneously

Answer 919

- suspect in pts w/ multiple stomach ulcers and thickened gastric folds on endoscopy - diagnosis is strongly suggested by a fasting serum gastrin level > 1000 pg/mL - pts w/ non-diagnostic serum gastrin levels should be evaluated w/ a secretin stimulation test

Answer 920

PPI, amoxicillin, clarithromycin

Answer 921

- relatively sensitive and specific physical exam finding for upper motor neuron damage affecting the upper extremities - some stroke pts will demonstrate pronator drift in the absence of other significant findings

Answer 922

- presents weeks after a MI w/ chest pain that is improved by leaning forward - NSAIDs are the treatment of choice - anticoagulation should be avoided to prevent development of a hemorrhagic pericardial effusion

Answer 923

-start IV heparin immediately upon suspicion; definitive tx is surgical embolectomy or intra-arterial fibrinolysis/mechanical embolectomy via interventional radiology

Answer 924

- inhibits platelet aggregation and causes vasodilation | - sometimes used to treat chronic claudication

Answer 925

- triad of systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis - nasal cartilage destruction and vasculitic cutaneous lesions (tender nodules, palpable purpura, ulcerations) are common external manifestations

Answer 926

- increased vascular response to cold temperature or emotional stress - usually found in women age

Answer 927

- occurs in 6-10% of renal failure pts, typically those w/ BUN levels > 60 mg/dL - most UP pts do not present w/ the classic ECG changes of pericarditis (eg diffuse ST segment elevation) - hemodialysis leads to rapid resolution of chest pain and reduces the size of any associated pericardial effusion

Answer 928

- autosomal dominant genetic disorder caused by mutation in one of several genes encoding the myocardial contractile proteins of the cardiac sarcomere - mutations in the cardiac myosin binding protein C gene and cardiac beta-myosin heavy chain gene are responsible for about 70% of identifiable mutations in pts w/ HCM

Answer 929

- nuclear remnants within RBCs typically removed by the spleen - their presence strongly suggests physical or functional hyposplenism

Answer 930

- hemoglobin precipitation seen in G6PD deficiency - hemoglobin becomes oxidized and forms insoluble precipitants - appear after staining w/ crystal violet dye

Answer 931

- most cases will disappear spontaneously by the age of 12 months and can be safely observed during that period - those that do NOT resolve spontaneously should be removed surgicallly due to risk of inguinal hernia

Answer 932

- classified as social anxiety disorder, performance-only type - PRN beta-blockers or benzo's in pts w/o hx of substance abuse - CBT

Answer 933

- most common late manifestation of untreated Lyme disease | - synovial fluid typically about 25,000 WBC

Answer 934

-any hemorrhage occurring before the 20th wk of gestation w/ a live fetus and closed cervix

Answer 935

H. influenza and Strep pyogenes

Answer 936

-HTN that occurs before pregnancy or before 20 weeks gestation w/ subsequent development of proteinuria

Answer 937

-associated w/ panacinar emphysema and cirrhosis

Answer 938

minimal change disease - light microscopy shows normal architecture - EM shows effacement of foot processes - no biopsy if under 10 - tx w/ steroids

Answer 939

membranous glomerulonephritis (thickened BM, subepithelial spikes)

Answer 940

- common and usually asymptomatic infection in endemic areas like Mississippi and Ohio River valleys and Central America - usually found in soil w/ a high concentration of bird or bat guano droppings

Answer 941

- calcium oxalate crystals | - ethylene glycol poisoning

Answer 942

- mucocutaneous blistering disease that is characterized by flaccid bullae and intercellular IgG deposits in the epidermis - autoantibodies are formed against desmoglein, an adhesion molecule

Answer 943

- benign pruritic disease characterized by tense blisters | - immunofluorescence shows IgG and C3 deposits in the dermal-epidermal junction

Answer 944

- tx w/ topical retinoids and benzoyl peroxide - moderate and moderate to severe cases will benefit from the addition of topical antibiotics - oral abx and isotretinoin are usually reserved for severe or recalcitrant acne

Answer 945

- can affect the GU tract to cause a neurogenic bladder w/ urinary retention and distended bladder - pts can then develop overflow incontinence (eg dribbling, poor urinary stream) w/ a high post-void residual volume

Answer 946

- X-linked recessive bleeding disorders from factor VIII (A) and IX (B) deficiency - recurrent hemarthrosis and skeletal muscle hemorrhage after mild trauma are the most common manifestations of this disorder - hematuria is also seen, but renal function is usually normal

Answer 947

Multiple sclerosis

Answer 948

Caudate nucleus

Answer 949

- Aortic aneurysms (due to involvement of the branches of the aorta) - pts should be followed w/ serial chest x-rays

Answer 950

-hepatitis B and C, syphilis, gold, penicillamine, SLE, and rheumatoid arthritis

Answer 951

- best tx is rapid re-warming w/ warm water - NO ATTEMPT SHOULD BE MADE TO DEBRIDE ANY TISSUE INITIALLY; true demarcation between dead and viable tissue may take weeks

Answer 952

- typically occurs within the first few days of warfarin therapy - caused by a rapid decline in protein C levels, usually in pts w/ underlying hereditary protein C deficiency - tx involves immediate warfarin cessation and administration of protein C concentrate

Answer 953

-caused by autoantibodies to platelet factor 4 (PF4) complexed w/ heparin, and is characterized by thrombocytopenia, arterial or venous thrombosis, and necrotic skin lesions at heparin injection sites within 5-10 days of therapy

Answer 954

- vitamin K-independent inhibitor of the clotting cascade | - antithrombin III deficiency predisposes to thrombus formation

Answer 955

-increases the risk of venous thromboembolism -also increase risk of cerebral, mesenteric, and portal vein thrombosis -

Answer 956

- develop signs between 12-48 hrs after last drink - acute stage: sweating, hyperreflexia, tremors, and seizures - next is acute hallucinosis in the absence of autonomic symptoms - final stage is delirium tremens: altered sensorium, hallucinations, autonomic instability (tachycardia, fever, sweating)

Answer 957

- presents w/ bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, and cardiogenic shock - IV fluids and atropine are first-line tx - IV glucagon should be administered in pts w/ profound or refractory hypotension

Answer 958

- methylxanthine which acts by blocking phosphodiestease, thereby increasing levels of cAMP - causes bronchodilation and has positive inotropic/chronotropic effects

Answer 959

- life threatening arrhythmias - anorexia, N/V, abdominal pain - fatigue, confusion, weakness, CHANGES IN COLOR VISION

Answer 960

- associated w/ neurodevelopmental injury if not recognized and treated early - decreased activity, hoarse cry, jaundice; majority of infants are asymptomatic though - thyroid dysgenesis is the most common cause worldwide

Answer 961

> 250 mm H2O

Answer 962

Abdominal CT -look for inflammation in pericolic fat, presence of diverticula, bowel wall thickening, soft tissue masses (eg phlegmons), and pericolic fluid collections suggesting abscess

Answer 963

- presents w/ acute onset of unilateral pelvic pain immediately after strenuous activity or sexual intercourse - pelvic US can show free fluid in the pelvis - supportive care (eg analgesics) is recommended for uncomplicated cyst rupture; complicated rupture may require surgical intervention

Answer 964

- caused by surfactant deficiency - important risk factors include prematurity and maternal diabetes mellitus - fetal hyperglycemia causes hyperinsulinemia, which antagonize cortisol and block the maturation of sphingomyelin

Answer 965

- should be suspected in an otherwise well-appearing infant w/ intermittent cyanosis and distress during feeding that is relieved by crying - failure to pass a catheter through the nose into the oropharynx is suggestive of the diagnosis - a CT scan shows narrowing at the level of the pterygoid plate in the posterior nasal cavity

Answer 966

SSRI or clomipramine

Answer 967

-causes centrilobular or diffuse hepatocyte necrosis

Answer 968

-hepatocyte swelling and necrosis, Mallory bodies, and neutrophilic infiltration

Answer 969

-periductal portal tract fibrosis and segmental stenosis of extrahepatic and intrahepatic bile ducts

Answer 970

-class 3 antiarrhythmic agent frequently used for conversion and maintenance of sinus rhythm in pts w/ AF

Answer 971

- complication of a chronic inflammatory condition (eg chronic infections, IBD, rheumatoid arthritis) resulting in extracellular tissue deposition of fibrils into tissues and organs. - pts can develop multi organ dysfunction (eg kidneys, liver, GI) - tx involves treating the underlying condition and Colchicine

Answer 972

- preseptal cellulitis is a mild infection of the eyelid anterior to the orbital septum - orbital cellulitis is a serious infection posterior to the orbital septum - orbital cellulitis causes pain w/ extraocular movements, diplopia, and ophthalmoplegia - dangerous complications include blindness and intracranial infection from orbital cellulitis

Answer 973

- associated w/ false positive VDRL, prolonged PTT, and thrombocytopenia - can promote arterial and venous thromboses and a resultant tendency toward spontaneous abortions - prophylaxis w/ low dose aspirin and LMWH are recommended to avoid pregnancy loss

Answer 974

- should be provided to all adolescents at age 11-12 - a booster is recommended at age 16 - esp. important for military recruits, college students living in dorms, and travelers to sub-Saharan africa

Answer 975

the non-polio enteroviruses, such as echoviruses and coxsackieviruses

Answer 976

- benign neonatal rash characterized by blanching erythematous papules and/or pustules - resolves spontaneously within 2 wks after birth

Answer 977

- infection of the submandibular and sublingual glands - the source of infection is most commonly an infected tooth, usually the second or third mandibular molar - asphyxiation is the most common cause of death in this disease - pts present w/ fever, dysphagia, odynophagia, and drooling

Answer 978

- Desmopressin - it can provide immediate improvement for frustrated families when behavior modifications and alarm therapy have failed but has a high rate of relapse if used alone

Answer 979

NSAIDS, methotrexate, anti-TNF agents

Answer 980

- rare tumor affecting the pancreatic cells that produce VIP - most pts develop VIPoma syndrome (pancreatic cholera) w/ watery diarrhea, muscle weakness/cramps (due to hypokalemia), and hypo- or achlorhydria (due to decreased gastric acid secretion) - stool studies are consistent w/ secretory diarrhea; a VIP level > 75 pg/mL confimrs the diagnosis - most are located in the tail of the pancreas

Answer 981

- flushing, diarrhea, bronchospasm | - 70-80% arise in small intestine

Answer 982

- can occur during or immediately after surgery in pts undergoing major surgery and requiring extensive transfusions - HYPERactive deep tendon reflexes may be the initial manifestation

Answer 983

hemorrhage!

Answer 984

- abnormal bone remodeling in "mosaic" pattern - many pts are asymptomatic and are diagnosed after an isolated elevation in alkaline phosphatase is noted on lab testing - headaches, increased head size, hearing loss, and compression of cranial nerves, spinal cord, or spinal nerve roots

Answer 985

- aka echinocytes | - spiculated RBCs seen in liver disease and end-stage renal disease

Answer 986

- basophilic nuclear remnants that appear as small, black pellets in RBCs - seen in pts w/ hx of splenectomy or functional asplenia

Answer 987

- aka acanthocytes | - RBCs w/ irregularly sized and spaced projections that are most commonly seen in liver disease

Answer 988

- typically presents w/ acute renal failure (w/o previous kidney disease) and malignant HTN (eg headache, blurry vision, nausea). - UA may show mild proteinuria - peripheral blood smear can show microangiopathic hemolytic anemia w/ schistocytes and thrombocytopenia

Answer 989

- usually causes an asymptomatic or minor respiratory illness in healthy pts, but immunocompromised pts can develop severe pulmonary or disseminated disease - the most rapid and sensitive test to diagnose disseminated histoplasmosis in immunocompromised pts is URINE or SERUM assay for Histoplasma antigen

Answer 990

Itraconazole for mild to moderate disease. Amphotericin B for severe disease

Answer 991

- presents early on w/ hepatosplenomegaly, cutaneous lesions, jaundice, anemia, and rhinorhea - metaphyseal dystrophy and periostitis may be seen on radiography

Answer 992

congenital rubella

Answer 993

-intrauterine growth restriction, hepatosplenomegaly, petechiae or purpura, microcephaly, chorioretinitis, sensorineural hearing loss, and periventricular calcifications

Answer 994

-used to prevent hemorrhagic cystitis caused by cyclophosphamide

Answer 995

-antidote for acetaminophen overdose and nephroprotective agent to prevent radiocontrast-induced nephropathy

Answer 996

- can result from overproduction or underexcretion of uric acid - induction chemo results in rapid tumor cell lysis and releases uric acid into the circulation - distinguish between prevention and tx of gout: for prevention, allopurinol and probenecid are use; for tx during acute attacks, NSAIDs, colchicine, and steroids are used

Answer 997

- diagnosis: improvement after abstaining from dairy; acid pH of stool; presence of positive reducing sugars - confirmed by HYDROGEN BREATH TEST

Answer 998

- suspect in child w/ sudden-onset abdominal pain, bloody diarrhea, and triad of anemia, thrombocytopenia, and renal failure - tx is supportive; possibly plasmapheresis

Answer 999

- appears as an enlarged, "water bottle" shaped cardiac silhouette on CXR - physical exam findings of effusion w/o cardiac tamponade include diminished heart sounds on auscultation and a difficult to palpate PMI

Answer 1000

-hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy, acute phase of MI

Answer 1001

- inflammatory disorder characterized by fibrosclerosis of the thyroid, surrounding tissues, and often remote nonthyroidal structures (eg retroperitoneum) - subclinical or overt hypothyroidism may be seen, but most pts have a hard goiter

Answer 1002

- common cause of recurrent or occult painless lower GI bleeding in pts age > 60 years - they have been reported to cause lower GI bleeding in pts w/ aortic stenosis (Heyde's syndrome) and end-stage renal disease due to increased bleeding risk in these pts unmasking sites prone to bleeding

Answer 1003

- defined by: Proteinuria (> 3.5 g/day), hypoalbuminemia, edema, hyperlipidemia and lipiduria - HYPERCOAGULABLE condition which manifests as venous or arterial thrombosis, and even PE - renal vein thrombosis is the most frequent manifestation - complications include: protein malnutrition, iron-resistant microcytic hypochromic anemia, increased susceptibility to infection, and vitamin D deficiency

Answer 1004

-obstructive: FEV1 70%, FVC

Answer 1005

- can be diagnosed in late adulthood - confirmed by PFTs - reversible airway obstruction (>12% increase in FEV1) w/ normal diffusion capacity for carbon monoxide suggest asthma regardless of age

Answer 1006

-human herpesvirus-8 (HHV-8)

Answer 1007

-nontender, firm, hyperpigmented nodules that are usually

Answer 1008

- most common adverse reaction that occurs within 1-6 hrs of transfusion - pts usually develop fever, chills, and malaise w/o hemolysis - leukoreduction of donor blood can prevent febrile nonhemolytic reaction and reduce the risk of HLA alloimmunization and CMV transmission

Answer 1009

- results from chronic inflammation, fibrosis, and contracture of the joint capsule - pts experience shoulder stiffness out of proportion to pain, and exam shows reduction of both passive and active ROM

Answer 1010

- clinically useful to differentiate between cardiac and liver disease-related causes of lower extremity edema - pts w/ peripheral edema due to heart failure have elevated JVP and positive hepatojugular reflux - those w/ peripheral edema from primary hepatic disease and cirrhosis have reduced or normal JVP and negative hepatojugular reflux

Answer 1011

- Gonococcal conjunctivitis - can be prevented w/ application of topical erythromycin ointment within 1 hr of birth - conjunctivitis caused by Chlamydia trachomatis is usually milder and presents 5-14 days after birth

Answer 1012

catheter tip infection

Answer 1013

- administered in high risk pregnancies to assess for fetal hypoxemia - considered reactive if there are 2 or more heart rate acclerations of 15 bpm above baseline that last for 15 seconds over 20 minutes of observation

Answer 1014

- associated w/ Pseudomonas aeruginosa bacteremia that is characterized by rapidly progressive skin lesions that develop into nontender nodules w/ central necrosis - can be seen in pts who are immunocompromised, and tx should consist of anti-pseudomonal antibiotics

Answer 1015

- causes decreased compliance of the lungs, and spirometry typically reveals decreased TLC, decreased FVC, decreased FEV1, and a normal FEV1/FVC ratio - bibasilar fine, dry crackles are typically heard on auscultation - note that normal values for FEV1 and the FEV1/FVC ratio are between 80% - 120% of predicted values!!!!

Answer 1016

-decreased FEV1, normal FVC, decreased FEV1/FVC ratio

Answer 1017

- most commonly caused by ectopic ACTH production by SMALL CELL LUNG CARCINOMA - hyperpigmentation is frequently present and is due to coproduction of melanocyte-stimulating hormone w/ ACTH

Answer 1018

-typically seen in neuroendocrine tumors, such as carcinoid (serotonin) or pheochromocytoma (norepinephrine, epinephrine)

Answer 1019

- refers to a slow progression of cervical dilatation, whereas arrest disorders are diagnosed when the cervix ceases to dilate after reaching at least 4 cm - if the membranes are still intact, an amniotomy is usually the first step to promote the progression of labor

Answer 1020

- common cause of pleural effusions - the effusion is exudative w/ protein concentrations often greater than 4 g/dL - the fluid also consists of a lymphocytic leukocytosis w/ no gross purulence and a glucose concentration typically mildly below the serum glucose level

Answer 1021

-empyema, malignancy, RA, esophageal rupture, pancreatitis, pulmonary infarction, TB

Answer 1022

Azithromycin

Answer 1023

- potential complication of lung malignancy, and is manifested by headache, facial swelling, and jugular venous engorgement without peripheral edema - the primary tx is radiation therapy as a palliative measure

Answer 1024

- impaired consciousness (such as alcoholics, epileptics, or pts w/ a recent stroke) - the presence of tracheal or NG tubes - impaired gag reflex

Answer 1025

- common complication of ascites in which the peritoneal fluid becomes infected by an enteric organism that translocates across the intestinal wall - the finding on paracentesis of greater than 250 neutrophils/uL in the ascitic fluid is diagnostic

Answer 1026

- autoimmune blistering disease that typically causes the formation of bullae in the flexural surfaces, groin, and axilla - biopsy of the lesion characteristically shows a subepidermal blister under light microscopy and linear Ig of basement membrane under immunofluorescence

Answer 1027

- autoimmune disease that causes INTRAepidermal blistering - usually have involvement of the oral cavity, and intact blisters are rare - tombstone appearance under light microscope

Answer 1028

-ovoid plaques in the periventricular region, corpus collosum, and deep white matter

Answer 1029

- most common intracranial tumor in adults - most often due to melanoma, lung, breast, or renal cancer - appear as peripheral, circumscribed, enhancing lesions surrounded by vasogenic edema on MRI

Answer 1030

-characterized by proximal muscle tenderness as opposed to weakness, and elevations of AST, ALT, and CPK are NOT typically seen

Answer 1031

- symmetric, proximal muscle weakness along w/ the elevation of muscle enzymes, such as LDH and CPK - diagnosis can be confirmed using combination of autoantibody tests, EMG, and muscle biopsy

Answer 1032

- can cause an inflammatory arthritis that is usually migratory, polyarticular, and symmetric - the knees and hands are most commonly involved - the presence of other signs of SLE, such as renal disease and photosensitivity, can help to establish the diagnosis of lupus

Answer 1033

-used in the treatment of SUPRAventricular tachycardia (think of the den above the ventricles)

Answer 1034

-used in tx of SUPRAventricular tachyarrhythmias such as atrial fibrillation (think of digging oxygen to prevent atrial fibrillation, which is a common effect of hypoxemia)

Answer 1035

- used to treat SUPRAventricular tachycardia if adenosine is not effective in terminating the rhythm - NOT EFFECTIVE FOR VENTRICULAR TACHYCARDIA!!!!!

Answer 1036

- should be considered to be ventricular in origin unless its definitively interpreted as supraventricular tachycardia w/ aberrancy - in stable pts, tx consists of a loading dose of AMIODARONE ("aims at the down one" (ventricle))

Answer 1037

- most common intracranial tumor in adults - most often due to melanoma, lung, breast, or renal cancer, and appear as peripheral, circumscribed, enhancing lesions surrounded by vasogenic edema on MRI

Answer 1038

Penicillamine (copper binder)

Answer 1039

- ratio of SYSTOLIC BP of ankle to SBP of brachial artery | - a normal ABI is 1.0-1.3; values between 0.4-0.9 suggest peripheral artery disease, and values

Answer 1040

- most often due to bilateral adrenal hyperplasia or an aldosterone-producing adrenal adenoma - adrenalectomy is recommended for an adenoma, whereas aldosterone antagonists are recommended for bilateral hyperplasia - best test is early morning plasma aldosterone to renin ratio; elevated aldosterone (> 15 ng/dL) w/ a PAC/PRA ratio > 20 suggests PH - pts w/ PH should undergo CT of adrenal glands

Answer 1041

- usually due to increased tumor production of parathyroid hormone-related peptide (PTHrP) - PTH levels are suppressed in pts w/ HoM - serum calcium levels are generally much higher in HoM than in primary hyperparathyroidism!

Answer 1042

Ursodeoxycholic acid

Answer 1043

-most frequently associated w/ small vessel vasculitides such as granulomatosis w/ polyangiitis (Wegener's)

Answer 1044

autoimmune hepatitis

Answer 1045

-primary biliary cirrhosis (PBC)

Answer 1046

CREST syndrome

Answer 1047

-anti-dsDNA and anti-smith antibodies

Answer 1048

-usually more difficult to localize (eg generalized, crampy abdominal pain that pts experience w/ small bowel obstruction)

Answer 1049

pain secondary to destruction of nerve tissue itself, as in peripheral neuropathy -burning and tingling are common symptoms

Answer 1050

-complex regional pain syndrome of the extremities characterized by swelling, pain, and bone demineralization often following minor trauma

Answer 1051

- well-localized, and is usually secondary to peritoneal irritation - in contrast, visceral pain is more vague in localization, and is usually the result of mechanical stretching of the abdominal viscera

Answer 1052

- characterized by the inability of the kidneys to excrete water due to an abnormal amount of ADH - clinically, SIADH is suspected in a pt w/ hyponatremia, low serum osmolality, elevated urine osmolality, and elevated urine sodium

Answer 1053

- may result from a neurogenic bladder, and is treated w/ augmented voiding techniques and cholinergic agonists - more severe cases are treated w/ intermittent or indwelling bladder catheterization

Answer 1054

- should be suspected in any patient w/ ascites and altered mental status - a diagnostic paracentesis that reveals more than 250 neutrophils/mm3 is diagnostic of SBP!!!! - initial tx consists of broad-spectrum antibiotics

Answer 1055

- in adults, typically presents w/ an erythematous, scaly, pruritic rash - usually located on the flexural surfaces of the arms and knees as opposed to the extensor surfaces in psoriasis

Answer 1056

-coin shaped, very pruritic patches of eczema that tend to involve the back and lower extremities

Answer 1057

- form of dermatitis that involves the palms and soles | - tiny fluid filled blisters on palms and fingers

Answer 1058

- skin infection caused by the YEAST, Malassezia furfur | - results in abnormally colored macules that are most commonly seen on the trunk and upper extremities

Answer 1059

- should be considered to be pancreatic cancer until proven otherwise - elevation of bilirubin and alk phos implies a cholestatic cause of jaundice, which can be caused by blockage of the common bile duct by a pancreatic mass

Answer 1060

- causes GI hemorrhage, which is made evident by bloody diarrhea and hematemesis - severe poisoning may result in metabolic acidosis, hepatotoxicity, bowel obstruction, or death

Answer 1061

-upper lobe infiltrate w/ cavitation and hilar lymphadenopathy

Answer 1062

-can be both diagnostic and therapeutic for pts w/ SUPRAventricular tachycardia (SVT)

Answer 1063

-used to treat certain inflammatory diseases, such as RA or Crohn's disease

Answer 1064

-cytokine that can be used to treat pts w/ RA

Answer 1065

-used in tx of various cancers including colorectal cancer

Answer 1066

-inhibits BCR-ABL tyrosine kinase that is present in WBC of pts w/ CML!!!

Answer 1067

- occurs in elderly individuals - can be asymptomatic or have nonspecific symptoms such as fatigue, weight loss, or night sweats - may pts have a good prognosis even w/o tx, but treatment w/ a monoclonal antibody directed against the CD20 antigen on B lymphocytes may be used in symptomatic pts.

Answer 1068

-muscle relaxant used in the tx of nueroleptic malignant syndrome, which refers to an idiosyncratic reaction to D2 antagonists characterized by fever, diffuse rigidity, mental status changes, and autonomic instability

Answer 1069

- type of extrapyramidal symptom and a common side effect of antipsychotic meds, particularly high-potency 1st generation antipsychotics (haloperidol) - tx consists of anticholinergic meds or diphenhydramine

Answer 1070

- should be in the differential diagnosis in any middle-aged woman w/ vague pelvic complaints, particularly if an adnexal mass is palpated - intraperitoneal spread is common in advanced cases

Answer 1071

- seen on plain radiography as dilatation of the small bowel greater than 3 cm w/ absence of air within the colon - most common cause of SBO in developed nations is adhesions from prior abdominal surgeries; next most common causes are indirect hernias or obstructing lesions

Answer 1072

-used to tx hyperprolactinemia caused by pituitary adenomas

Answer 1073

- radial nerve injury | - results in weakness of the wrist and finger extensors as well as loss of sensation in the dorsum of the hand

Answer 1074

- generally cause diffuse MSK pain - management involves pain control, hydration, and supplemental oxygen - sickle cell disease in general is more common in african americans and affected pts are usually chronically anemic

Answer 1075

-class 1 antiarrhythmic med that blocks sodium channels

Answer 1076

-alpha-2-adrenergic agonist that functions as an anti-hypertensive agent by decreasing sympathetic outflow from the CNS

Answer 1077

-dihydropyridine calcium channel blocker that produces vasodilatation, thereby reducing BP

Answer 1078

-characterized by normal P waves and a PR interval that gradually increases w/ successive beats until a P wave fails to conduct to the ventricles, resulting in the absence of a QRS complex

Answer 1079

- characterized by wide, fixed splitting of the second heart sound on physical exam - a systolic murmur sometimes heard at the left upper sternal border from increased flow across the pulmonary valve, but there is usually not a murmur from the ASD itself

Answer 1080

- most common cause of antibiotic-associated colitis - pts present w/ low grade fever, diarrhea, abdominal pain, and leukocytes in the stool - the most appropriate tx is oral metronidazole or oral vancomycin

Answer 1081

- round, eosinophilic, and intracytoplasmic inclusions within the neurons of the substantia nigra - episodic fluctuating cognitive function (eg daytime drowsiness, daytime naps lasting > 2 hours, prolonged staring spells, episodes of disorganized speech), visual hallucinations, and parkinsonism

Answer 1082

- measured as part of the work-up for possible carcinoid syndrome - affected pts present w/ diarrhea, abdominal cramping, flushing and telangiectasias

Answer 1083

- evaluate for multiple myeloma - renal failure can occur in multiple myeloma from a variety of causes, but the most common is a toxic effect of light chain casts on the renal tubules - diagnosis is confirmed w/ serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), bone marrow biopsy, and skeletal survey w/ plain radiographs to assess for lytic lesions.

Answer 1084

Lesch-Nyhan syndrome

Answer 1085

- causes inflammation of the vulva and vagina, resulting in erythema and pruritis - it can be distinguished from other causes of vaginitis by a normal vaginal pH of 3.8 - 4.2

Answer 1086

- (a,-)(-,-) - hemoglobin H disease (composed of 4 beta chains) - severe microcytic, hypochromic anemia w/ target cells and Heinz bodies as well as hepatosplenomegaly

Answer 1087

- characterized by one alpha globin gene mutation (a,a)(a,-) | - pts typically have no clinical or lab abnormalities

Answer 1088

- hydrops fetalis - most severe form of alpha thalassemia - not compatible with life

Answer 1089

- typically asymptomatic although pts may complain of mild fatigability - affected pts will have mild hypochromic anemia, severe microcytosis, and target cells - may be cis (a,a)(-,-) or trans (a,-)(a,-)

Answer 1090

6-12 mmHg | -provides indirect estimate of left atrial pressure

Answer 1091

- characterized by a low-pitched diastolic murmur heard best at the apex - occurs earlier in diastole w/ worsening stenosis, and can become holodiastolic in pts w/ severe stenosis

Answer 1092

- immunocompromised: onset of sexual intercourse; every 6 months x 2 then annually - age 65: no screening if negative prior screens and not high risk for cervical cancer - hysterectomy (w/ cervix removed): no screening if no hx of high-grade precancerous lesion, cervical cancer, or exposure to diethylstilbestrol

Answer 1093

- characteristic of hypertrophic cardiomyopathy | - common in young pts who present w/ syncope, and is important to diagnose because it can lead to sudden cardiac death

Answer 1094

Epididymitis

Answer 1095

-nephrotoxicity, tinnitus and hearing loss, electrolyte abnormalities, severe nausea and vomiting, and neurotoxicity

Answer 1096

- urine protein excretion of > 3.5g/day, edema, and hypoalbuminemia - FSGS is the most common cause of NS in adults, particularly african americans

Answer 1097

-common consequence of thoracic trauma that generally manifest over the course of the first day w/ an airspace opacity on CXR and findings consistent w/ alveolar fluid on physical exam

Answer 1098

-typically diagnosed in children under the age of 7 who have a wide array of seizure types accompanied by mental retardation

Answer 1099

- usually present in their teenage years w/ a progression from absence to myoclonic to generalized tonic-clonic seizures - the seizures typically occur upon awakening - JME is genetic, and symptoms can be worsened w/ sleep deprivation

Answer 1100

- presents w/ central obesity, proximal muscle weakness, androgen excess, menstrual irregularities, HTN, and easy bruising - in the absence of exogenous glucocorticoid administration, the most common etiologies of Cushing's syndrome include increased pituitary secretion of ACTH (Cushing's disease), an adrenal tumor, and ectopic ACTH production

Answer 1101

- should be suspected in any neonate w/ bilious vomiting - rapid evaluation and surgical tx is required as bowel necrosis can develop quickly - the classic finding on upper GI series is a corkscrew-shaped duodenum that is abnormally located in the right abdomen

Answer 1102

combination of amphotericin B and flucytosine | -subacute presentation

Answer 1103

-pyrimethamine and sulfadiazine (NOT TMP-SMX!!!! This is for prophylaxis!!)

Answer 1104

- important cause of meningitis in adults over the age of 60 and in immunocompromised pts - AMPICILLIN should be added to the empiric abx regimen of ceftriaxone and vancomycin in these pts

Answer 1105

treats ACUTE gouty arthritis

Answer 1106

- febuxostat and allopurinol are xanthine oxidase inhibitors that decrease uric acid production - allopurinol is usually preferred, and febuxostat is reserved for pts who cannot tolerate allopurinol - probenecid is a uricosuric med that increases uric acid excretion in the kidneys

Answer 1107

- aortic regurgitation | - most common cause in an elderly patient w/ atherosclerotic risk factors is aortic root dilation

Answer 1108

- typically presents w/ symmetric, ascending weakness and loss of reflexes w/ relative preservation of sensory function - it is often associated w/ a preceding respiratory or GI infection - the classic finding on LP in pts w/ GBS is an elevated protein content w/ a normal WBC count, referred to as ALBUMINOCYTOLOGIC DISSOCIATION

Answer 1109

-excessive anxiety and preoccupation with 1 or more unexplained symptoms

Answer 1110

-fear of having a serious illness despite few or no symptoms and consistently negative evaluations

Answer 1111

-neurologic symptom incompatible w/ any known neurologic diseas; often acute onset associated w/ stress

Answer 1112

-intentional falsification or inducement of symptoms w/ goal to assume SICK ROLE

Answer 1113

-falsification or exaggeration of symptoms to obtain external incentives (SECONDARY GAIN)

Answer 1114

- eosinophilic vasculitis | - may present w/ renal and upper airway symptoms, but asthma and eosinophillia are present in nearly all pts

Answer 1115

- form of granulomatous vasculitis that typically presents w/ involvement of the upper airways, lungs, and kidneys - diagnosis can be confirmed w/ serum ANCA testing or by finding granulomatous inflammation on biopsy of upper airway lesions

Answer 1116

- hematologic disorder that is more common in pts over 65 yrs old and usually presents w/ macrocytic anemia, leukopenia, and thrombocytopenia - ovalo-macrocytes are commonly seen on a peripheral smear along w/ neutrophils w/ decreased segmentation, as opposed to the megaloblastic, hypersegmented neutrophils seen in pts w/ B12 or folate deficiency

Answer 1117

-used in the treatment of severe bradycardia

Answer 1118

-first, a-blockade w/ a med such as phenoxybenzamine followed by the use of b-blockers, after which surgery should be performed

Answer 1119

- presents as an erythematous skin lesion covered w/ a golden crust, and is typically seen on the face or upper extremities - S. aureus and group A strep are the most common etiologies - pts who have group A strep impetigo are at risk of developing post-strep glomerulonephritis

Answer 1120

- should be diagnosed when a patient w/ underlying COPD presents w/ increased SOB, cough, or sputum production - systemic glucocorticoids should be given to pts w a COPD exacerbation because they have been shown to improve lung function and promote a shorter hospital stay

Answer 1121

-marked by hypocalcemia, hyperphosphatemia, hyperkalemia, and elevated uric acid levels causing nausea and vomiting, bowel disturbances, low urine output, acute renal insufficiency, seizures, tetany, and/or arrhythmias

Answer 1122

- very common in diabetic pts due to a combination of peripheral neuropathy and peripheral vascular disease - important factors in evaluating foot ulcers include the depth of involvement and the presence of infection - if there is no infection and the ulcer does not involve the bone, debridement of the necrotic tissue is usually sufficient tx

Answer 1123

-type of measurement bias in which the investigator unconsciously influences the outcome of the study by knowing the exposure status of each participant

Answer 1124

-refers to a change in behavior that occurs if the participants know they are being studied

Answer 1125

-occurs when the results from an atypical population are extrapolated into the entire population

Answer 1126

-characterized by sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech/behavior) lasting at least 1 day and less than 1 month

Answer 1127

-characterized by a lifelong pattern of detachment from social relationships and restricted range of emotions

Answer 1128

-characterized by psychotic symptoms that last 1-6 months

Answer 1129

-pts are typically "odd", holding magical beliefs and strange (but not overtly psychotic) though processes

Answer 1130

- involves a pervasive pattern of impulsivity, mood instability, and an unstable sense of self - associated characteristics include fear of abandonment and unstable chaotic relationships - transient paranoia and psychosis may occur and last minutes to hours; these have been termed "micropsychotic episodes"

Answer 1131

-impaired bicarb reabsorption in the proximal renal tubules, which causes a non-anion gap metabolic acidosis

Answer 1132

type 1 renal tubular acidosis, which causes a non-anion gap metabolic acidosis

Answer 1133

- presents w/ polyuria, polydipsia, abdominal pain, vomiting, and metabolic acidosis - low serum bicarb, elevated anion gap, and hyperglycemia are diagnostic of the condition - lack of insulin causes breakdown of fatty acids to ketones in the liver, which leads to acidosis and the clinical manifestations of DKA

Answer 1134

- consists of gradual fluid resuscitation w/ a 10 mL/kg bolus of normal saline over 1 hour; this should be followed by an IV insulin drip w/ isotonic fluids containing potassium - the patient can be transitioned to a subcutaneous insulin regimen when the anion gap closes and the metabolic acidosis resolves

Answer 1135

-lactic acidosis, hepatitis, hypersensitivity reaction

Answer 1136

pancreatitis

Answer 1137

non-nucleoside reverse transcriptase inhibitor known to cause insomnia with vivid, bizarre dreams

Answer 1138

- refers to an involuntary leakage of urine accompanied by a sensation of urgency - initial tx are conservative, consisting of bladder training and establishing a voiding schedule

Answer 1139

-childhood vasculitis that typically consists of fever, conjunctival injection, oral mucous membrane changes, erythema or edema of the palms and soles, polymorphous rash, and cervical lymphadenopathy

Answer 1140

- childhood illness w/ pathologic findings of leukocytoclastic vasculitis w/ IgA deposition - clinical findings include palpable purpura, abdominal pain, renal failure, and arthralgia

Answer 1141

- can cause pain w/ walking, sitting, and sexual intercourse - exam reveals a tender mass in the medial aspect of the labia majora at either the 4 or 8 o'clock position - as with any abscess, incision and drainage is the most appropriate therapy

Answer 1142

- abortives: triptans, NSAIDs, acetaminophen, antiemetics, ergots - preventatives: topiramate, divalproex sodium, TCAs, beta-blockers

Answer 1143

- associated w/ the development of coronary artery aneurysms - tx w/ IVIG and aspirin helps decrease the risk of coronary complicaitons - diganosis: fever for 5 or more days, along w/ 4 or more of the following: oral mucous membranes changes (strawberry tongue, cracked lips), bilateral nonexudative conjunctivitis w/ limbal sparing, cervical lymphadenopathy (> 1.5 cm), polymorphous rash, erythema or edema of the hands and feet

Answer 1144

doxycycline

Answer 1145

-small white spots on buccal mucosa seen in measles

Answer 1146

-petechiae on soft palate seen in rubella

Answer 1147

- increased IOP | - presents w/ progressive loss of vision in the peripheral visual fields followed by central visual loss

Answer 1148

-caused by pigment accumulation in the retina, which typically presents w/ central visual loss

Answer 1149

- characterized by painless loss of vision that is worse at night; classically described as "glare" while driving at night - surgical tx is required

Answer 1150

- should be suspected in any young pt w/ dysuria, cervical friability, or vaginal discharge, esp. if the Gram stain of the discharge shows numerous neutrophils w/o any organisms - chlamydial infection can lead to the development of PID if untreated, which can eventually cause infertility

Answer 1151

-antiarrhythmic used to manage VENTRICULAR arrhythmias in pts w/ heart failure and/or systolic LV dysfunction

Answer 1152

- adjunctive therapy for symptom control in pts w/ heart failure and LV systolic dysfunction - reduces the rate of hospitalization for heart failure but has not been shown to improve overall survival

Answer 1153

- ACE-I - ARBs - beta-blockers (metoprolol, carvedilol, bisoprolol) - aldosterone angatgonists - combo of hydralazine and nitrates in blacks

Answer 1154

- in pregnancy: fluid accumulation within the carpal tunnel - in hypothyroidism: accumulation of matrix substances (mucin, mucopolysaccharide) within both the perineurium as well as tendons

Answer 1155

-calcium channel blockers (eg nifedipine), b-agonists (terbutaline, ritodrine), and cyclooxygenase inhibitors (eg indomethacin; only between 24-32 wks though)

Answer 1156

-used for fetal neuroprotection in preterm births

Answer 1157

- develop hypertriglyceridemia - a classic clinical finding is striate palmar xanthomas - the most appropriate initial tx is w/ a fibric acid derivative (eg fenofibrate)

Answer 1158

-regular contractions occurring before 37 wks gestation associated w/ cervical changes

Answer 1159

-act on pancreas to increase endogenous insulin production

Answer 1160

-both increase the insulin sensitivity of peripheral tissues

Answer 1161

-maintaining a BP of less than 130/80, particularly w/ ACE-I or ARBs

Answer 1162

- usually occurs at the elbow, either in the epicondylar groove or the cubital tunnel - repetitive flexion and extension of the elbow, often secondary to occupational stress, may lead to compression in the cubital canal - typical symptoms include paresthesias in the 4th and 5th fingers as well as the medial forearm in addition to weakness of the intrinsic hand muscles

Answer 1163

Coxsackie virus

Answer 1164

- non-purulent cellulitis - impetigo (nonbullous) - scarlet fever (confluent erythematous rash preceded by strep pharyngitis) - erysipelas (raised, demarcated dermal inflammation/tenderness/warmth)

Answer 1165

- viral infection caused by human herpesvirus 6 | - characterized by 3-5 days of a very high fever followed by a rose-colored maculopapular exanthem

Answer 1166

- cold induced vasospasm typically seen in the fingers, and is more common in pts w/ connective tissue disorders such as scleroderma - tx consists of CCBs such as nifedipine

Answer 1167

- increases risk: breast and cervical (returns to normal within 10 yrs of dc) - decreases risk: endometrial and ovarian

Answer 1168

- should be suspected in pts w/ thrombocytopenia after a recent hx of heparin exposure - despite the low platelet count, most of the complications of HIT occur from thrombosis - therefore, tx w/ alternative anticoagulants is required after stopping all heparin containing therapies - do NOT give platelet transfusions!! may worsen hypercoagulability

Answer 1169

- can lead to an altered mental status, and is sometimes seen in pts w/ squamous cell carcinoma of the lung due to the secretion of parathyroid hormone-related peptide (PTHrP) - pts w/ severe hypercalcemia are typically volume depleted, and as a result, initial therapy should consist primarily of fluid resuscitation w/ isotonic saline

Answer 1170

- common cause of infertility and cyclic pelvic pain in young females - possible findings on exam include pain or nodularity of the rectovaginal septum as well as fixation of the uterus in a retroverted position - diagnosis usually requires laparoscopy, but a pelvic US can sometimes be helpful in localizing a large endometrioma

Answer 1171

-may be used in the tx of ventricular arrhythmias, other than torsades de pointes

Answer 1172

-may be used in tx of SUPRAventricular tachycardia

Answer 1173

-may be used for the tx of heart failure or as a rate control agent in atrial fibrillation

Answer 1174

-CCB used for rate control in SUPRAventricular tachycardias

Answer 1175

-used in tx of ventricular and atrial arrhythmias

Answer 1176

-sudden, painless, transient monocular vision loss that most commonly results from retinal artery emboli originating from a carotid artery atherosclerotic plaque

Answer 1177

- seen in young women as a firm, rubbery mass that moves easily w/ palpation - either FNA or sonogram can establish diagnosis - removal is optional

Answer 1178

- seen in very young adolescents, where they have very rapid growth - removal is needed to avoid deformity and distortion of the breast

Answer 1179

- senn in late 20s - breast mass that grow over many years, becoming very large, replacing and distorting the entire breast, yet no invading or becoming fixed - most are benign, but they have malignant potential - core or incisional biopsy is needed (FNA is NOT sufficient), and removal is MANDATORY

Answer 1180

- seen in 30s and 40s, w/ bilateral tenderness related to menstrual cycles (worse in last 2 weeks) and multiple lumps that seem to come and go (they are cysts) - persistent mass requires aspiration, if clear fluid and mass goes away, that's it; if mass persists, formal biopsy required

Answer 1181

- seen in young women (20s to 40s) w/ BLOODY NIPPLE DISCHARGE - mammogram is needed to identify other potential lesions, but will not show papilloma - galactogram may be diagnostic and guides surgical resection

Answer 1182

- seen only in lactating women | - I&D is needed, but biopsy of the abscess wall should be done also

Answer 1183

- should be suspected in any woman w/ a palpable breast mass - other indicators: ill-defined fixed mass, retraction of overlying skin, "orange peel" skin, recent retraction of nipple, eczematoid lesion of the areola, reddish orange peel skin over mass (INFLAMMATORY breast cancer), and palpable axillary nodes - note that a hx of trauma does NOT rule out cancer!!

Answer 1184

- diagnosed exactly as if pregnancy did not exist and is treated the same way except for: no radiotherapy during ENTIRE pregnancy, and no chemo during the FIRST TRIMESTER - termination of the pregnancy is not necessary

Answer 1185

- standard form of breast cancer - INFLAMMATORY cancer is the only variant w/ much worse prognosis (and the need for pre-op chemo) - other variants (lobular, medullary, mucinous) have slightly better prognosis and are treated the same way as the standard infiltrating ductal - lobular has higher incidence of bilaterality

Answer 1186

- cannot metastasize (thus no axillary sampling is needed), but has very high incidence of recurrence if only local excision is done - total simple mastectomy is recommended for multicentric lesions throughout the breast - lumpectomy followed by radiation is used if the lesion is confined to 1/4 of the breast

Answer 1187

- cefTAZidime (3rd gen) - cefePIME (4th gen) - aminoglycosides (gentamicin, amikacin, streptomycin, tobramycin, etc.) - ticarcillin - aztreonam - carbapenems - ciprofloxacin

Answer 1188

Rinne test results: -Normal hearing will show an air-conduction time that is twice as long as the bone conduction -If a patient has conductive hearing loss, the bone conduction sound is longer than or equal to the air conduction sound. -If a patient has sensorineural hearing loss, air conduction is heard longer than bone conduction, but it is not heard to be twice as long. Weber Test Results: -Normal hearing will indicate sound in both ears. -Conductive loss will indicate the sound travels towards the poor ear. -Sensorineural loss will indicate the sound travels towards the good ear

random Flashcards

(1481 cards)