0
Q
Describe the presentation of measles (rubeola)?
A
- Cough
- Coryza (thick runny nose)
- Conjunctivitis
- Koplik spots on buccal mucosa (gray pearl on a red base)
- Morbiliform rash (blotchy)
- Complications:
- Otitis media
- SSPE (Subacute Sclerosing Panencephalitis): total demylenation and scarring of the brain
1
Q
Describe the pathophysiology of rubella (German measles) infection.
A
- Couple days of fever
- Swollen lymph nodes behind ear and neck
- Forscheimer spots (patchy erythema on soft palate)
- Dangerous to fetuses in first trimester
2
Q
Which viral infection is complicated by SSPE (Subacute Sclerosing Panencephalitis)?
A
Rubeola
3
Q
What is the presentation of Roseola?
A
- High fever
2. Rash after fever resolves (trunk -> extremities)
4
Q
What is the most common cause of morbidity and mortality in SLE patients?
A
Renal involvement
5
Q
Initial management of lupus patient with renal abnormalities?
A
Kidney biopsy
- If extensive abnormalities treat with IV Methylprednisolone
6
Q
How do you monitor disease activity in patients with lupus nephritis?
A
- Serum complement or
2. Anti-ds DNA
7
Q
What is the treatment for tuberculosis during pregnancy?
A
- Isoniazid, Rifampin, and Ethambutol for a period of nine months.
Multi drug-resistant tuberculosis
– Isoniazid, Rifampin, Ethambutol, and Pyrazinamide
8
Q
What is the most well-known side effect of ginkgo biloba?
A
Increased risk of bleeding and potentiation of the side effects of anticoagulation therapy through various mechanisms, including the inhibition of platelet activating factor.
9
Q
What is the mechanism of action of alpha-1 blockers such as prazosin?
A
- Treatment of benign prosthetic hypertension
- Beneficial in patients with type two diabetes mellitus because it increase insulin sensitivity
- Decreases LDL cholesterol
- Increases HDL cholesterol
10
Q
What is the treatment of torsade de pointes?
A
In an unstable patient
– Immediate non-synchronized electric defibrillation
If patient is stable
– Magnesium sulfate
11
Q
Describe erysipelas
A
- Group a streptococcus
- A form of cellulitis
- Red, painful, and edematous, and elevated.
- Abrupt onset with the presence of systemic symptoms (fever, chills, malaise)
12
Q
What puts a baby most at risk for intentional head trauma?
A
- Babies who are fussy
- Born to first-time parents
- Parents with no close family support
13
Q
What is a common finding it and majority of infants with shaken baby syndrome?
A
Bilateral retinal hemorrhage (flame shaped)
14
Q
What is the significance of blood seen on ultrasound in Morrison’s pouch?
A
This suggests that greater than 500 cc of free blood is present in the abdomen
15
Q
What is the best testing modality for confirmation of acute aortic dissection?
A
Transesophageal echocardiography
16
Q
What is the initial drug of choice for patients with aortic dissection?
A
Intravenous beta blockers (propranolol or labetalol)
– Goal: Reduce the systolic blood pressure to 100 to 120 mmHg and heart rate to less than 60 bpm
17
Q
Describe Ménière’s disease
A
Classic triad
- Periodic vertigo
- Unilateral hearing loss
- Tinnitus
18
Q
What is the next best step in patients with positive ELISA anti-HCV antibodies?
A
Confirm diagnosis by high-specificity testing (usually HCV RNA)
19
Q
What is the pathophysiology of chronic myeloid leukemia?
A
- Translocation of chromosomes 9 and 22, which produces the Philadelphia chromosome
- The presence of the BCR/ABL fusion protein is diagnostic and results in unregulated tyrosine kinase activity
20
Q
What is the initial treatment of choice for chronic myeloid leukemia?
A
Tyrosine kinase inhibitors such as IMATINIB
21
Q
Before deciding to medically, surgically, or conservatively manage an incidentally detected unilateral adrenal mass what should you do?
A
Evaluation for hormone production should be completed first
22
Q
What antibiotic is used in the treatment of all dog and cat bites?
A
Amoxicillin/clavulanate
23
Q
Describe the evaluation of renal masses
A
Low likelihood of malignancy
– Ultrasound
If solid tumor is discovered on ultrasonography
– CT scan required for staging
24
Describe the presentation of renal cell cancer.
1. Flank pain
2. Palpable mass
3. Non-glomerular hematuria
4. Increase hemoglobin and hematocrit
5. Smoking is a major risk factor
25
What is the initial treatment of Parkinson's disease?
Dopamine agonist, such as pramipexole.
| – Particularly in younger patients due to concerns about the long-term efficacy and side effects of Levodopa
26
What is a Kleihauer-Betke test?
– Measures fetal cells in maternal circulation
| – Indicated when there's a large antepartum bleed in a mother who is Rh negative
27
What is a subchorionic hematoma?
Bleeding in the gestational sack
28
How do you diagnose a subchorionic hematoma?
Ultrasound, which should be reevaluated with a repeat ultrasound one week later.
29
What is the treatment of a subchorionic hematoma?
– There are no known therapeutic interventions for this condition
– Women with this condition are managed expectantly
30
Describe gestational trophoblastic disease
– Aggressive malignant cancer in the uterus
– Only occurs after pregnancy
– Continued vaginal bleeding in a woman with recent history of hydatidiform mole, abortion, or term pregnancy.
31
What is the most troubling known complication of subchorionic hematoma?
Spontaneous abortion
32
Presentation of achalasia
– Difficulty in swallowing both solids and liquids
| – Dysmotility type dysphasia
33
What is the gold standard for diagnosing active tuberculosis?
Sputum cultures (three specimens)
34
How do you diagnose latent tuberculosis infection?
– Tuberculin skin test
| – Interferon gamma release assay (IGRA)
35
What is the marker for infectivity and tuberculosis?
Sputum microscopy for acid-fast bacilli
– Three negative sputum microscopy smears considered noninfectious
– However, patients with negative smears may still have active infection which will require treatment (treat while waiting for sputum culture results)
36
Which antihypertensive medication is commonly associated with photosensitivity reaction as a side effect?
Hydrochlorothiazide
37
Describe meningovascular syphilis
A condition where low-grade infection in the subarachnoid space affects the intracranial vessels and can eventually result in stroke.
– Treat with penicillin
38
What is the initial laboratory evaluation in patients suspected to have lead poisoning?
– CBC
– Serum iron and ferritin
– Reticulocyte count
39
What is progressive multifocal leukoencephalopathy?
An opportunistic infections seen in immunocompromised patients
– Predominately involves the cortical white matter
– Symptoms include: hemiparesis and disturbances in speech, vision and gate.
40
What is the best modality to confirm progressive multifocal leukoencephalopathy?
MRI
| – Findings include: multiple demyelinating, non-enhancing lesions with no mass effect
41
What is the most common long-term complication of a transurethral resection procedure (TURP)?
```
Retrograde ejaculation (dry ejaculate)
– The bladder neck fails to close after the procedure, and enables the sperm to flow backward to the bladder.
```
42
Common side effect of Clozapine?
Agranulocytosis
| – Requires close monitoring of the white blood cell count
43
Common side effect of valproic acid
Hepatotoxicity
| – Patient requires regular monitoring of liver function test
44
Common side effect of Lithum
– Hyperthyroidism
| – Diabetes insipidus
45
What must be checked before initiating lithium therapy?
Thyroid and kidney function
46
What is the protocol for someone who has had percutaneous or mucous membrane exposure to HIV-infected bodily fluids?
4 weeks
Source patient has asymptomatic infection or low viral load
– 2 drug regimen using nucleoside reverse transcriptase inhibitors
Patient with high viral load
– Add a protease inhibitor to the above
47
Systemic Inflammatory Response Syndrome (SIRS) criteria
Temperature: < 36°C or >38°C
Heart rate: >90 per minute
Respiratory rate: > 20 per minutes or PaCO2 < 32 mmHg
WBC: 12,000/mm3, or 10% bands
48
What is the treatment in a patient with a possibly infected Hickman catheter presenting with symptoms of SIRS?
– Catheter removal is indicated, especially in patients who are hemodynamically unstable
Vancomycin:
– As the majority of catheter associated infections are due to coagulase negative Staphylococcus, and the majority of those are methicillin-resistant.
– Cefepime:
– Cephalosporin
– Pt with neutropenia or sepsis should receive gram-negative coverage as well
49
What is the investigational procedure of choice for vertebral osteomyelitis?
MRI
50
Describe McMurray's maneuver
Used to detect presence of meniscal tears
- Pt in supine position with the knee in maximum flexion.
- One hand of the examiner is placed on the posteromedial margin of the involved knee, with the other hand supporting the foot.
- The tibia is then externally rotated, and the knee is extended slowly
- Positive: Audible click or popping sensation during extension
51
Describe patellar tendon rupture
- Excrucuating pain
- Swelling in the anterior part of the knee
- Inability to maintain passive extension of the knee against gravity
52
What is the most common cause of secondary hypertension in young patients?
Reno parenchymal disease
53
What is erythema nodosum?
– An initial manifestation of sarcoidosis
| – Presents as erythematous and tender subcutaneous nodules over the lower legs, usually over the pretibial region
54
What radiographic chest x-ray finding do you expect in patients with sarcoidosis?
Bilateral hilar adenopathy with or without right tracheal lymph node enlargement
55
What is the most common complication of patients admitted to the hospital for acute variceal bleeding?
Bacterial infections
– Urinary tract infection, Spontaneous bacterial peritonitis, Respiratory infection, Aspiration pneumonia, Primary bacteremia
Prophylactic treatment with antibiotics for 7 to 10 days is preferred usually a fluoroquinolone (ofloxacin, norfloxacin, or ciprofloxacin)
56
What is a hepatorenal syndrome?
A common cause of acute renal failure in patients with cirrhosis
– Diagnosis of exclusion: a fluid bolus is needed to confirm that renal failure is not secondary to intravascular volume depletion
57
What is the treatment of choice for hepatorenal syndrome?
A combination of Midodrine and Octreotide along with albumin
| – Only definitive treatment is liver transplant
58
Describe iritis
– Characterized by: pain, redness, variable visual loss, and a constricted and irregular pupil
– Diagnosis confirmed by: visualization of leukocytes in the anterior segment
59
What drug do you use to diagnose superventricular tachycardia's?
Adenosine: by increasing the patient's vagal tone (this can also be achieved with the Valsalva maneuver)
60
What is the relationship between glucocorticoids and calcium?
– Decreases intestinal absorption
– Increases excretion in the urine
(Treatment should include administration of supplemental calcium and vitamin D)
61
What is the relationship between patients treated with corticosteroids and bone density testing?
They should be evaluated with a baseline densitometry, and the test repeated every year as long as therapy continues
62
Describe the standardized mortality ratio (SMR)
SMR = observed number of deaths/expected number of deaths
63
How is neonatal polycythemia diagnosed?
When the peripheral venous hematocrit is higher than 65%
64
What is the presentation of neonatal polycythemia?
```
– Irritability
– Drowsiness
– Poor feeding
– Abdominal distention
– Hypotonia
– Apnea
– Hypoglycemia
– Hyperbilirubinemia
– Cardiac and respiratory compromise
```
65
What is the treatment of neonatal polycythemia?
Adequate hydration and partial exchange transfusion
66
What is the general description of potentially malignant nipple discharge?
– Spontaneous
– Unilateral
– Guaiac positive or grossly bloody
Screen for breast cancer with a mammogram
67
What is Nelson's syndrome?
Pituitary enlargement, hyperpigmentation, and visual field defect following bilateral adrenalectomy for Cushing's disease
68
What is the treatment for Nelson's syndrome?
Surgery &/or local radiation
69
What are some clues for diagnosing mitral stenosis?
– Low pitch, rumbling diastolic murmur
– Prominent pulmonary arteries at the hilum
– Elevation of the left mainstem bronchus
– Left atrial enlargement with a flattening of the left heart border
– Most commonly linked to a remote episode of rheumatic fever
70
How do you manage pregnant patients with Eisenmenger syndrome?
– Recommend an elective termination of pregnancy
| All patients with cyanotic congenital heart disease should be advised the same
71
Describe the typical symptoms of diabetic gastroparesis
```
– Early satiety
– Postprandial fullness
– Constipation
– Sweating during meals
– Labile glucose control
```
72
With diabetic gastroparesis what is the difference in obtaining an upper G.I. endoscopy versus a nuclear gastric emptying study?
Upper gastrointestinal endoscopy or barium swallow
– Used to rule out a mechanical obstruction
Nuclear gastric emptying study
– Used to CONFIRM the diagnosis
73
What is the treatment of diabetic gastroparesis?
Initially, dietary modification
– Smaller, more frequent meals with decreased fat and fiber intake
If dietary changes are insufficient promotility agents maybe used
– Erythromycin or Metoclopramide
74
What medications are used to treat diabetic gastroparesis?
Erythromycin and Metoclopramide
| – Promotility agents
75
What's fungal infection is common in bone marrow transplant recipients?
Invasive aspergillosis
| – Typically involves the respiratory tract, including the lungs and sinuses
76
In patients with PCP pneumonia, when is treatment with corticosteroids recommended?
– Alveolar to arterial gradient of 35 mmHg or more
| – Arterial oxygen tension (PaO2) of 70 mm or less on room air
77
What is acute retroviral syndrome?
Primary HIV infection
– Characterized by: low-grade fever, fatigue, maculopapular rash, headache, lymphadenopathy, pharyngitis, myalgias and arthralgias, gastrointestinal symptoms, night sweats, and oral ulcers or thrush
– Thrombocytopenia and leukopenia may also be noted
78
What is the treatment for symptomatic, severely thrombocytopenic children with ITP?
Corticosteroids and/or intravenous immunoglobulin
79
A previously vaccinated person who is potentially reexposed to rabies should receive what?
Only active immunization with a rabies vaccine
80
A previously unvaccinated individual who is exposed to a potential source of rabies should receive what?
Both active (rabies vaccine) and passive (rabies immunoglobulin) immunization
81
What is the initial test for diagnosis of suspected CAD?
Exercise electrocardiography
82
What is the treatment for Paget disease of the bone?
Calcitonin or Bisphosphonate (reduces bone turnover) therapy
| – May slow the progression of hearing loss, but does not appear to reverse the loss that has already occurred
83
What is the management of patients with symptomatic lower extremity varicose veins?
Initially conservative measures
– Leg elevation
– Weight reduction
– Compression stockings
84
When would you use injection sclerotherapy for a person with varicose veins?
Patients who have failed at least 3 to 6 months of conservative treatment (leg elevation, weight reduction, and compression stockings)
85
How do you obtain sputum samples in children?
Morning gastric aspirate
| – Often used to obtain bacteriologic samples from sputum swallowed during the night
86
What is the treatment for latent tuberculosis?
```
First-line: Isoniazid
– Nine months (children and adults)
Second-line (Isoniazid resistance): Rifampin
– Six months (children)
– Four months (adults)
```
87
What is the protocol for a patient who has had unprotected sexual intercourse with an individual who is HIV-positive?
Two nucleoside reverse transcriptase inhibitors
| – For 4 weeks
88
What is the best diagnostic test for superior vena cava syndrome?
Contrast CT scan of the chest and neck
89
What is the common presentation of superior vena cava syndrome?
– Dyspnea
– Orthopnea
– Neck pain and swelling
– Cervical and upper extremity venous dilation
90
What strategy has been useful in decreasing mortality in ARDS patients?
Mechanical ventilation with low tidal volume
91
Describe capillary hemangiomas
– Benign vascular lesion
– Evident at birth
– May undergo subsequent growth for a period of several months
– Spontaneous regression is usual
92
What is the treatment for capillary hemangiomas?
Observation
– If, small in size, do not affect normal functioning, and do not constitute a significant cosmetic problem
Laser treatment
– Lesions at the site of potential functional impairment and on the face
Corticosteroids
– Used to treat rapidly growing lesions
93
Which issues can an adolescent be treated for, without parental consent?
```
– Pregnancy
– Contraception
– Sexually transmitted diseases
– Substance use
– Emotional illness
```
94
What is the difference in presentation in patients with peritonitis, versus those with renal colic?
Peritonitis
– Tend to lie flat and motionless to limit irritation of the peritoneum
Renal colic
– Tend to writhe in pain
95
What is the best modality to detect possible rupture of the bowel leading to a pneumoperitoneum?
Upright chest x-ray
| This position insures that any air within the peritoneal cavity can be visualized beneath the diaphragm
96
What you use to confirm the diagnosis of acute pancreatitis?
Elevated LFTs including serum lipase (more sensitive and specific than amylase)
97
What is the treatment for mild acute pancreatitis?
Adequate pain control (narcotics) and intravenous fluid resuscitation
98
Describe malignant otitis externa
– Typically seen in elderly patients with diabetes mellitus
– Marked pain (otalgia)
– Purulent drainage or discharge (otorrhea)
– Granulation tissue at the floor of the bone-cartilage junction in the external auditory canal is pathognomonic
– Pseudomonas aeruginosa is the usual causative organism
99
What is the treatment of malignant otitis externa?
Anti-pseudomonal antibiotic therapy
– Fluoroquinolones (ciprofloxacin), antipseudomonal penicillins (piperacillin, ticarcillin) with our without aminoglycosides, and third-generation cephalosporins (Ceftazidime)
– All patients should be treated with IV antibiotics initially then switched to oral, to complete 6 to 8 weeks
STEP 3
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