-
What is the classic presentation of pneumonia (lung exam, fever)? In elderly patients?
Bronchial breath sounds, egophony, increased tactile fremitus, and dullness to percussion. Fever may be absent, and confusion may be the only presenting symptom in elderly patients.
-
Lung findings in pulmonary embolism
Rarely abnormal
-
Which quadrant is the most common site of retinal detachment?
Most retinal detachment begins with a tear in the superior temporal quadrant. Vitreous then passes through the tear and becomes lodged behind the sensory retina. The pull of gravity results in progressive detachment.
-
What is the typical presentation of herpetic gingivostomatitis?
Decreased intake of foods/liquids and a low-grade fever. Small, white ulcers on the oral mucosa, red gingivae, and regional lymphadenopathy.
-
What causes herpangina? How does herpangina present?
Coxsackievirus causes herpangina, which manifests itself as a grayish-white tonsillar and palatal papules that become shallow ulcers. High fevers, malaise, and vomiting are frequently found.
-
What is the best management for exercise-induced asthma?
Cromolyn and nedocromil sodium inhaled medications are mast cell stabilizers that are very effective in the prevention of asthma when there is a known precipitant, such as exercise.
-
What is the most common malignant liver tumor in childhood?
Hepatoblastoma
-
How does hemolytic-uremia syndrome present?
Hemolytic anemia with low platelets, bleeding, proteinuria, and hematuria. No jaundice or splenomegaly.
-
What are the characteristic embolic findings in endocarditis (IV drug user)?
Splinter hemorrhages, petechiae, Janeway lesions, Osler nodes
-
In a patient with clinical features of acute hepatitis, what is the initial screening test for hepatitis C?
Anti-HCV ELISA
-
Chest x-ray associations:
Consolidation
Kerley B lines
Air bronchograms
Visceral pleural lines
- Consolidation: pneumonia
- Kerley B lines: CHF
- Air bronchograms: pneumonia
- Visceral pleural lines: especially on expiration- pneumothorax
-
How does Meniere's disease present?
Hearing loss and episodic vertigo usually accompanied by tinnitus
-
Common presentation of acoustic neuroma
unilateral hearing loss with vertigo
-
Which serum level will be most helpful in diagnosing pancreatitis?
Serum lipase levels increase in parallel with serum amylase levels. The lipase level remains elevated longer and may help to diagnose pancreatitis after an attack has ended.
-
Indications for admission to the hospital for patients with PID
Failure to respond to outpt therapy, inability to tolerate outpatient therapy (e.g., from nausea and vomiting), fever greater than 39 deg C, those with guarding and rebound tenderness in lower quadrants, or patients who look toxic.
-
What are the early symptoms of renal failure? What are the late symptoms?
- Early: anorexia, fatigue, weakness
- Late: Oliguria, dyspnea, chest pain, nausea, vomiting, abdominal pain
-
Major contraindications to curative resection of a lung tumor
Distant mets, except for solitary brain and adrenal mets, MI within past 3 mos, SVC syndrome due to metastatic tumor, b/l endobronchial tumor, contralateral lymph node mets, and malignant pleural effusion
-
Treatment of choice in patients with PE with normal ventricular function and no absolute contraindications
Anticoagulation
-
Presentation of viral croup
barking cough and stridor
-
Which lesions are most commonly seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders?
lentigines
-
Small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. Better felt than seen, having a rough, sandpaper feel and are often tender to palpation. Pre-malignant.
Actinic keratosis
-
Usually occurs as isolated lesion on the face appearing as erythematous, dome-shaped nodule with a central keratinaceous plug. low-grade malignancy
keratoacanthomas
-
Common benign plaque in elderly, velvety or warty surface associated with stuck-on appearance and greasy feel
seborrheic keratosis
-
most common cause of respiratory distress in the premature infant
hyaline membrane disease
-
presentation of hyaline membrane disease in the premature infant: clinically and on cxr
tachypnea, cyanosis, expiratory grunting, on chest x-ray: hypoexpansion and air bronchograms
-
Drug of choice for treatment of bulimia nervosa
Fluoxetine (Prozac)
-
Low output heart failure occurs secondary to...?
ischemic heart disease, hypertension, dilated cardiomyopathy, and valvular and pericardial disease
-
High output heart failure occurs in...?
hyperthyroidism, anemia, pregnancy, arteriovenous fistulas, beriberi, and Paget’s disease
-
Risk factors for retinopathy of prematurity
perinatal oxygen therapy, sepsis, low birthweight, prematurity
-
Which hormone is responsible for producing calcitriol in the kidney?
PTH
-
Most common cause of post-partum hemorrhage
Uterine atony
-
Treatment for traveler's diarrhea
ciprofloxacin
-
How does Peyronie's disease present?
Fibrotic areas under penile skin along with history of penile curvature during erection
-
infant's birthweight at 4-5 mos, and then at 1 year
should double at 4-5 mos, then triple at 1 year
-
Terminal hematuria- where is the source of bleeding?
Bladder neck or prostatic urethral source
-
Hematuria at the beginning of the urinary stream- where is most likely source?
Anterior/penile source
-
total hematuria- source?
bladder or upper urinary tract source (renal pelvis)
-
recommended age range for MMR vaccination?
12-15 mos
-
Ectopia lentis, aortic root dilation, and aortic dissection are major criteria for the diagnosis of what disease?
Marfan's syndrome
-
overweight, adolescent male with pain that is referred to the thigh or medial side of the knee associated with a limp. normal x-rays
slipped capital femoral epiphysis
-
What is the normal respiratory rate in a newborn?
30-60 breaths per minute
-
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of _.
LH
-
High dose oxygen administration to COPD patients precipitate respiratory failure. Why?
They have chronic hypercapnia.
-
persistent profuse, frothy, greenish, foul-smelling vaginal discharge and vulvar pruritis. vaginal pH of 6.5. Is this bacterial vaginosis or trichomoniasis?
trichomonisis- it's frothy and colored d/c; in BV, the d/c is homogenous and grayish-white
-
What will you see on a positive fern test? on a negative fern test? What do these results mean?
- The fern frond pattern indicates an estrogenic effect on the mucus without the influence of progesterone;
- thus, a non-frondlike pattern can be interpreted as showing that ovulation has occurred
-
A 26 yo female G1p0Ab0 appears to be in the 2nd stage of labor. Vaginal exam reveals fetal head at level of maternal ischial spines. What station is the patient in?
0
-
Dark field microscopy is used to test for which disease?
Syphillis
-
Ovulation can be confirmed with mid-luteal phase measurement of _.
Progesterone
-
What is Nagele's rule?
LMP + 7 days - 3 mos = estimated date of delivery/confinement
-
in the treatment of endometriosis, which drug has adverse effects associated with a hypoestrogenic state, particularly loss of bone mineral density? Other side effects include vasomotor symptoms, vaginal dryness, and mood changes.
Leuprolide (Lupron)
-
adverse effect of endometriosis treatment: acne, oily skin, deepening of the voice, weight gain, edema, and adverse plasma lipoprotein changes. Most changes are reversible upon cessation of therapy, but some (such as deepening of the voice) may not be. What medication is this?
Dantrolene (Danazol)
-
deep regular respirations with periods of apnea
Cheyne-Stokes respirations
-
fundal height is at level of umbilicus- what is the gestational age?
20 weeks
-
The USPSTF recommends screening mammography, with or without CBE, every how many years for women aged how old?
every 1-2 years, aged 40 and older
-
spotting during the first and second trimesters; sudden painless, profuse bleeding in the third trimester, initial cramping in 10% of cases
placenta previa
-
What is the drug of choice for reversing magnesium sulfate toxicity in the management of premature labor?
Calcium gluconate
-
Which immunoglobulin crosses the placenta?
igG
-
chronic anovulation, hyperandrogenism, hirsutism, obesity (80%), increased risk of DM, CV disease, metabolic syndrome
PCOS
-
36 yo woman, worsening PMS, premenstrual inability to cope with job, irritability and depression, regular menses, mild cramping, no other symptoms. normal PE. what is first step?
chart sx on calendar and return for f/u
-
What is the most common form on ILP?
Idiopathic pulmonary fibrosis
-
Exertional dyspnea, a nonproductive cough, and inspiratory crackles with or without digital clubbing may be present on physical examination. The HRCT lung scans typically show patchy, predominantly basilar, subpleural reticular opacities, often associated with traction bronchiectasis and honeycombing
IPF
-
What is Chadwick's sign
bluish/purplish discoloration of vagina and cervix in a pregnant patient
-
What is used in the treatment of ovulation disorders in patients who want to become pregnant?
Clomiphene citrate
-
What does a positive progestin challenge test mean?
Infertility is due to anovulation
-
What is used to treat pre-eclampsia during pregnancy?
Magnesium sulfate
-
A patient returns from a hiking trip. Macular rash first appeared on ankles and the rest of the LE. Lesions on soles of feet and the trunk. What is the dx?
Rocky mountain spotted fever
-
Why is there an increased BUN level in massive GI bleed?
when blood is digested, it gives off urea/nitrogen
-
thickening and roughening of the skin resulting from repetitive irritation caused by scratching is called _.
lichenification
-
A classic finding of poorly healing, indolent ulcers on the LE would be found in patients with what disease?
Inflammatory bowel disease
-
A patient presents with a rash, characterized by red macules and edematous papules with a clearing center. What is it?
Erythema multiforme
-
Treatment of choice for Influenza B?
Zanamivir (relenza)
-
What virus has been linked with the development of acute myocarditis?
Coxsackie B virus
-
most tumors present with the following characteristics: painless nodule, shiny and waxy, indurated, firm and immobile, pearly, rolled border, and with fine (small) telangiectatic vessels on the surface. What kind of carcinoma is this?
basal cell carcinoma
-
What is the post-exposure prophylaxis for rabies in the U.S.?
In the United States, postexposure prophylaxis consists of a regimen of one dose of HRIG and five doses of rabies vaccine over a 28-day period. Human rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure, preferably within 24 h. Four formulations of three inactivated rabies vaccines are available in the United States, including human diploid cell vaccine (HDCV) (produced in human diploid cells; Imovax, Pasteur Merieux Connaught), rabies vaccine adsorbed (RVA) (produced in fetal rhesus diploid lung cells; Rabies Vaccine Adsorbed, SmithKline Beecham), and purified chick embryo cell culture vaccine (PCEC) (produced in chick embryo cells; RabAvert, Chiron)
-
In a patient suspected of having seborrheic dermatitis, the most common site involvement would be the _.
scalp
-
What are the 4 pathophysiologic features of acne?
- Hyperkeratinization
- Sebum production
- Bacterial proliferation
- Inflammation
-
Indication for transferring a patient with 2nd and 3rd degree burns to a burn center?
- >10% of BSA
- Burns that involve the face, hands, feet, perineum and major joints
- Electrical, chemical and inhalation injuries
- Circumferential burns of an extremity or chest
- Burns involving trauma
- Patients with a burn and a complicating medical disorder
-
Indication for transfer to burn center for patient with 3rd degree burns?
- > 2% BSA
- Burns that involve the face, hands, feet, perineum and major joints
- Electrical, chemical and inhalation injuries
- Circumferential burns of an extremity or chest
- Burns involving trauma
- Patients with a burn and a complicating medical disorder
-
begins with a 2- to 4-day respiratory prodrome of malaise, cough, coryza, conjunctivitis with lacrimation, nasal discharge, and increasing fever. 1- to 2-mm blue-white spots on a bright red background, typically located on the buccal mucosa- what is this disease and what are these spots?
measles (rubeola), Koplik's spots
-
grows as a mold in association with soil and avian habitats, being enriched by alkaline nitrogenous substrates in guano
H. capsulatum
-
After inhalation, the conidia develop into yeast cells and are engulfed by alveolar macrophages, where they are able to replicate. On radiographic examination, most patients will have hilar lymphadenopathy and pulmonary infiltrates or nodules. Gram stain of sputum reveals many oval, budding cells. What is this?
Histoplasma capsulatum
-
Fine maculopapular rash of 3 days duration; face to trunk to extremities
Rubella (german measles)
-
What presents with a prolonged aPTT and normal platelet count and is treated with Factor VIII or cryoprecipitate?
Hemophilia A
-
What drug is indicated in vW disease, which presents with a prolonged bleeding time?
Desmopressin acetate
-
what is commonly noted in HIV patients and presents with multiple ring-enhancing lesions in the brain?
toxoplasmosis
-
What is the treatment of choice for possible toxoplasmosis, acute infection?
Sulfadiazine and pyrimethamine
-
what is the treatment of choice for prophylaxis of toxoplasmosis?
Trimethoprim-sulfamethoxazole
-
What is Hegar's sign?
softening of the cervix that often occurs with pregnancy
-
McDonald's sign?
when the uterus becomes flexible at the uretocervical junction at 7-8 weeks
-
What is Cullen's sign?
Purplish discoloration periumbilically, noted in pancreatitis
-
What is responsible for breast swelling prior to menses?
Growth of the lobules and alveoli under the influence of progesterone that is secreted from the corpus luteum.
-
What causes proliferation of the mammary ducts?
Estrogen
-
What portion of the spinal column affects pain and temperature sensation?
Lateral spinothalamic tract
-
What portion of the spinal column affects pressures and touch sensations?
Ventral spinothalamic tract
-
Which portion of the spinal column affects proprioception and vibration sense?
Posterior column
-
Patients with what injury will have loss of sensation distal to the area of injury along with paralysis and hyperactive reflexes in the area distal to the lesion?
transection of the spinal cord
-
Risk factors for CAD?
- F.A.C.H.L.O.
- Family history of premature CAD
- Age
- Cigarette smoking (current)
- Hypertension
- Low HDL level (less than 40 for men, 50 for women)
- Obesity
-
What will a peak flow reading help you do?
gauge a patient's current extent of airflow obstruction, monitor effectiveness of any treatment interventions
-
What is the indication for a V/Q scan?
suspected PE
-
Up to 50% of patients with atopic dermatitis develop what condition(s) in the future?
asthma and/or allergic rhinitis
-
Fever, bilateral conjunctivitis, oral mucosal changes, rash, cervical lymphadenopathy, peripheral extremity changes, Elevated erythrocyte sedimentation rate and C-reactive protein levels, a vasculitis characterized by the infiltration of vessel walls with mononuclear cells and later by IgA secreting plasma cells that can result in the destruction of the media and aneurysm formation
Kawasaki's disease
-
illness of fever and four of the following criteria for at least 5 days: bilateral nonexudative conjunctivitis, mucous membrane changes of at least one type (injected pharynx, erythema, swelling and fissuring of the lips, strawberry tongue), peripheral extremity changes of at least one type (edema, desquamation, erythema of the palms and soles, induration of the hands and feet, Beau lines [transverse grooves of the nails]), a polymorphous rash, and cervical lymphadenopathy greater than 1.5 cm
Kawasaki's disease
-
What is the most serious systemic complication of Kawasaki's disease?
coronary artery aneurysms (in 20% of affected children)
-
Treatment of choice for variant/Prinzmetal's angina?
CCB
-
Pharmacologic treatment of gestational diabetes should include what?
Insulin
-
For which hepatitis should ilicit drug users receive the vaccine?
Hepatitis A
-
Which axis IDs clinical disorders and other clinical conditions that may be the focus of clinical attention?
Axis I
-
Which axis IDs any physical disorder or general medical condition that is present in addition to the mental disorder?
Axis III
-
Which axis IDs the psychosocial and environmental problems having a significant contribution to the disorder?
Axis IV
-
Which axis IDs personality disorders and mental retardation?
Axis II
-
What diagnostic test will help you evaluate hearing loss in a 2 month old infant?
Auditory evoked potentials
-
What is the youngest a patient can be to be evaluated with audiometry?
3 years old
-
Tympanometry is used to what?
ID effusion as a cause of hearing loss
-
A chest x-ray of atelectasis would not be normal.
A chest x-ray of atelectasis would not be normal.
-
Which anti-cytokine agent is used in the treatment of RA and has a side effect of reactivation of dormant TB?
Etanercept
-
After chronic adminstration of this drug, osteomalacia develops.
Phenytoin (Dilantin)
-
Where is hairy leukoplakia commonly seen?
lateral tongue
-
What syndrome is due to autonomic degeneration and typically presents with orthostatic hypotension?
Shy-Drager
-
Which drugs are frequently implicated in toxic epidermal necrolysis?
NSAIDs, Abx, anti-convulsants
-
What is the Somogyi effect?
Nocturnal hypoglycemia stimulates counter regulatory hormone release resulting in rebound hyperglycemia
-
Which dermatome is at the level of the umbilicus?
T10
-
Pulmonary fibrosis and pulmonary infiltrates are known side effects of which medication?
Bleomycin (Blenoxane)
-
Cherry-red fovea and boxcar segmentation of the retinal veins are findings seen in _.
central retinal artery occlusion
-
Papilledema is seen with _.
increased ICP
-
A-V nicking is common in _.
chronic hypertension
-
Abdominal cramps, nausea, and vomiting, and watery diarrhea typically last 1-2 days with what kind of food poisoning?
S. aureus
-
What is a probable cause of fetal distress resulting in late decelerations?
Placental insufficiency
-
Therapy of choice in patients with symptomatic bradyarrhythmias in sick sinus syndrome?
permanent pace maker
-
Drug of choice for insomnia in an elderly patient
benzodiazepines
-
what view on plain films is preferred to ID spondylolysis?
oblique
-
Humeral mid-shaft fracture impinges on what nerve, and what PE finding will occur?
radial nerve, inability to extend wrist against resistance
-
proximal humeral fractures and anterior shoulder dislocations commonly entrap what nerve, what PE finding will occur?
axillary nerve- numbness over deltoid muscle
-
what causes winging of the scapula and why?
injury to long thoracic nerve, due to innervation of serratus anterior muscle
-
injury to the subscapular nerve results in weakness and pain of which muscle?
infraspinatus
-
tx of pyelonephritis in a pregnant patient
IV cephalosporins
-
When blood is found at the external urinary meatus prior to insertion of a catheter, what diagnostic test should be performed?
retrograde urethrography
-
what test is indicated for blunt trauma including those resulting in hematuria or when renal injury is suspected?
CT of abd/pel
-
H2 blocker for mild, intermittent sx of GERD
Ranitidine (Zantac)
-
tx of duodenal ulcers
sulcralfate
-
first line for gastroparesis and second-line for refractory GERD
Metoclopramide (Reglan)
-
prevention of NSAID-induced gastritis
Misprostol (Cytotec)
-
Radioactive iodine (131) is most successful in treating hyperthyroidism that results from _.
Graves
-
fixed split s2
atrial septal defect
-
for single vessel CAD
PCI, not CABG
-
Anxiety, decreased cognition, tremulousness, increasing irritability, and hyperactivity are common early clues to what?
delirium tremens
-
Mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances, seizures, CV abnormalities are common signs and sx of what?
delerium tremens
-
What organism is responsible to dental caries?
Strep mutans
-
abnormal uterine bleeding, irregular enlargement of the uterus, pain rarely present unless vascular compromise
leiomyoma
-
has effects on bone turnover and bone mass and has been shown to decrease vertebral fractures. It has anti-estrogen effects on the non-skeletal portions of the body and increases hot flashes in perimenopausal females
Raloxifene (Evista)
-
A positive Wood's light exam demonstrates what?
Microsporum
-
What is the most common cause for acute MI?
thrombus development at site of vascular injury (not microemboli)
-
tx for isolated superficial actinic keratosis?
cryotherapy
-
what diagnostic findings in urinary sediment is specific for a dx of chronic renal failure?
broad waxy casts
-
major risk factors for the development of oral cancer?
smoking and etoh
-
mitral stenosis leads to enlargement of the L atrium, which is the major predisposing factor for the development of what?
a-fib
-
urine content of -pre-renal ARF; intrarenal disease; postrenal disease
dec sodium; WBC casts; RBCs
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