STEP2 Uworld

polymyalgia rheumatica

geriatric inflammatory disorder of the muscles and joints characterized by pain and morning stiffness in the neck, shoulders, upper arms, and hips and thighs. there is no muscle weakness or point tenderness. there might be weight loss and/or elevated ESR or C-reactive protein

malingering

intentional falsification or exaggeration of illness for a secondary goal such as narcotics, days of work, shelter, etc.

chest tube placement (complicated parapneumonic effusion)

&0 y/o M with 4-day hx of fever, SOB and right-sided pleuritic chest pain has a chest x-ray that reveals R-Lower Lobe infiltrate and a pleural effusion. US examination reveals the pleural effusion is free flowing w/out loculation. Thoracentesis is performed and gram stain shows gram positive cocci in pairs. In addition to antibiotic therapy what is the next most appropriate step?

ceftriaxone

19 y/o F patient cervical swab for NAAT is negative for Chlamydia trachomatis but positive for N.gonorrhoeae. What is the most appropriate next step in management

VSD (ventricular septal defect)

1 mo old is brought for routine well-child visit. they've had no symptoms and are feeding well. PE is unremarkable except for a grade 3/6 holosystolic murmur and systolic thrill that is present at the left sternal border. Chest x-ray reveals an enlarged left heart contour. What is most likely the patient's diagnosis>

cerebral palsy

10 mo old, preemie( born are 32w) hasn't begun to stand. she can pull herself along the floor using her arms but drags her legs. There is mild hypertonia of the UE; b/l LE are hypertonic w/resistance to passive ext. Patellar reflexes are brisk. b/l feet have equinovarus deformities. The Babinski reflex is present b/l. what is your diagnosis?

topical antifungal cream (Candida diaper dermatitis)

18 mo girl has diaper rash that was initially helped with petroleum and zinc oxide but now is worsening. She has no fever or vomiting and continues to eat and sleep normally. She attends day care but non of her classmates have had a rash. Vitals are normal. What is the next best step in management?

F

18 t/o football player has persistent pain following a hard tackle from the front. Immediately afterward he began experiencing abdominal discomfort and nausea. BP: 92/64 mmHg, pulse: 118/min. The abdomen is mildly distended and tender diffusely. Chest and pelvic x-ray are normal. FAST reveals intraperitoneal free fluid. Further evaluation of this patient is most likely to reveal which of the following? A. AA tear B. Bladder rupture C. Diaphragmatic teat D. Duodenal hematoma E. Pancreatic transection F. Splenic laceration

D

19 y/o M comes to ED due to persistent abdominal discomfort. He was previously here 3 days ago after bike accident where he hit the handlebar prior to flipping over and landing on his back. At that visit trauma workup was normal so he was sent home. Now he has persistent upper abdominal pain, nausea and episodes of nonbilious emesis. Temp is 100.6, BP is 100/64. Ecchymosis across upper abdomen. Bedside US reveals large amount of free fluid in the upper abdomen. Which of the following is most likely the cause of the patient's condition? A. diaphragmatic rupture B. hepatic laceration C. splenic rupture D. pancreatic duct injury

duodenum

19 y/o is brought to ED for fever and worsening abdominal and right flank pain. the day prior he received a direct blow to the central upper abdomen during football practice. He is also nauseas. Temp is 102.9, BP:100/64 and pulse is 112/min. Abdomen is diffusely tender with guarding over the epigastrium. X-ray reveals free air in the retroperitoneum. Which retroperitoneal organ is torn/ruptured

C (required to diagnose and distinguish between Chron's and ulcerative colitis)

20 y/o M presents with change bowel habits. 6 months ago, the patient began to have loose, watery stools w/increased frequency. In addition, hes had crampy, intermittent abdominal pain that usually improves. Denies; nausea, vomiting, melena, fever, night sweats or weight loss. PE is unremarkable. Rectal examination reveals scant blood in the stool but no hemorrhoids or fissures. Lab results yield: low Hb, and Elevated C-reactive protein. stool studies are negative for ova and parasite as well as C. difficile. What is the next best step? A. check fecal calprotectin B. check serum tissue transglutaminase C. obtain colonoscopy D. recommend loperamide and a low FODMAP diet

C (common in sickle cell patients)

21 y/o M comes to office with new-onset left hip pain. the pain started 3 weeks ago and was initially only w/weightbearing, but has progressively worsened and is now constant. his last hospitalization was 3mo ago for sickle cell acute pain crisis. he is sexually active with a new female partner. he denies any drug use. his temp is 99F. there is no local tenderness but there is restriction of abduction and internal rotation of the left hip. other joints are normal. hip x-rays and ESR are normal. Which of the following is most likely diagnosis? A. Bacterial infection of the femur B. Gonococcal infection of the synovial fluid C. Osteonecrosis of the proximal femur D. Slippage of the femoral head epiphyseal plate

C

22 y/o M undergoes prolonged surgery to repair left tibial fracture and popliteal artery injury. the next day he has increasing pain in the left leg is given IV fluids and morphine. Within 2 hrs he continues to have pain that worsens with passive ankle movement. and is associated with sensation of "pins and needles" in the limb. there is tense tender swelling in the calf. what is the next step in management? A. obtain doppler us of lower extremity B. obtain x-rays of lower extremity C. return to the operating room for fasciotomy D. elevate the leg and apply ice

A (hereditary hemorrhagic telangiectasis)

23 y/o M comes to ED due to hemoptysis. The patient has had increasing dyspnea for several months. Today, he coughed up approximately 20 mL of blood. he also reports frequent episodes of epistaxis since childhood but no ther medical conditions. PE shows clear lungs, faint continuous bruit on the right infrascapualr region. Labs shows microcytic anemia and normal urinalysis. X-ray reveals several round lung nodules w/well-demarcated, smooth borders and no calcifications. What does this patient have? A. AV malformations B. disseminated tuberculosis C. granulomatosis w/polyangiitis D. pulmonary histoplasmosis E. septic emboli

B

24 y/o Female comes to the office due to a breast lump. Patient has regular menses, is sexually active and recently started oral combined OC pills. The patient is an avid runner and wears a sports bra almost daily. PE shows an ovoid 4cm mass in the superior outer quadrant of the right breast. The mass is form, nontender and mobile. Which of the following is most likely the diagnosis? A. fat necrosis B. fibroadenoma C. fibrocystic changes D. galactocele

Small Bowel Obstruction (SBO)

25 y/o M comes to ED due to abdominal pain, nausea, and vomiting. the symptoms began 2 months ago and were intermittent and localized ot RUQ but now has progressed to diffuse and constant. He has not had a bowel movement in 2 days altho he can pass flatus. PMH: Crohn disease w/ileal involvement. He smokes but does not use any other drugs. Abdomen is distended, tympanic, and tender to palpation w/no rebound tenderness or guarding. What does this patient have?

C

26 y/o F who is currently on levothyroxine becomes pregnant. Her dose has been working for the past couple years and she has no side effetcs. What is the most appropriate recommendation for this patient considering her levothyroxine medication. A. continue current dose throughout pregnancy B. decrease levothyroxine dose now C. increase levothyroxine dose now D. d/c levothyroxine

D

28 y/ F presents after MVA due to drinking. She is found severely hypotensive and with hip and multiple rib fractures along w/blunt abdominal trauma. She underwent emergent laparotomy which revealed liver laceration and extensive hemoperitoneum. Her condition was stabilized with surgical intervention, fluid resuscitation, and blood transfusions. In the early postoperative period soon after extubation, the patient developed numbness in the fingertips and around her lips. She also developed forceful flexion of the wrist with abduction of the thumb while the nurse was measuring her BP. Temp is 99.3, BP is 120/68mmHg, pulse is 80/min, respirations are 12/min, Which of the following is most likely her diagnosis? A. alcohol withdrawl B. fat embolism C. hypercalcemia D. hypocalcemia E. hypermagnesemia F. hypomagnesemia

B

28 y/o comes due to painful breast mass. She has no chronic medical conditions and only takes daily combined OC. on breast examination, ther are skin changes or nipple discharge. the mass is softa, mobile and tender. Brest US shows a single, thin walled, cyst. fine needle aspiration yeilds clear-yellow fluid. However after aspiration the mass is still there. what is the next best step? A. breast MRI B. core needle biopsy C. discontinue OC D. repeat breast exam in 1 yr

orotracheal intubation (cervical cord injury = diaphragmatic paralysis)

29 y/o M sustained a gunshot wound to the neck 30min ago. Blood pressure is 92/50 mmHg and pulse is 40/min. He is awake and alert. The wound is present on the right and left side of the posterior portion of the patient's mid-neck. Neck is swollen and carotid bruit are absent. There is reduced inspiratory effort and poor air movement in the lungs. He is unable to move his extremities. what is the next step in management

Fournier's gangrene

34 y/M has 24hrs of increasing pain in the lower abdomen, scrotum and perineum. He has had no abdominal sx, or recent perianal/scrotal trauma. Temperature is 103.5, BP: 80/60mmHg. PE reveals skin over the lower abdomen, scrotum, and perineum to be tense, tender, erythematous, and swollen w/evidence of crepitus. There is mild bilateral, lower extremity edema present. blood cultures are obtained and IV fluids and antibiotics are initiated. Based on presentation the attending decides to perform emergent surgery. What is most likely this patients diagnosis?

D

36 y/o M comes in due to neck pain and upper back pain after lifting weights. He describes it as dull and intermittent sharp pain that radiates to left hand with neck movements. He also admits tingling in his left hand but denies weakness. PE shows cervical paraspinal muscle spasm and mildly decreased pinprick sensation in the left 4th and 5th digit. All other neurological PE is unremarkable. what is the best next step for this patient? A. cervical spine x-ray B. epidural corticosteroid inj. C. MRI of the C-spine D. Provocative activity avoidance and NSAIDs

C (entamoeba histolytica)

36 y/o M comes to the ED due to week of progressive RUQ pain, malaise, anorexia and fever. 3 months ago he retuned from a vacation in Nepal where he hiked mountains. During his trip, the patient had several self-resolving episodes of diarrhea. Temp: 101.3F, blood pressure is 120/70 mmHg, and pulse is 96/min. Breath sounds are decreased in the right lung base. The liver is palpable 3cm below the right costal margin w/ a tender, smooth edge. There is no splenomegaly. Lab results reveal elevated neutrophils, and alkaline phosphatase. Abdominal US reveals a small, solitary hypoechoic lesion on the right lobe of the liver. which of the following is most like the cause of the patient's condition? A. hepatotropic viral infection B. polymicrobial liver infection C. protozoal infestation D. tapeworm infestation

nonalcoholic fatty liver disease (NAFLD)

37 y/o old primigravida at 14 weeks has T2DM and HTN. Patients lab results reveal elevated Alk phos, AST and ALT levels. RUQ US reveals a hyperechoic-appearing liver, several gallstones w/o gallbladder wall thickening, and a normal appearing common bile duct. What is most likley the cause of her abnormal liver studies

A

38 yr old M present with fever and mailaise for past 2 days. He complains of fatigue and lethargy. PMH: alcoholic cirrhosis which was treated with orthotopic liver transplant 10w ago. currently taking tacrolimus, MP-mofetil, and low dose prednisone. Temp 100.6F. Scleral icterus is present. Total bilirubin, Alk Phos, ALT and AST are very elevated. A liver biopsy shows inflammatory infiltration of the portal tracts w/ eosinophils, lymphocytes, and neutrophils. Interlobular bile duct destruction and prominent endotheliitis. What is the nest best step? a. administer high-dose corticosteroid b. discontinue immunosuppressant cocktail c. administer ursodeoxycholic acid d. start metronidazole

Primary sclerosing cholangitis, colonoscopy

42 y/o M is here to discuss abnormal blood work. patient currently feels well and reports no symptoms. Pertinent Liver function studies are as follow: Alk Phos: 521 U/L GGT 390 U/L ( ALT,AST, albumin and total bilirubin are normal) RUQ ultrasound is normal. The patient undergoes MRCP, which reveals luminal irregularities w/mild focal dilations w/in both the intrahepatic and extrahepatic biliary ducts. What is your diagnosis and what additional test should be obtained?

B

43 y/o M is brough to the emergency department after a fall while skiing. he feels severe pain in his left hip and on physical exam his hip flexed, adducted, internally rotated, and the left lower extremity appears shortened. x-ray is given. what is the next most appropriate step? A. admit for pain control and orthopedic consultation in the AM B. closed reduction in the ED C. discharge home with crutches and orthopedic follow-up D. place a pelvic binder on the patient

Emergency laparotomy

44 y/o F presents w/worsening abdominal pain two weeks after a laparoscopic hysterectomy. She was fine until 2 days ago when she began experiencing increased nausea and abdominal cramps after meals. her last bowel movement was 3 days ago and she has not passed flatus today. the abdomen is distended and tympanic on percussion. There is abdominal tenderness but no rebound or guarding. There is a tender, palpable mass under the right-sided incision. Abdominal x-ray reveals multiple air-fluid levels w/in the Small bowel and no air in the rectum. An NG tube is placed. In this patient what is the next best step?

C

44 y/o M is brought to the ED due to epigastric and RUQ pain. Two years ago he was started on total parenteral nutrition after extensive small bowel resection. Vital signs unremarkable. US reveals several gallstones which were not there 2 yrs ago. Which of the following most likely caused development of the gallstones? A. Gallbladder stasis B. Hypertriglyceridemia C. Increased enterohepatic recycling of bile acids D. Increased RBC destruction

B (diagnostic of small intestinal bacterial overgrowth)

45 y/o M visits due to 4-month history of abdominal bloating and 4 or 5 watery stools daily. the patient has had no recent travel exposure to patients w/diarrhea or changes in diet, PMH : surgical resection of cecum and terminal ileum 5 yrs ago due to abdominal GSW. Exm shows well-heald surgical scar and no tenderness or masses of abdomen but there is slight distension. What is the most appropriate next step in diagnosing this patient? A. capsule endoscopy B. carbohydrate breath testing C. fecal elastase D. upper endoscopy w/duodenal biopsy

C ( ZE syndrome)

45 y/o comes w/ recurrent, burning epigastric pain, diarrhea, and unintended weight loss. There is midepigastric tenderness to deep palpation. Test of the stool for occult blood is positive, and stool fat is also positive. GI endoscopy reveals duodenal ulcers and jejunal ulcer. Which of the following is the best explanation for this patient's impaired fat absorption. A. bacterial overgrowth B. pancreatic enzyme deficiency C. pancreatic enzyme inactivation D. reduced bile acid absorption

bed bugs

5 y/o girl with multiple prurtic lesions over her neck and arm for two weeks. the lesions are small erythematous papules that are arranged in a liner pattern. several with central hemorrhagic punctum

D (OA of hand)

51 y/o F presents with pain and stiffness in her hands that gets worse with extensive use of hand tools or opening jars. on PE there enlargement at the DIP and PIPs. What is the most appropriate therapy? A. Methotrexate B. Prednisone C. Topical diclofenac E. Tramadol

Pheochromocytoma

51 y/o F with hypertension despite being treated with lisinopril, HCTZ and amlodipine presents for follow up. She has been keeping a BP log which shows highly variable BP readings. She also reports "hot flashes and anxiety" since her menopause at age 50 for which she started paroxetine which doesnt seem to be helping. She denies all other ROS and PR is benign. BMP and TSH levels are also normal. What is the cause of her symptoms and high BP.

C (because of positive lateral margins)

52 y/o F comes for 1w follow-up after right breast partial mastectomy and right axillary sentinel lymph node biopsy for invasive ductal carcinoma. surgical pathology reveals completely excised IDC; DC in situ is present at the specimen's lateral margin. the tumor is ER-,PR-,HER2-. the sentinel lymph node is negative for metastases. Which of the following is the best next step in management of this patient's breast cancer? A. aromatase inhibitor therapy B. observation and repeat mammography in 6 months C. reexcision of the lateral margin D. right modified radical mestectomy

E

54 y/o M has progressive fatigue and frequent steatorrhea. the patient has lost 20lbs in the past 6months. he was hospitalized multiple times for for epigastric pain radiating to the back w/nausea and vomiting. pain will last 15-30min after meals. the patient has PMH of chronic alcoholic use but quit several years ago. Bowel sounds are normal, there is epigastric tenderness on deep palpation. which of the following is most likely to improve his symptoms? A. gluten free diet. B. H.pylori eradication C. mesenteric angioplasty D. restriction of dairy products E. pancreatic enzyme supplementation

E

55 y/o M comes in for 6 month follow-up of total thyroidectomy followed by radioactive iodine treatment for papillary thyroid CA. since then he has been taking levothyroxine and has had no issues. no other PMH. Vitals and PE unremarkable. Labs show significantly elevated serum thyroglobulin concentration compared to 6months ago. which of the following best explains the patient's labs? A. adverse effect of radioactive iodine therapy B. Ab formation against tumor neoantigens C. enhanced negative feedback to the pituitary D. excessive thyroid hormone replacement E. recurrence of the thyroid malignancy

A

55 y/o M comes to the office due to progressive abdominal distension for the past 2 months. The abdomen is grossly enlarged and nontender. Shifting dullness is present. Trace pitting edema is found in B/L lower extremities. Paracentesis reveals bloody ascites fluid. Repeat paracentesis from another site yields similar bloody fluid. What is most likely this mans diagnosis? A. Hepatocellular carcinoma B. Nephrotic syndrome C. Portal vein thrombosis D. Spontaneous bacterial peritonitis

Dupuytren's contracture

55 y/o M diabetic, gardener presents with hard lump on the palm of high right hand that has been present for several months. It is painless and does not affect hand function. On examination, a hard, fibrous, nodular band is present at the base of the ring finger. The patient is experiencing a progressive fibrosis of the palmar fascia due to fibroblast proliferation and disordered collagen deposits. what is the most likely diagnosis?

A

56 y/o M is being evaluated fo fever post-ip day 3. the patient is on mechanical ventilation. Examination is positive for RUQ tenderness to palpation and decreased bowel sounds. Labs reveal leukocytosis. Chest x-ray is unremarkable. Which of the following is most likely his diagnosis? A. acalculous cholecystitis B. acute cholangitis C. acute pancreatitis D. Right lower lobe pneumonia E. Right-sided pyelonephritis F. subphrenic abscess

Methemoglobinemia ( benzocaine oxidizes iron on Hb)

56 yr. old man comes for elective upper GI endoscopy to evaluate esophageal varices after diagnosis of chronic hepatitis C induced cirrhosis. The patient has remote history of injection drug use but does not us tobacco or alcohol. VS are normal. Benzocaine throat spray along with midazolam and fentanyl for sedation. During the procedure the patient's O2 saturation by pulse ox decreases to 85% and there is a bluish discoloration of the lips and fingertips. Lungs are clear and heart sounds are normal. Lab results yield; Low Hematocrit levels, PaO2 level that is way above normal on room air and oxygen saturation is 99%. What has this patient most likely acquired?

emphysematous cholecystitis

58 y/o F presents w/RUQ pain, nausea, vomiting and fever since yesterday. PMH = HTN, stable coronary disease and DMII. Abdominal imaging demonstrates a distended gallbladder w/gas in the gallbladder wall and lumen. There is no gas in the biliary tree. What is most likely diagnosis in this patient?

patellar tendon

62 y/o Female presents with right knee swelling after falling on her knee when going up the stairs. On exam there is right knee effusion and the patient cannot keep her leg straight while flexing at the hip. passive range of motion at the knee is intact. X-ray is given. What tendon most likely ruptured?

E ( peritoneal dialysis-related peritonitis)

65 y/o F is brought to the ED due to abdominal pain and nause for a day. PMH: ESRD due to diabetes. She undergoes home peritoneal dialysis. Temp: 100.9F, BP 150/84mmHg, pulse 108/min and regular. Cardiac and Pulm exam normal. Abdominal exam shows diffuse tenderness. Blood leukocyte count is elevated. What is the bets next step in management of this patient? A. CT scan of the abdomen B. MR angiography C. multiple sets of blood cultures D. urine culture E. gram stain and culture of peritoneal fluid

Glucocorticoids (this is first line treatment for GCA)

65 y/o F presents with weakness of lower extremities 6 months after being diagnosed and treated for giant cell arteritis. There is no pain or tenderness. ESR and creatinine kinase levels or normal. What is most likely the cause of this patients myopathy?

C ( dx: colovesical fistula due to diverticulitis)

65 y/o M comes to office dur of 2 weeks of dysuria and turbid urine. the patient has also noticed air bubbles while urinating. PMH includes BPH and acute diverticulitis, both treated. The abdomen is soft and mildly tender. Urinalysis is positive for numerous WBCs. Urine culture grows E.coli, Proteus mirabilis, and Klebsiella pneumoniae. What is the most appropriate next step in diagnosis? A. Bladder ultrasound B. CT scan w/rectal contrast C. Cystoscopy D. Prostate biopsy

Diverticulitis

66y/o M come to Ed w/worsening abdominal pain. over the past week he's had vague left lower abdominal discomfort, nausea, anorexia and constipation. the pain initially improved but then gradually intensified to involve the entire abdomen accompanied by light-headedness and vomiting. Temp is 100.9 F, pulse: 108/min. Bowel sounds are diminished. the abdomen is diffusely tender w/guarding and rebound tenderness. Abdominal imaging reveals free air in the peritoneal cavity. what does the patient most likely have?

(atraumatic) splenic rupture

74 y/o F is brought to the ED after acute onset of abdominal pain followed by syncope during her exercise class. She has nausea, dizziness and diffuse abdominal pain. There was no trauma. PMH: chronic lymphocytic leukemia, recurrent infections, A-fib, diverticulosis, and HTN. Meds include apixaban, metoprolol, and amlodipine and she has been taking them as prescribed. On examination she is lethargic and pale. Temp is 99.1, BP =80/54, pulse =120/min. Labs yield Low Hb and platelet levels, leukocytosis and normal coagulation studies. CT scan shows free intraperitoneal fluid. What is your diagnosis?

D (Seborrheic keratosis)

83 y/o women is concerned about a skin lesion that has started to get bigger slowly. she reports no itching or pain at the lesion. skin exam is given. which of the following is the most appropriate next step in diagnosis of the patient? A. excisional biopsy with narrow margin B. incisional biopsy C. shave biopsy D. no additional testing is needed

abdominal aortic aneurysm rupture

84 y/o M with chronic cigarette smoking presents with severe left sided flank pain and nausea over the last hour. The patient is hypotensive, appear anxious, pale and diaphoretic. There is diffuse abdominal tenderness to deep palpation and L-CVA tenderness. Bowel sounds are present and there is no ridgity or gaurding. peripheral pulses are decreased. what is your diagnosis?

Pilonidal disease

Acute abscess in the sacrococcygeal area, ruptures spontaneously leaving unhealed sinus tract w/chronic damage. Leisons are secondarily invaded by hair.

B (gallstone ileus)

An 82 y/o women has severe abdominal pain and vomiting. She has been feeling unwell with nausea and decreased appetite for the past 5 days. PMH includes DM, HTN, mitral valve prolapse, OA, gallstones and constipation. Her abdomen is soft but distended w/ hyperactive bowel sounds. Lab workup is significant for leukocyte count 11,000 and mild elevation of liver transaminases. Abdominal x-ray shows dilated loops of bowel and air in the intrahepatic bile ducts. What is most likely the cause of the patients symptoms? A. Emphysematous cholecystitis B. Mechanical bowel obstruction C. Pancreatic cancer D. Peptic ulcer perforation E. Diverticulitis

Doxycycline

Asymptomatic patient cervical swab for NAAT is positive for Chlamydia trachomatis but negative for N.gonorrhoeae. What is the most appropriate next step in management

Bacterial endophthalmitis

Deeper bacterial infection of the eye that involves the vitreous and/or aqueous humors. Usually results from bacterial inoculation after trauma/surgery

A

Due to hypercatabolic state, what is the optimal form of nutrition, when feasible, for a patient that is in the ICU? A. Enteral nutrition via feeding tube B. intermittent administration of 50% dextrose C. IV infusion of 5% dextrose in normal saline D. Total parenteral nutrition via central venous catheter

Esophagogram (barium swallow)

Patient acquires esophageal perforation after undergoing a upper GI endoscopy. what is the best initial study to confirm esophageal perforation?

B

Patient develops a febrile illness with lymphadenopathy and leukopenia while taking immunosuppressives following a solid organ transplantation. Lab results = low Hb, platelet count, and elevated LDH plus a positive EBV PCR test. Which of the following is most likely the occurring in this patient A. graft v. host disease B. pneumocystis jiroveci pneumonia C. proliferation of immortal B cells D. transplant rejection

CT scan without contrast

Patient fell headfirst down a flight of stairs while intoxicated and due to his altered mental status and intoxication he is at high risk of cervical spinal(CS) injury. what is the preferred screening test to evaluate for CS injury

Piperacillin/Tazobactam

Patient has acute calculous cholecystitis, an inflammatory condition of the gallbladder that can occur when a gallstone obstructs the cystic duct. this causes bile stasis w/in the proximal biliary tree which increase the risk for secondary bacterial infection. Therefore, what is a common first line agent antibiotic for patients with this condition?

Cyanide

Patient is given IV furosemide and nitroprusside infusion for improvement of CHF exacerbation and HTN. Two days later the patient is confused and has generalized tonic clonic sz. BP is 160/75, pulse 110/min and respirations are 29/min. Lungs are CTA. BMP just prior to sx shows a new metabolic acidosis. What is most likely the cause of this patients new neurologic findings?

hepatocellular carcinoma (HCC)

Patient presentation is indicative of metastatic cancer of the spine along with elevated alpha fetoprotein serum levels. Elevated AFP should raise strong suspicion primary testicular cancer such as yolk sac tumor or liver cancer such as?

A

Patient presents with ascites due to portal hypertension from cirrhosis and heavy alcohol use. diagnostic paracentesis reveals straw-yellow fluid. which of the following fluid analysis test should be performed? A. cell count and differential B. cytology C. bilirubin D. fluid pH E. lactate dehydrogenase

give the vaccine

Patient recent studies showed a positive HIV test. He has no current symptoms and other lab work reveals CD4 count of 500/mm and AB testing shows immunity against Hep A, Hep B, MMR but VZV IgG is negative. They do not recall getting VZV vaccine in childhood and admit to being born outside the US. What is the most appropriate recommendation regarding the live varicella vaccine for this patient?

CT scan (in order to stage the cancer)

Patient undergoes gastroduodenoscopy after 4 weeks of postprandial epigastric pain. Four biopsies from the margins f the ulcers are positive for adenocarcinoma. What is the next appropriate step in management?

E ( post-ERCP pancreatitis)

Patient was recently diagnosed with functional biliary sphincter of Oddi dysfunction via ERCP 24 hrs ago. She no has severe epigastric pain that radiates to her back especially after eating, fever, nausea, and vomiting. She doe snot drink alcohol or has any other chronic medical issues. What is the next most appropriate test? A. CT scan of abdomen B. HIDA C. MRCP D. RUQ Ultrasound E. Serum Lipase

C

Patient who recently had a urinary tract infection now has several days of unilateral flank pain, weight loss, fever, and leukocytosis, with no UTI symptoms or bacteria. this presentation is most concerning for? A. acute interstitial nephritis B. papillary necrosis C. renal abscess D. renal cell carcinoma E. renal tuberculosis

C

Patient with clinical presentation of acute cholangitis with abdominal imaging also revealing a cyst in the common bile duct with dilation of the intrahepatic ducts should be managed with which of the following? A. cholecystectomy B. cystenterostomy C. endoscopic sphincterotomy and drainage D. percutaneous drainage of the cyst

Refeeding syndrome

Patient with malignant gastric outlet obstruction and 2 month history of cachexia and unintended weight loss undergoes laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction. postoperatively, he tolerates tube feeding but experiences worsening weakness. the patient also has frequent episodes of non-sustained ventricular tachycardia. Lab results: hypophosphatemia and hypokalemia. What is most likely the cause of this patient's worsening condition?

pulmonary edema

Patient with preeclampsia 3 hrs after being in the hospital develops dyspnea, hypoxia and bibasilar crackles on physical exam along with 3+ pitting edema of the lower extremities. What life threatening complication has most likely developed?

ERCP

Patient's presentation of recurrent RUQ abdominal pain and nausea post-cholecystectomy has an abdominal US that reveals mild dilation of the common bile duct. The pancreas appears normal. What is the best next step?

kidneys

Patients with chronic hypoventilation due to COPD, obesity hypoventilation syndrome, or NM causes result in chronic respiratory acidosis which then becomes a chronic secondary metabolic alkalosis due to compensation by _____________.

Class IC (flecainide, propafenone, moricizine: Na+ channel inhibition)

Pt is dx w/ paroxysmal A-fib and is initiated on meds. During a treadmill exercise test the patients heart rate increases from 75/min to 165/min and QRS complex duration increases dramatically. Which class of antiarrhythmics is patient likely on?

Alzheimer's disease

Rivastigmine is effective in patients with what diagnosis?

Abdominal Compartment Syndrome (ACS)

Sustained IAP of >20 mmHg with or without an APP of 60 mmHg Associated with new organ dysfunction or failure

Angiodysplasia

Tortuous dilation of vessels-> bleeding. Most often found in cecum, terminal ileum, and ascending colon. More common in older patients. Confirmed by angiography.

otosclerosis

condition which causes fixation of the stapes, which results in conductive hearing loss. It often presents in young women and may progress during pregnancy

Erythema nodosum

delayed hypersensitivity reaction with common triggers such as infection , IBD, sarcoidosis, penicillin, sulfonamides and oral contraceptives

losartan

What anti-hypertensive medication is first line therapy for a patient recently diagnosed with HTN but with PMH of gout

splenic flexure

What is the most commonly involved segment of the colon in a patient who has ischemic colitis?

A

Which of the following is associated with the worst/worsening prognosis for a patient with acute pancreatitis? A. elevated BUN B. high BMI C. alevated Lipase D. low Hematocrit level

A

Which of the following opportunistic infections is most common following a renal transplant and is typically associated with colitis? A. CMV B. EBV C. HSV D. Pseudomonas aeruginosa

Acute Interstitial Nephritis (AIN)

acute renal failure, fever, maculopapular rash, new drug exposure (e.g. sulfonamide), and WBC casts on urinalysis is the typical clinical presentation of?

Icythyosis Vulgaris, topical alpha hydroxy acid (keratolytics)

chronic, inherited disorder tha is caused by mutations of the FLG gene and leads to epidermal hyperplasia and defective keratinocytes desquamation. skin is rough and dry and worsens in winter. what is the condition and treatment?

ace, arbs, beta blockers, aldosterone inhibitors, sglt-2 inhibitors

name the 5 medications that have shown to improve long-term mortality in patients with HFrEF

F

patient has developed pneumonia and has signs of septic shock, including fever, tachycardia, hypotension, and poor urine output. after securing an airway and giving antibiotics, which of the following is the next most appropriate step in management of this patient? A. red blood cell transfusion B. IV sodium bicarb C. IV hydrocortisone D. IV dopamine E. IV albumin infusion F. IV lactated Ringer

0.9% saline (NS)

patient presents with severe hydration and symptomatic hypovolemic hypernatremia secondary to gastroenteritis. which type of fluid should be inititated as a bolus in initial resuscitation treatment for this patient

Guillain-Barre

patient recently diagnosed with acute HIV infection now has progressive lower extremity weakness w/absent deep tendon reflexes is consistent with what auto-immune demyelinating disease?

osteonecrosis

patient with progressive hip pain that localizes to the groin area and is aggravated with forced abduction and internal rotation of the femur. PMH is positive for long term glucocorticoid use. what is most likely the cause of his hip pain?

cardiac tamponade

patients presets with hypotension, reduced urine ouput and cool extremities in ICU postoperative day 1 from CABG surgery. Pulm cath readings are as follows: RA: Elevated, RV: Elevated, PCWP: Elevated. Indication elevated and equilibrated intracardiac diastolic pressures. What is your diagnosis?

Epidermolysis bullosa simplex

•A genetic disorder caused by mutations in keratin genes (skin blisters develop due to skin cell disruption after minor trauma).

HELLP (hemolysis, elevated liver enzymes, low platelets)

pregnant patient with hypertension RUQ, has a syndrome that is due to distension of the liver capsule. What is this syndrome called?

ALS

riluzole is used to treat what motor neurodegenerative disorder?

Aortic Stenosis (AS)

risk of bleeding from Angiodysplasia is increased with end stage renal disease and _________ __________ which is thought to trigger bleeding from angiodysplasia due to destruction of circulating von Willebrand factor multimers.

suprascapular nerve entrapment

shoulder pain, weakness of shoulder abduction and external rotation but passive range motion is preserved is most likely due to?

E.coli

those age >35 most commonly develop acute epididymitis from bacteriuria related to bladder outlet obstruction. what is the most common bacteria?

acute pancreatitis

valproic acid is commonly associated with what abdominal organ complication.

atelectasis

what is one of the most common postoperative pulmonary complications especially after abdominal/thoracoabdominal surgery due to pain and changed in lung compliance which causes impaired cough and shallow breathing.

Mycoplasma pneumoniae

what is the most common bacterial cause of community-acquired pneumonia in school-aged children?

urine albumin-to-creatinine ratio (UACR >30 mg/g suggests DN)

what is the most sensitive test for screening diabetic nephropathy?

cystoscopy

what is the recommended diagnostics for a patient in the absence of evidence of glomerular disease or infection with gross and microscopic hematuria an associated risk factors for bladder cancer?