FM EOR

How does asthma present clinically

dyspnea, wheezing, cough, prolonged expiration

How does fulminant hepatitis present clinically

encephalopathy (vomiting, coma, AMS, seizures, asterixis, increased ammonia, hyperreflexia, cerebral edema, increased ICP, coagulopathy, hepatomegaly, jaundice

How is hepatitis E transmitted

fEco-oral route (waterborne outbreaks)

What clotting factor deficiency is associated with hemophilia A

factor 8

What clotting factor deficiency is associated with hemophilia B

factor 9

How does cirrhosis present clinically

fatigue, weakness, wt loss, muscle cramps, Hepatic Encephalopathy (confusion lethargy), Esophageal varices, Spontaneous bacterial peritonitis

How do you manage a fistula

fistulotomy

How does acute sinusitis present clinically

headache radiating to upper teeth fever, facial pain, purulent rhinorrhea

How do you prevent acute hepatitis B

hep b vaccine given at 0, 1, 6 months

How does invasive diarrhea present clinically

high fever, blood, fecal leukocytes, not voluminous, mucus

How does meniscus tear present clinically

joint line pain, effusion, locking after twist injury + feeling of knee giving away + pain walking up or down stairs + pain with squatting

What is the recommended modality to evaluate for microcalcification and spiculated breast masses

mammogram

How do you manage C. diff

metronidazole 1st line, Vancomycin PO 2nd line (1st line if severe)

How do you manage an aorta 3-4 cm

monitor by ultrasound annually

How do you manage an aorta 4-4.5 cm

monitor by ultrasound every 6 months

How does gastritis present clinically

most asymptomatic, if symptomatic there will be epigastric pain, possible signs of upper GI bleed (hematemesis, melena), N/V

How do you manage an aorta <3cm

no testing needed

How does Crigler-Najjar Syndrome Type II present clinically

often asymptomatic

How does Gilbert's syndrome present clinically

often asymptomatic but can have episodes of jaundice during periods of stress, fasting, alcohol intake or illness

How does prepatellar bursitis present clinically

pain with direct pressure on the knee (kneeling), swelling over the patella

How does osteoarthritis present clinically

pain worse with activities, swelling, stiffness, sticking, grinding palpable crepitus

How do you manage stage 4 non-small cell bronchogenic carcinoma

palliative

How do you manage Crigler-Najjar syndrome type I

phototherapy is mainstay, plasmapheresis in acute crisis, liver transplant for definitive

Patient is a 19-year-old male transported to the ED following a car crash. Upon arrival, he is alert and anxious and appears to be in respiratory distress. A quick assessment reveals that he sustained trauma to his face, neck, and chest. His left hemithorax appears to be expanding more than the right. He is receiving oxygen via nonrebreathing mask. His vital signs are: respiratory rate 36 and labored. SpO2 is 85%. On physical exam, you notice decreased tactile fremitus, deviated trachea, hyperresonance, and diminished breath sounds. What does this patient likely have

pneumothorax

How does ACL tear present clinically

pop and swelling, instability, giving out, hemarthrosis after a quick plant and twist injury

How does encephalitis present clinically

profound lethargy, abnormal cerebral functions, seizures

What is primary dysmenorrhea associated with

prostaglandins

How do you manage an aorta >4.5 cm

refer to vascular surgeon

How does TTP present clinically

remember FAT RN: Fever, Anemia, Thrombocytopenia, Renal failure, Neurological symptoms

How do you manage hepatitis E

self-limiting

How do you manage Hepatitis A

self-limiting within weeks, post exposure prophylaxis for close contacts with HAV immune globulin

How does adhesive capsulitis present clinically

shoulder pain and stiffness that comes in cycles with decreased passive range of motion

How does rotator cuff tendinopathy/tear present clinically

shoulder pain with overhead activity, at night lying on arm or weakness and immobility after acute injury, passive motion > active range of motion

How do you diagnosis autoimmune hemolytic anemia

+ Direct coombs test, retic count >2, elevated LDH, low hemoglobin, increased indirect bilirubin

How does pneumonia present on physical exam

+ egophony, increased tactile fremitus, dullness to percussion

How do you diagnose Hereditary spherocytosis

+ osmotic fragility test

How do you diagnose sickle cell disease

+HgbS on hemoglobin electrophoresis, Howell jolly bodies

How do you diagnosis testicular carcinoma

+bHCG, + alpha fetoprotein, scrotal ultrasound

How do you manage acute hepatitis B

supportive

How does patellar tendinitis present clinically

swelling over the tendon and tenderness at the inferior border of the patella

What dose epinephrine should be used in acute anaphylaxis

0.2-0.5 mg of 1:1000 IM every 5-15 minutes

What is the folic acid supplementation for women prior to conception

0.4-08 mg and 4 mg for secondary prevention

What is the lifetime incidence for breast carcinoma development in women

1 in 8

What are the indications for percutaneous transluminal coronary angioplasty

1 or 2 vessel disease not involving the left main coronary artery in whom ventricular function is normal

When does ITP often present

1-2 weeks after a viral infection

How does Bell palsy present clinically

unilateral facial paralysis, ipsilateral hyerpacusis (ear pain), taste disturbance (anterior 2/3)

What factors compromise the common pathway

10 and 5

How long does the copper IUD last

10 years

How do you manage cluster headaches

100% (6-10 L), can use SQ sumatriptan or Ergotamines

How does bullous pemphigoid present clinically

urticarial plaques that progress to tense bullae

What is normal serum sodium

135-145

What factors are deficient in von Willebrand deficiency

vWF and factor 8

What is the daily maintenance fluid requirement for adults

1500-2500 mL

What are the 5 levels of Clark classification system of microstaging melanoma

1: confined to epidermis (in situ), 2: invasion into the papillary dermis, 3: penetration to the papillary-reticular interface, 4: invasion into the reticular dermis, 5: penetration into subcutaneous fat

Define Naegele's rule

1st day of LMP + 7 days - 3 months + 1 year

What are risk factors for breast cancer

1st degree relative with breast cancer history, obesity/alcohol use, >65, late >17 or early <12 menarche, early menopause, increased estrogen exposure, BRCA1 and BRCA2

How do you treat impetigo if extensive disease or systemic sx (fever)

1st gen cephalosporin (Keflex)

How do you treat acute exacerbations of chronic bronchitis in which bacterial causes are more likely

1st line empiric: 2nd generation cephalosporin, 2nd line: 2nd generation macrolide or Bactrim

How do you diagnose endocarditis

2 major criteria or 1 major and 3 minor or 5 minor

Due to isotretinoin teratogenicity how often must women receive pregnancy test with therapy

2 serum pregnancy test prior to starting and monthly thereafter

What is a normal bleeding time range

2-8 minutes

How does noninvasive diarrhea present clinically

vomiting, watery, voluminous, no fecal WBCs or blood

At what bilirubin level does jaundice begin to occur

2.5 mg/dL

How long should you irrigate chemical burns with water

20 minutes

What amount of variation in pulse between right and left arm is indicative of aortic dissection

20 mmHg

When should you initiate screening for cervical cancer

21-year-old

In patients with STEMI it's important to get an immediate coronary angiography but how long can you wait in patients with NSTEMI

24-48 hours

How do you diagnose pheochromocytoma

24-hour catecholamines + CT or MRI of abdomen

What is the GOLD STANDARD for diagnosing GERD

24h ambulatory pH monitoring

How long does the progestin only IUD Mirena last

3-5 years

At what angle should the knee be bent in order to test for MCL laxity

30 degrees

How do you calculate rough estimate of fluid intake requirement for 24-hour period

30 x patient's weight in kg

What is the incubation period of mono and how is it transmitted

30-50 days and transmitted via salvia

what age group is duodenal ulcers more common

30-55 yo

How much weight is lost with banding procedures in first few years

35-45%

How many weeks is considered a term pregnancy

37-42 weeks

How do you treat osteomyelitis in sickle cell patients

3rd generation cephalosporin: fluoroquinolone: cipro or levofloxacin

How do you classify clavicle fractures

3rds, medial/middle/lateral third

What is considered normal peak expiratory flow rate

400-600

What is are positive results on a polysomnography test

5 or more predominantly obstructive respiratory events per hour of sleep in patients with symptoms/comorbidities or 15 or more in patients regardless of symptoms/comorbidities

What is the average age of menopause

51.5

How long must a diaphragm remain in place after intercourse

6-24 hours

How you manage patella fractures

6-8 weeks immobilization and may partially weight bear if nondisplaced, ORIF if displaced fracture

How do you manage a tibial plateau fracture

6-8 weeks in cast if nondisplaced, ORIF if displaced

When should you discontinue cervical cancer screening

65 years old

What factor does PT pathway include

7

What is a normal CD4 count

700-1500

How much weight is loss in the first 2 years with gastric bypass

75-85% of excess body weight

Foreign body aspirations most commonly occur where

80% in mainstem or lobar bronchus, right > left

How does Osgood Schlatter present clinically

9-14-year-old athletic male complaining of tenderness and swelling over tibial tubercle

Describe full can test

90-degree abduction, 30-degree flexion, rotate externally, apply downward pressure, positive test is weakness or pain

Describe empty can test

90-degree abduction, 30-degree flexion, rotate internally, apply downward pressure, positive test is weakness or pain

How fast should serum sodium be corrected

< or = 10 mEq/L over 24 hours

What TBSA in adults is consider a minor burn

<10%

What percent body area is considered to be SJS

<10%

What percent full thickness burn is considered a minor burn

<2%

At how many weeks of gestation is fetal loss considered an abortion

<20 weeks

What potassium level is considered decreased

<3.5

How do you manage nephrolithiasis

<5 mm pass spontaneously, >5 - 10 mm may require lithotripsy, stones >10 mm urethral stent or percutaneous nephrostomy

What TBSA in young/old is consider a minor burn

<5%

What mm of induration is considered positive in healthcare workers

> or = 10 mm

What mm of indurations is considered positive in those without risk factors

> or = 15 mm

What Ranson's criteria score is suggestive of severe pancreatitis

> or = 3

In patients with history of HIV, immunocompromised, close contacts of patient with active TB or chest x-ray consistent with old/healed TB, what mm of induration is considered positive

> or = 5 mm

At what age should everyone receive annual influenza vaccination

> or = 6 months

What is considered a normal forced expiratory volume in one second to forced vital capacity ratio

> or = 80%

What percent full thickness burn is considered a major burn

>10%

What level anion gap is considered elevated

>16

What TBSA in young/old is considered a major burn

>20%

What TBSA in adults is considered a major burn

>25%

What size aorta is considered aneurismal

>3 cm

What potassium level is considered elevated

>5-5.5

What percent stenosis is seen with stable angina

>70%

What can be used for elective medical abortion in the first 7-9 weeks

? Mifepristone and misoprostol

What does ABCDE stand for when describing skin lesions

A = asymmetry, B = border, C = color (varied), D = diameter (increasing or > 6 mm), E = elevation (raised)

What are the 3 strains of influenza

A, B, and C

What is used to estimate stroke after TIA

ABCD2 score: Age, blood pressure, clinical features, duration of symptoms/diabetes mellitus

How do you manage burns

ABCs, fluid replacement, topical antibiotic (silver sulfadiazine/aloe vera or bacitracin for superficial burns)

What should your workup of arterial/venous ulcer disease include

ABI: <0.9 indicates arterial insufficiency, evaluation for diabetes, ask about history of DVT, workup for thrombophilia, biopsy if vasculitis suspected, duplex sonography, tissue culture, bone scan (osteomyelitis)

Patient is a 37-year-old right-hand dominant male fell off his bicycle four days ago and injured his left non-dominant shoulder. There is an abnormal contour of the left shoulder with an elevation of the clavicle, AC joint tenderness, and pain with cross chest testing. What does this patient have

AC joint separation

What blood pressure medication is contraindicated in renal vascular disease

ACE inhibitors

What drug class decreases comorbidity and mortality in patients with CHF

ACE inhibitors

How do you treat systolic left heart failure

ACE inhibitors + beta blockers + loop diuretic

How do you treat diastolic heart failure

ACE inhibitors + beta blockers or calcium channel blockers

What drugs can cause aplastic anemia

ACE inhibitors, sulfonamides, phenytoin, chloramphenicol, chemotherapy, radiation

Fungal pneumonias are common in patients with what risk factors

AIDS, steroid use, organ transplant

How does severe asthma or status asthmaticus present

AMS, pulsus paradoxus (inspiratory drop in SBP by 10), silent chest, tripoding, inability to speak in full sentences, PEFR <40%

What radiographic views should be ordered for clavicle fracture

AP and clavicle

What views should you order for a possible shoulder dislocation

AP, axillary lateral, scapular Y-view

What imaging should you order in a suspected tibial plateau fracture

AP, lateral and oblique radiographs

What imaging can should be ordered in patellar tendinitis

AP, lateral and skyline views of the knee

What radiographs should be ordered for suspected LCL tear

AP, lateral and varus stress

What lab value is positive in patients with Crohn disease

ASCA

What is the diagnostic test of choice for acute pancreatitis

Abdominal CT

Patient is a >60-year-old male complaining of severe abdominal pain radiating to the back. EMS states that he had a syncopal episode. Pulse is 110, BP 90/50 O2 93% RR 14. On physical exam you appreciate a pulsatile abdominal mass. What is this patient likely experiencing

Abdominal aortic aneurysm

How do you diagnose small bowel obstruction

Abdominal x-ray will show air fluid levels in step ladder pattern, dilated loops of bowel, can use an UGI series

How do you diagnose chronic pancreatitis

Abdominal x-ray will show calcified pancreas

Define secondary amenorrhea

Absence of menses for 3 months in a woman with previously normal menstruation or 6 months in a woman with a history of irregular cycles

How does adhesive capsulitis present on MR arthrogram

Absence of normal axillary recess

Patient is a 13-year-old obese male who is being seen for his routine physical. His skin examination reveals velvety, hyperpigmented, papillomatous lesions of the neck and axillae. The remainder of the examination is unremarkable. The patient has a strong family history of diabetes. Laboratory analysis reveals a Hgb A1C - 5.9 (high), Insulin level - 18 (normal); lipids, CMP, T4, TSH, and cortisol are all normal. What does this patient have

Acanthosis nigricans

What is considered first line treatment for mild to moderate osteoarthritis pain and no evidence of inflammation

Acetaminophen

What is the most common cause of fulminant hepatitis

Acetaminophen, along with drug reactions, viral hepatitis and Reye syndrome

Hormone that directly stimulates parietal cells to secrete HCl acid via parasympathetic activation of the vagus nerve

Acetylcholine

What hormone is known as the rest and digest hormone

Acetylcholine, increase GI activity

40 yo Pt presents with dysphagia of solids & liquids, wt loss, dehydration, regurgitation of undigested food, CP and cough. What does this pt have

Achalasia

What is the role of bicarbonate

Acid buffer from the chyme entering the duodenum from the stomach

How do you manage gastritis if H. pylori comes back negative

Acid suppression: PPI, H2 blocker, antacids, sucralfate

How do you manage gastritis if h. pylori negative

Acid suppression: PPI, H2 blocker, antacids, sucralfate

Vertigo associated with ataxia and neurofibromatosis type 2

Acoustic neuroma

Patient is a 69-year-old man with male-patterned baldness is concerned because the skin on his scalp is no longer smooth. He describes it as feeling rough, like "sandpaper." While he is now retired, he was a gardener and often spent hours working under the sun. Physical exam reveals discrete yellow-brown, scaly patches on sun-exposed areas of the face, scalp, ears, forearms, and the dorsum of the hands. What does this patient have

Actinic keratosis

Patient is a 23-year-old-female with a one-week history of cough productive of whitish sputum. This was preceded one week prior by an URI. She denies chills, night sweats, shortness of breath or wheeze. Temperature is 99.9°F (37.7°C). What does this patient have

Acute bronchitis

Patient is a 47-year-old male presenting with fever/chills, jaundice, and RUQ pain. What does this patient have

Acute cholangitis, patient is presenting with Charcot's triad

Patient is a 40-year-old, fertile female who mildly obese c/o of RUQ pain. Pt states that she has experienced nausea and note that her symptoms started after eating a juicy burger and fries. What does this patient most likely have

Acute cholecystitis

Patient is a 3-7 y/o child with lymphadenopathy, bone pain, bleeding, and fever. Bone marrow demonstrates > 20% lymphoblasts. What does this patient have

Acute lymphocytic leukemia (ALL)

Patient is a 62-year-old male with a history of atrial fibrillation, CAD and hyperlipidemia complaining of abdominal pain. Upon physical exam you note his pain to be out of proportion to your physical findings. What does this patient likely have

Acute mesenteric ischemia

Patient is a 52-year-old male who reports that he has been feeling very tired lately and his wife thinks that he looks pale. You order a complete blood count, which shows: Hgb 8.5 g/dL (normal 13.5-17.5); WBC 1,200/microliter (normal 4,500 - 11,000); platelets 70,000/microliter (normal 150,000 - 400,000). The patient is referred for bone marrow biopsy, which shows myeloblasts with Auer rods. What does this patient have

Acute myelogenous leukemia (AML)

Patient is a 47-year-old white male with a history of alcohol abuse complaining of constant epigastric pain that radiates to his back. Patient is tachycardiac on physical exam and states that his pain is better with sitting forward but worse with laying back. What does this patient have

Acute pancreatitis

What are some complications of choledocholithiasis

Acute pancreatitis and acute cholangitis

Patient is a 34-year-old previously healthy male with complaints of facial pressure and rhinorrhea for the past 3 weeks. The patient reports that several weeks prior, he had a "common cold" which resolved. However, he has since developed worsening facial pressure, especially over his cheeks and forehead. He reports over 1 week of green-tinged rhinorrhea. His temperature is 100.1 deg F (37.8 deg C), Nasal exam reveals edematous turbinates and purulent discharge. The patient has facial tenderness with palpation over the involved sinus. What does this patient have

Acute sinusitis

What is the most common type of gastric carcinoma worldwide

Adenocarcinoma

What type of lung cancer presents as a non-smoker, with an incidental finding and a small peripheral lesion

Adenocarcinoma

What are the 3 type of non-small cell lung cancer

Adenocarcinoma (35-40%), squamous cell (25-35%), large cell (5%/Anaplastic)

What is the most common type of esophageal cancer I the united states

Adenocarcinoma, occurs in lower 1/3 esophagus

What are causes of secondary dysmenorrhea

Adenomyosis, endometriosis, fibroid, PID, IUD

Patient is a 58-year-old female presenting with a rapidly enlarging painful breast mass. Her overlying skin exhibits edema, warmth and erythema. You note swollen/enlarged lymph nodes on the ipsilateral side. What does this patient have

Adenopathy

What is the are 2 most common causes of small bowel obstruction

Adhesions and incarcerated hernias

Patient is a 50-year-old female complaining of right shoulder pain and stiffness that has been ongoing for a little over a year. Patient denies any previous injuries to her shoulder but states she has history of diabetes and hypothyroidism. On physical exam you note decreased external rotation and resisted passive range of motion. What does this patient have

Adhesive capsulitis (frozen shoulder)

What are common complications of shoulder fractures

Adhesive capsulitis or rotator cuff tear

30% of spontaneous pneumothoraxes recur how do you manage, a recurrence

Administer noxious agent to obliterate the pleural space or partial pleurectomy or abrasion of the pleural space

Patient is a 69-year-old female found to have an incidental 6.2 × 4.0 × 3.8 cm left adrenal mass on non-contrast CT scan of the abdomen obtained for abdominal pain. The patient has a recent history of new-onset hypertension, 25-lb weight loss and complaints of fatigue, muscle weakness, poor appetite, emotional lability, and insomnia. She has no significant family history of endocrine disease and no prior history of malignancy. What does this patient likely have

Adrenal carcinoma

How do you treat pheochromocytoma

Adrenalectomy

How do you manage adrenal carcinoma

Adrenalectomy or systemic chemotherapy and external-beam radiation if >90% resection not possible

What test is used in suspected thoracic outlet syndrome

Adson: loss of radial pulse with head extended and rotated to affected side, then armed pulled back

What is the PERC criteria for ruling out PE in low suspicion patients

Age <50, Pulse <100, O2 >95%, no prior: PE, trauma, surgery, hemoptysis, estrogen use, unilateral leg swelling

What are the 3 main triggers of asthma

Airway hyperactivity: allergen (extrinsic - increased IgE) vs infection or pharmacological use (intrinsic), Bronchoconstriction: obstruction, inflammation

Give 2 examples of SABAs

Albuterol or levalbuterol

What are the 2 most common causes of chronic pancreatitis

Alcohol abuse and idiopathic

What are the most common causes of cirrhosis

Alcohol, hepatitis (B, C, D), nonalcoholic fatty liver disease, hemochromatosis

Patient is a 4-year-old female with spots of hair loss that has been progressively worsening. According to the patient's mom, her daughter lost all the hair on her head, including eyelashes and eyebrows, 2 years ago. Her hair grew back and now new spots of hair loss are appearing. What does this patient have

Alopecia

Oval shaped well-demarcated hair loss, autoimmune - attack against hair follicles. Onset usually prior to 30 years of age; men and women are equally affected. Well-documented genetic predisposition. What is this called

Alopecia areata

What genetic disease is linked to COPD in patient <40 years old

Alpha 1 antitrypsin deficiency

What agents should you preoperatively in someone with pheochromocytoma

Alpha blockade with phenoxybenzamine or phentolamine x 7-14 days (don't use Beta blockade)

What are causes of secondary polycythemia

Altitude related, COPD, OSA, bloodletting, neoplasms

How do you treat influenza A

Amantadine or Rimantadine

Monocular vision loss - temporary lampshade down on one eye is called

Amaurosis Fugax

How do you manage bronchiectasis

Ambulatory oxygen, aggressive antibiotics, chest physiotherapy and eventually lung transplant

What protozoan infection presents with GI colitis, dysentery, stool ova and parasites

Amebiasis

How do you manage inflammatory bowel disease

Aminosalicylates: Sulfasalazine with folic acid, mesalamine + Corticosteroids for acute flares: prednisone, methylprednisolone + immune modifying agents: 6-mercaptopurine, azathioprine, methotrexate or anti-TNF agents: Adalimumab, infliximab, certolizumab

What is the treatment of choice in children <8 years old or pregnant patients who have early Lyme disease

Amoxicillin or Cefuroxime

What type of antibiotics can be used in mild exacerbation of chronic bronchitis

Amoxicillin, doxycycline, Bactrim

How do you treat cryptococcus

Amphotericin B

How do you treat histoplasma capsulatum

Amphotericin B

How do you manage acute cholangitis

Ampicillin/sulbactam (Unasyn) / Piperacillin/tazobactam (Zosyn) vs Ceftriaxone + Metronidazole or Fluoroquinolone + Metronidazole or Ampicillin + Gentamicin. All of that + ERCP due provide decompression and stone extraction

Bacterial pneumonia associated with poor dental hygiene

Anaerobes

Patient is a 35-year-old male with a history of IBS-D. Patient states that he noticed bright red blood after wiping. Patient states that along with the blood he has had severe pain and is now fearful of passing a bowel movement. Upon inspection of the perianal area you note a linear crack in the posterior midline. What does this patient have

Anal fissure

How do you treat sickle cell crisis

Analgesics, oxygen, hydration, hydroxyurea to decrease frequency of crises

Typical male pattern baldness

Androgenic alopecia

Patient is a 62-year-old male with a history of chronic kidney disease complains of weight loss, fatigue, and weakness. Iron studies reveal decreased serum iron, increased ferritin, and decreased TIBC. Peripheral blood smear shows normochromic RBCs. What does this patient have

Anemia of chronic disease

How does AML present

Anemia, nosebleeds, bruising, neutropenia, thrombocytopenia, bone pain, splenomegaly

How do you definitively diagnose acute mesenteric ischemia

Angiogram

What is the gold standard for diagnosing peripheral arterial disease

Angiography

What is the gold standard for evaluation of AAA

Angiography

What is the gold standard for diagnosing arterial embolism/thrombosis

Angiography, also order EKG and echocardiogram

Patient is a 47-year-old man with severe rectal pain when he defecates. He has a fever of 102.2 F (39 C). On exam there is perianal swelling, redness and tenderness. A palpable mass is felt at the anal verge. What does this patient have

Anorectal abscess

What is the 2nd stage in managing GERD

Antacids & OTC H2 receptor antagonists as needed

What is the most common type of shoulder dislocation

Anterior

Patient is a 24-year-old male with severe pain in the right knee. He is a professional football player and a few hours prior to presentation, an opposing player hit his leg from his left side. Afterward, he felt a "popping" sound that was followed by severe knee pain and a sensation of knee instability. On physical exam, there is an anterior translation of the proximal tibia when pulled as the patient has the knee flexed at 90° and supine. What does this patient have

Anterior Cruciate Ligament Tear

What type of stroke is associated with hemispheric signs and symptoms such as aphasia, apraxia, hemiparesis, visual field defects

Anterior circulation involvement

Describe Lachman test for ACL tear

Anterior pulling of the proximal tibia while stabilizing distal femur

Patient is an 80-year-old woman arrives at the emergency room with severe right shoulder pain and immobility. She fell down the steps outside her house and landed on her right side two hours prior to presentation. On exam, her right arm is abducted and externally rotated. She has decreased sensation to touch over the lateral aspect of her right shoulder. What does this patient have

Anterior shoulder dislocation

How do you diagnose hepatitis C virus

Anti HCV + in 6 weeks

What drug class should you not give with invasive diarrhea

Anti-motility agents

How do you treat hospital acquired pneumonia

Anti-pseudomonal beta lactam: piperacillin/tazobactam or cefepime + anti-pseudomonal aminoglycoside: Amikacin, gentamicin or fluoroquinolone: levofloxacin or moxifloxacin

How do you treat acute osteomyelitis

Antibiotics 4-6 weeks

How do you treat arterial embolism/thrombosis

Anticoagulated with IV heparin, surgical embolectomy within 4 to 6 hours, bypass for embolectomy failure

What drugs should not be used in a patient with shigella

Antidiarrheals: diphenoxylate or loperamide

What should you expect in a young woman with malar rash, arthritis, photosensitivity, renal/cardiac symptoms, fever, malaise, recurrent pregnancy loss and increased PTT

Antiphospholipid syndrome

How do you treat unstable angina

Antiplatelet drugs, beta blockers, nitroglycerin, calcium channel blockers, ACE inhibitors, statins, revascularization

What is the differential diagnosis for palpitations

Anxiety, electrolyte abnormalities (hypokalemia, hypomagnesemia), exercise, hyperthyroidism, ischemic heart disease, ingestion of stimulant, pheochromocytoma, hypoglycemia in DM type 1, MVP, atrial fibrillation, wolf-Parkinson-white syndrome, sick sinus syndrome

Patient is a 73-year-old female with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with severe, tearing, knife-like back pain. She states that the pain started approximately 30 minutes ago, and she has felt lightheaded and dizzy ever since its onset. On exam, her vitals are given: T: 98.6 F, HR: 115 bpm, BP: 95/53, RR: 14, SaO2: 97% on room air. What is this patient experiencing

Aortic dissection

Patient is a 25-year-old male recently started on phenytoin for seizure disorder is complaining of a low-grade fever, fatigue, and weakness. Physical exam reveals a temperature of 99.2°F, purpura, pallor, and gingival bleeding. There is no hepatosplenomegaly. His blood tests show WBC 1100/μL, platelets 35,000/μL, Hb of 4.0 g/dL; MCV 90 fl; and 1% reticulocyte count. A bone marrow biopsy is obtained, showing hypocellularity and increased adipose tissue. What does this patient have

Aplastic anemia

How do you test for adhesive capsulitis

Apley scratch test

How do you diagnose onychomycosis

Appearance, wet mount, culture, PCR

When does CK/CK-MB first appear, peak and how long does it last

Appears in 4-6 hours, peas at 12-24 hours, last for 3-4 days

When does troponin first appear, peak and how long does it last

Appears in 4-8 hours, peaks at 12-24 hours, last for 7-10 days

How do you manage appendicitis

Appendectomy

Patient is a 25-year-old female complaining of RLQ pain. Patient states that her pain started in the periumbilical/epigastric region but has now moved to her lower right quadrant. She reports nausea, vomiting, and loss of appetite. What does this patient have

Appendicitis

What is the characteristic finding of colorectal cancer on barium enema

Apple core lesion

How often is the NuvaRing applied

Applied every 3 weeks and off for 1 week

How do you manage osteoarthritis

Aquatic exercises, stretching, Acetaminophen 1 g PO QID vs tramadol or opioids vs topical or oral NSAIDs for refractory pain or intraarticular injections (corticosteroids, sodium hyaluronate) or glucosamine & chondroitin vs total joint replacement for unresponsiveness to conservative therapy

Describe drop arm test

Arm passively abducted and actively adducted slowly, positive test when arm drops quickly at 30 degrees

How do you manage a clavicle fracture

Arm sling or figure of 8 sling in children for 4-6 weeks, ortho consult if proximal 1/3

What neoadjuvant endocrine therapy is helpful in women that are postmenopausal ER positive patients with breast cancer

Aromatase inhibitors: Letrozole, Anastrozole

What is your differential for dyspnea on exertion

Arrythmia (Afib, sinus tach, sick sinus syndrome), Myocardial (cardiomyopathies, coronary ischemia), Restrictive (Constrictive pericarditis, pericardial effusion/tamponade), Valvular (Aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis

What should the differential of syncope include

Arrythmia, seizure, stroke, TIA, vasovagal, orthostatic hypotension, hypovolemia, medications, exercise

A 64-year-old patient with known history of type 1 diabetes mellitus for 50 years has developed pain radiating from the right buttock to the calf. Patient states that the pain is made worse with walking and climbing stairs. Based upon this history which of the following would be the most appropriate test to order

Arterial duplex scanning

Patient is A 56-year-old man is seen in the ED for onset of severe pain and numbness in his left leg that began 30 min ago. He has a past medical history significant for hypertension, diabetes, and hyperlipidemia. Physical exam reveals a temperature of 98.3 °F, blood pressure of 134/74 mmHg, pulse of 89/min, and respiratory rate of 16/min. Heart is irregularly irregular with no murmurs appreciated. On extremity exam, there is absent pulses in the left femoral, popliteal, and pedal arteries. On the right, all pulses are 2+. The left foot is cool to touch as compared to the right. Sensation to pinprick is decreased on the left dorsum of the foot compared to the right. What is this patient experiencing

Arterial embolism/thrombosis

Patient is a 62-year-old male with a 3.5 mm ulcerated area of the right medial malleolus. The wound is inflamed with associated edema. PMH is significant for varicosities. What does this patient likely have

Arterial/venous ulcer disease

What are the common causes of intracerebral hemorrhage

Arteriovenous malformation

What are some non-GI symptoms that can be seen with ulcerative colitis and Crohn disease

Arthritis, uveitis, episcleritis, fever, sweats, fatigue, erythema nodosum, pyoderma gangrenosum

How do you definitively diagnose septic arthritis

Arthrocentesis: WBC > 50,000 primarily PMNs; gram stain & culture, crystals

What are the 2 different types of meningitis

Aseptic or bacterial

What 2 syndromes can cause secondary amenorrhea

Asherman's: endometrial atrophy/scarring post pregnancy termination or Sheehan's: pituitary dysfunction due to hemorrhage

How do you treat stable angina

Aspirin, nitrates, beta blockers, calcium channel blockers, ACE inhibitors, statins, coronary angioplasty or coronary artery bypass graft

How do you manage an anal fissure

Assure patient that 80% resolve spontaneously, recommend supportive care: Sitz baths, analgesics, high fiber diet, stool softeners

What type of findings will you see on PE in a patient with cirrhosis

Asterixis (flapping tremor), ascites (abdominal distention), caput medusa, hepatosplenomegaly, jaundice, dupuytren's contractures, spider angioma

Patient is a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes. What does this patient have

Asthma

What are causes of secondary pneumothorax

Asthma, COPD, cystic fibrosis, interstitial lung disease

What is Samter's triad

Asthma, nasal polyps, ASA/NSAID allergy

What are some clinical manifestations of bronchial carcinoid tumors

Asymptomatic, recurrent pneumonia, SIADH, carcinoid syndrome: (diarrhea due to elevated serotonin), flushing, tachycardia, bronchoconstriction

How often should you recommend clinical breast exams

At least every 3 years if 20-39 and annually if >40

Name 3 examples of protease inhibitors (PI)

Atazanavir (Reyataz), Darunavir (Prezista), Lopinavir & Ritonavir (Kaletra)

What is the most common cause of peripheral arterial disease

Atherosclerosis

What is the most common risk factor for developing AAA

Atherosclerosis, followed by smoking, Caucasian, hyperlipidemia, connective tissue disorder, hypertension

What is the most common cause of embolus from the heart

Atrial fibrillation

What are the most common causes of thrombus formation

Atrial fibrillation and mitral stenosis

Vaginitis that presents with dyspareunia, irritation, dryness, recurrent UTI despite treatment, thin/pale mucosa on vaginal exam

Atrophic vaginitis

What laboratory finding supports a diagnosis of mononucleosis

Atypical lymphocytosis on WBC differential

What type of bacterial pneumonia is associated with an indolent course

Atypical pneumonia most commonly mycoplasma

Achalasia is the loss of what plexus which leads to increased LES pressure

Auerbach's - contains ganglion cells that produce Nitric Oxide which causes relaxation of LES

How do you manage dog bite

Augmentin or clinda + cipro or Bactrim

How do you manage human bite

Augmentin or clinda + moxifloxacin or Bactrim

How do you manage cat bite (Pasteurella multocida)

Augmentin or doxy if PCN allergic

How do you treat cat bite (Pasteurella multocida)

Augmentin or doxy if penicillin allergic

Bleeding when scale is picked is called

Auspitz sign

Patient is a 59-year-old male with complaints of fatigue, shortness of breath with physical exertion, and a sense of abdominal fullness. His wife accompanies him to his appointment and expresses concerns about his skin color, commenting that he has an "orange hue" to his skin. On physical exam the patient is noticeably jaundice with palpable splenomegaly. A peripheral smear comes back with spherocytes as well a smudge cells. His direct Coombs test is positive with anti-C3 and anti-IgG antibodies. What does this patient have

Autoimmune hemolytic anemia

Patient is a 49-year-old female with progressive left hip pain and limp which has become progressively worse over 13 months. Her past medical history is significant for heterozygous sickle cell anemia and she has been under hydroxyurea treatment for about 20+ years. She is on no other medication and denies alcohol or tobacco use. The pain is localized to the groin, lateral hip, and buttocks. What does this patient have

Avascular necrosis of hip

How do you treat G6PD deficiency

Avoid triggers (antimalarials, sulfa drugs, ASA, fava beans)

Where is adenopathy most commonly seen in patients with breast cancer

Axilla

What can be a complication of shoulder dislocation

Axillary nerve injury (transient neurapraxia), always check for sensation over the deltoid

What is the 1st line treatment for MAC

Azithromycin or Clarithromycin, 2nd line is Rifabutin

How do you prophylactically manage migraines

BBs, CCBs, TCAs, anitconvulsants (valproate, topiramate)

What are the indications for bariatric surgery

BMI of >40 kg/m2, a BMI >35 kg/m2 with a comorbid condition, or a BMI of >30 kg/m2 with dysmetabolic syndrome or difficult-to-control type 2 diabetes mellitus, failed other non-surgical weight loss programs

How do you diagnose orthostatic hypotension

BP measured with patient supine for 5 minutes, 1 minute in seated position and 3 minutes in standing. Can use tile table testing

Vaginitis that presents as fishy, grey, scant, sticky discharge, pH >4.5, clue cells on wet prep, + whiff test with KOH

Bacterial vaginosis

Does bacterial or fungal vaginal infection present with foul smelling vaginal discharge, that is grayish in color and pH >4.5

Bacterial, fungal has white curd-like discharge and pH <4.5

How do you treat pneumocystis jiroveci

Bactrim and steroids (Bactrim is also used as prophylaxis)

What is the 1st line treatment for Toxoplasmosis

Bactrim, 2nd includes Dapsone + Pyrimethamine + Folinic acid

What is the 1st line treatment for PCP

Bactrim, 2nd line includes dapsone or atovaquone

How do you manage shigella diarrhea if severe

Bactrim, always fluids if not severe

How do you treat methicillin-resistant staph aureus cellulitis

Bactrim, clindamycin, doxycycline vs IV vancomycin or linezolid

What type of cyst can be formed due to knee osteoarthritis

Baker's cyst

What surgeries are considered restrictive bariatric procedures

Banding and sleeve gastrectomy

What associated conditions should you consider in a patient with shoulder dislocation

Bankart or Hill-Sachs lesion, axillary nerve injury, rotator cuff tear, labral tear

What diagnostic test is contraindicated in acute diverticulitis

Barium enema

How do you diagnose esophageal webs & rings

Barium esophagram

What is the name of alpha thalassemia that has the A trait

Bart's (hydrops fetalis)

Patient is a 45-year-old fair-skinned woman who is concerned about a "pink mole" on her cheek. On physical examination you note a 7 mm pearly papular lesion on the right cheek with surface telangiectasias, rolled border and central erosion. What does this patient likely have

Basal cell carcinoma

How does lead poison diagnosed

Basophilic stippling

Tenderness to palpation at distal pole of the patella in full extension and no tenderness to palpation at distal pole of the patella in full flexion is called

Basset's sign

What are some examples of long-term medication for chronic asthma

Beclomethasone or triamcinolone (ICS), Salmeterol (LABA), Cromolyn (mast cell modifiers), montelukast (LTRA), theophylline

How do you treat obstructive sleep apnea

Behavior modification: weight loss/exercise, avoid alcohol/sedatives, sleep in nonsupine position; + positive airway pressure therapy/oral appliance if mild to moderate vs continuous positive airway pressure if severe

Idiopathic unilateral hemifacial weakness/paralysis due to inflammation/compression of CN VII is called

Bell palsy

What is the first-line treatment of ulcers

Below-knee compression stockings, surgical debridement with xylocaine gel, 30 min of brisk walking 5 times per week, elevation, refer nonhealing ulcers to wound care

How do you manage Osgood Schlatter disease

Benign and self-limiting, NSAIDs, ice, physical therapy: quad stretching vs surgical ossicle excision or resection for refractory cases

Vertigo characterized by changes in position but no hearing loss, tinnitus or ataxia

Benign positional vertigo

How do you manage stage 3 acne vulgaris

Benzoyl peroxide + systemic antibiotic

How do you manage stage 4 acne vulgaris

Benzoyl peroxide + systemic antibiotic or isotretinoin

How do you manage stage 2 acne vulgaris

Benzoyl peroxide +/- topical antibiotic +/- keratinolytic agent

What is the most common cause of SAH

Berry aneurysm rupture (anterior communicating artery)

What blood pressure medication is used to decrease expansion and rupture risk of AAA

Beta blockers

How do you manage NSTEMI in long-term

Beta blockers + nitroglycerin + aspirin + heparin

What drug is contraindicated in isolated peripheral arterial disease and why

Beta blockers because they can worsen claudication

How do you treat hyperthyroidism

Beta blockers for cardiac symptoms (atenolol) + antithyroid drugs (methimazole or PTU) vs radioactive iodine or thyroidectomy

What drug class is contraindicated in patients with Prinzmetal angina

Beta blockers such as propranolol

How do you treat inpatient community acquired pneumonia

Beta lactam: ceftriaxone + macrolide or doxycycline vs broad spectrum fluoroquinolone

Patient is a 33-year-old man who complains of left anterior shoulder pain for 4 weeks. The pain is made worse with overhead activities. On examination, you note maximal pain in the shoulder with palpation between the greater and lesser tubercle. Pain in the shoulder is exacerbated when the arm is held at the side, elbow flexed to 90 degrees, and the patient is asked to supinate and flex the forearm against your resistance. What does this patient have

Biceps Tendonitis

Explain speed test for biceps tendonitis

Bicipital groove pain with resisted forward flexion while arm is supinated (can be positive with SLAP lesions)

How does essential tremor present

Bilateral intention tremor that doesn't occur at rest, autosomal dominant, better with alcohol

Patient is a 40-year-old obese Caucasian female complaining of RUQ/epigastric pain. She states that the pain comes in episodes, lasting for 30 minutes and is made worse by eating. She also notes that she is currently taking OCPs. What does this patient have

Biliary colic

What is acute cholangitis

Biliary tract infection secondary to obstruction

What bariatric surgeries are considered malabsorptive

Biliopancreatic diversion and biliopancreatic diversion with duodenal switch

How do you diagnose Kaposi sarcoma

Biopsy

How do you diagnose squamous cell carcinoma

Biopsy

What are the causes of Histoplasma capsulatum

Bird or bat droppings, associated with Mississippi or Ohio river valley

What is the common appearance of Achalasia on esophagram

Bird's Beak

What three specific beta-1 selective drugs reduce mortality from heart failure

Bisoprolol, carvedilol, metoprolol succinate

How do you treat osteoporosis caused by hyperparathyroidism

Bisphosphonates

Spider bite that causes neurologic manifestations

Black widow

How do you diagnose Dubin-Johnson Syndrome

Black-liver on biopsy and isolated conjugated hyperbilirubinemia between 2-5 mg/dL

Patient is a 60-year-old male with painless hematuria. He first noticed the color of his urine darkening several weeks ago, and it has recently worsened. He denies any pain. Vital signs are stable. Physical examination is within normal limits. Past medical history is significant for a 25 pack/year history of smoking. He has no costovertebral angle tenderness. Urinalysis is positive for heme with with >100 RBC/HPF and urine culture is negative. What does this patient have

Bladder carcinoma

How would you describe urticaria

Blanchable, edematous pink papules, wheals or plaques

What is a common cause of spontaneous pneumothorax

Bleb rupture

What are some complications of PUD

Bleeding, perforation, penetration, obstruction

What is the MOA of PPIs

Blocks H/K ATP-ase (proton pump) of parietal cells, reducing acid secretion

How do you treat vascular disease dementia

Blood pressure control

What is another name for someone with chronic bronchitis

Blue bloater due to obese and cyanotic appearance

Pt presents with retrosternal CP made worse with deep breathing/swallowing and hematemesis. On auscultation of chest you hear CREPITUS. What does this pt have

Boerhaave syndrome

What is the gold standard for diagnosing osteomyelitis

Bone aspiration

How do you confirm diagnosis of polycythemia

Bone marrow biopsy

How do you definitively manage alpha thalassemia

Bone marrow transplant

How do you diagnose ALL

Bone marrow with >20% blasts

What is the cause of Lyme disease

Borrelia burgdorferi via Ixodes/deer tick

Swelling of the proximal interphalangeal joint is called

Bouchard node

How do you manage toxic megacolon

Bowel decompression (NG tube), bowel rest, broad-spectrum antibiotics, electrolyte repletion vs colostomy for refractory cases

What is the most common nerve compressed in thoracic outlet syndrome

Brachial plexus followed by subclavian vein and subclavian artery

How do you conservatively manage MCL tear

Bracing and physical therapy vs surgery for chronic instability

Patient is a 32-year-old lactating female with breast pain, swelling, fever, chills and a fluctuant mass of her left breast. The area directly above the lesion is warm, erythematous and tender to touch. What does this patient likely have

Breast abscess

How do you definitively diagnosis breast carcinoma

Breast biopsy

Patient is a 33-year-old woman who arrives at your outpatient clinic for the evaluation of a painless breast mass that has been slowly enlarging over the past 3 months. Her past medical history is unremarkable. She has no prior history of breast complaints or trauma. The findings from the physical examination are unremarkable except for the breast examination. A hard, nontender 3-cm mass is noted in the upper outer quadrant of her left breast. The left axilla is without abnormalities. Examination of the right breast reveals no dominant mass or axillary adenopathy. What does this patient likely have

Breast carcinoma

How do you manage AC joint separation

Brief sling immobilization, analgesia, ice, ortho follow up, type III may need surgery

Rare neuroendocrine (enterochromaffin cell) tumors characterized by slow growth, low METs are called

Bronchial carcinoid tumors

Patient is a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. Pneumonia requiring hospitalization. On physical examination you notice foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with "plate-like" atelectasis (scarring). What does this patient have

Bronchiectasis

The subtype of adenocarcinoma bronchogenic carcinoma which is characterized by voluminous sputum and interstitial lung pattern on CXR is known as

Bronchioalveolar

How do you diagnose pneumocystis Jiroveci

Bronchoalveolar lavage (PCR)

How are central lesions diagnosed

Bronchoscopy

How do you treat foreign body aspiration

Bronchoscopy (rigid is preferred in children)

How do you diagnose bronchial carcinoid tumors

Bronchoscopy: pink to purple well-vascularized central tumor

Spider bite that causes central necrosis

Brown recluse

Within regard to acute cholecystitis, referred pain to the right shoulder/subscapular area is known as

Bsoas sign

How does a cystocele present

Bulge in the vagina, pelvic pressure, urinary dysfunction

What is the above called

Bullous pemphigoid

How does Lyme disease present in early localized stage

Bullseye rash, otherwise known as erythema migrans, viral-like syndrome, headaches, fever, malaise, lymphadenopathy

How do you treat SJS

Burn unit admission and IV immunoglobulin

How do you treat TENs

Burn unit admission, cyclosporine or plasma exchange if severe

How do you manage a subdural hematoma

Burr hole trephination, craniotomy or craniectomy

What labs should you order in workup of osteoarthritis

C-reactive protein and erythrocyte sedimentation rate which will be normal

What dermatomes are located over the shoulder and deltoid

C4 shoulder, C5 deltoid

What is the innervation of the SITS muscles

C5 and C6

How do you manage gastritis if H. pylori comes back positive

CAP (clarithromycin + Amoxicillin + PPI) - metro if PCN allergic

How do you manage PUD if H. pylori present

CAP (clarithromycin + Amoxicillin + PPI) or metro if PCN allergic vs quadruple therapy (PPI + Bismuth subsalicylate + tetracycline + metro)

How do you manage gastritis if h. pylori positive

CAP = clarithromycin, amoxicillin and PPI (metronidazole if PCN allergic)

How is shigella diarrhea diagnosed

CBC shows leukemoid reaction (WBC >50,000), sigmoidoscopy shows punctate areas of ulceration

What labs should you order for hematochezia/melena

CBC, chemistries, LFTs, Coags

What CD4 count is indicative of HIV

CD4 < 200 cells/uL

What tumor marker can be used to diagnose and monitor colorectal cancer

CEA

What are causes of hypervolemic hyponatremia

CHF, nephrotic syndrome, renal failure, cirrhosis

How do you diagnose epidural hematoma

CT

What is the gold standard in diagnosing bronchiectasis

CT

What is the study of choice for evaluating acute head injuries such as concussions

CT

What is the study of choice for pancreatic pseudocyst

CT

What is the initial test of choice for pancreatic carcinoma

CT but ERCP is most sensitive

What imaging studies are used in suspected adrenal carcinoma

CT scan

What is the diagnostic test of choice for diverticulosis/diverticulitis

CT scan

What is the test of choice for thoracic aneurysm and for further evaluation of patients with known abdominal aortic aneurysm

CT scan

What is the test of choice for evaluating aortic dissection

CT scan with contrast

How do you diagnose appendicitis

CT scan, can see leukocytosis, can conduct US initially

What is the initial test of choice in suspected TIA

CT without contrast

What drugs interact with emergency contraception

CYP3A4 inducers such as carbamazepine, topiramate, st. john's wort

What is the triad of chronic pancreatitis

Calcification, steatorrhea, diabetes mellitus

What does the mnemonic CHOBBS for Ranson's criteria within 48 hours stand for

Calcium <8.0 mg/dL, Hematocrit fall >10%, Oxygen PO2 <60 mmHg, BUN >5 mg/dL p IV fluids, Base deficit >4 mEq/L, Sequestration of fluid >6L

How do you treat hyperphosphatemia

Calcium carbonate and restrict potassium

What are the 4 types of kidney stones

Calcium oxalate (radiopaque), uric acid (radiolucent), cystine, struvite (seen with chronic UTI, treat with antibiotics)

What is Homan's sign

Calf pain with dorsiflexion of foot while leg extended indicated possible DVT or thrombophlebitis

What is the most common cause of bacterial enteritis in US and most common antecedent event in post-infectious GBS

Campylobacter jejuni

Incidence of GBS is associated with

Campylobacter jejuni or antecedent respiratory or GI infection

What are the common invasive diarrhea causes

Campylobacter, shigella, salmonella, Yersinia, enterohemorrhagic E coli

What causes paronychia

Candida if chronic and staph if acute

Vaginitis that presents with clumpy or cheesy vaginal discharge, pruritis, dysuria, pH <4.5 and branching hyphae on KOH

Candida vaginitis

What should you do if > 70% stenosis of internal or common carotid artery

Carotid endarterectomy

What is the first line revascularization option for patients with carotid disease

Carotid endarterectomy (CEA) vs carotid artery stenting if unable to tolerate CEA

How do you treat dysfunctional uterine bleeding

Cause cycle bleeding for protection of endometrium via progesterone therapy, OCPs, GnRh agonists, hysteroscopy, endometrial curettage or ablation, NSAIDs

How does TB present on x-ray

Cavitary lesions, infiltrates, ghon complexes in apex of lungs (calcified lymph + lesions), caseating granulomas

What antibiotics are used in treatment of gram-negative cocci or gonococcus suspected

Ceftriaxone

How do you manage bacterial meningitis caused by S. pneumo or N. meningitidis

Ceftriaxone + Vancomycin

What is the empiric treatment of meningitis

Ceftriaxone + Vancomycin in adults or Ampicillin + Cefotaxime in infants

What type of antibiotics can be used in moderate and severe cases of chronic bronchitis

Cefuroxime, Augmentin, Bactrim, levofloxacin, ciprofloxacin

Patient is a 64-year-old female with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12 cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque. What does this patient have

Cellulitis

What does the above image show

Cellulitis

How do you manage cellulitis if not worried about MRSA

Cephalexin or dicloxacillin

How do you treat mild cellulitis (MSSA)

Cephalexin or dicloxacillin, clindamycin or macrolide if penicillin allergic

What can rapid correction of hypernatremia cause

Cerebral edema and pontine herniation

Patient is a 45-year-old female with post coital bleeding and painful intercourse. On exam you notice a friable, bleeding cervical lesion. The cytological evaluation shows a high-grade squamous intraepithelial lesion (HSIL/CIN2/3). She is referred for colposcopy and directed biopsies. What does this patient have

Cervical cancer

Define menopause

Cessation of menses for at least 12 months

What is another name for cervical motion tenderness

Chandelier sign

What is Reynold's pentad

Charcot's triad + AMS and Shock: hypotension

How do you treat Kaposi sarcoma

Chemotherapeutic agents

How do you stage 4-5 melanoma

Chemotherapy

How do you manage small cell bronchogenic carcinoma

Chemotherapy +/- radiotherapy

How do you manage stage 3 non-small cell bronchogenic carcinoma

Chemotherapy then surgery

What is the recommended adjunctive therapy post lumpectomy/mastectomy for women with stage II-IV breast cancer or inoperable breast cancer

Chemotherapy: Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxol

How do you manage spontaneous pneumothorax if larger and severe

Chest tube placement (thoracostomy)

How do you diagnose viral pneumonia

Chest x-ray shows bilateral interstitial infiltrates, rapid antigen test for flu, RSV nasal swab, cold agglutinin titer is negative

How do you diagnose bronchiectasis

Chest x-ray shows linear lung markings (tram track), atelectasis, plate-like atelectasis

How do you diagnose emphysema

Chest x-ray shows loss of lung markings, hyperinflation, parenchymal bullae and blebs, decreased FEV1/FVC ratio

How do you diagnose pneumonia

Chest x-ray shows patchy, segmental lobar or multilobar consolidation + blood cultures x 2 and sputum gram stain

What should your workup of foreign body aspiration include

Chest x-ray with expiratory view and ABG to access ventilation

What should your workup of CHF include

Chest x-ray, ECG, BNP

How do you diagnose lung cancer

Chest x-ray, bronchoscopy + biopsy for central lesions or FNA

How do you diagnose bronchogenic carcinoma

Chest x-ray, sputum cytology (squamous/small cell), bronchoscopy (central lesions), transthoracic needle biopsy (peripheral)

What are common causes of cystoceles in women

Childbirth, constipation, violent coughing, heavy lifting

How does ALL present

Children 3-7 years old + lymphadenopathy + bone pain + bleeding + fever

Tibial plateau fractures are commonly seen in what patient population

Children in MVA

What is the difference in calculating burns in children as compared to adults

Children's head is 18% total, legs are 14% total

Bacterial pneumonia associated with college kids, sore throat, long prodrome

Chlamydia pneumonia

How do you manage cholelithiasis

Cholecystectomy or if asymptomatic: observation/Ursodeoxycholic to dissolve stone

What hormone aids in the breakdown of fats & proteins via stimulation of pancreatic release of trypsin, amylase and lipase

Cholecystokinin (CCK)

Patient is a 45-year-old female presenting with a complaint of RUQ pain that has been ongoing for the past 2 days. Patient states that she has noticed her eyes have started to turn yellow. She notes that she has felt feverish and in office temperature is 38.2 C. What does this patient likely have

Choledocholithiasis

Gallstones in the gallbladder without inflammation is called

Cholelithiasis

How do you manage pruritus caused by cirrhosis

Cholestyramine (Questran which is a bile acid sequestrant)

How do you manage Alzheimer disease

Cholinesterase inhibitors such as Donepezil or tacrine

What is the most common cause of spontaneous abortion

Chromosomal abnormalities

Patient is a 60-year-old female with shortness of breath of recent onset. She has a six-year history of Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring. Obstruction or secretions in larger airways are frequent causes of rhonchi and is on oxygen at home. Physical assessment reveals the following: respiratory rate 32, slightly labored, temperature 98.9F. Her SpO2 is 90% while receiving oxygen via nasal cannula at 2 Lpm. What does this patient have

Chronic bronchitis: COPD

Hyperphosphatemia is associated with what disease

Chronic kidney disease

What is the most common secondary cause of hyperparathyroidism

Chronic kidney disease

Patient is a 60-year-old male complains of fatigue, blood tests demonstrate severe anemia, decreased neutrophil count, and small, abnormal B lymphocytes in the bone marrow (>30%) with levels at 90,000 per cubic millimeter. Has painless cervical lymphadenopathy and hepatosplenomegaly. What does this patient have

Chronic lymphocytic leukemia

Patient is a 49-year-old healthy male complains of no symptoms, but on a routine complete blood count (CBC) has a markedly increased white blood cell count of 40,000 per uL (normal 4500 - 11,000). A peripheral blood smear demonstrates leukocytosis with myeloid cells present at various stages of differentiation, with more mature cells present at a greater percentage than less mature cells. The cytogenetic analysis is positive for the Philadelphia chromosome. What does this patient have

Chronic myelogenous leukemia (CML)

What is the most important risk factor for the development of COPD

Cigarette smoking/exposure

How do you treat septic arthritis in IV drug abusers due to pseudomonas

Cipro or Levaquin

How do you prophylactically treat patients exposed to someone with meningitis

Ciprofloxacin 500 mg PO x 1 dose or Rifampin

What is post exposure prophylactic treatment for meningitis

Ciprofloxacin or Rifampin

How do you treat osteomyelitis due to puncture wounds

Ciprofloxacin or levofloxacin

How do you treat puncture wounds if through the shoe

Ciprofloxacin to cover for pseudomonas

Irreversible liver fibrosis with nodular regeneration secondary to chronic liver disease is called

Cirrhosis

Describes the 4 classes of NYHA functional classification of heart failure

Class 1: no limitations, Class 2: Comfortable at rest, slight limitation of physical activity, Class 3: comfortable at rest, marked limitation of physical activity, Class 4: discomfort at rest

Patient is a 65-year-old male presenting with a 5-month history of progressively worsening right calf pain upon walking. He describes the pain as a tightening or cramping, and it comes on after walking two blocks. The pain forces him to stop walking and is relieved after he sits down for 10 min. He can then resume walking again. What is this patient experiencing

Claudication

Patient is a 23-year-old woman arrives at the emergency room after a biking accident. She reports acute pain after falling on her shoulder. On physical exam, there is swelling, erythema, and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is noted. Distal pulses are intact, and there is no motor or sensory deficits. What does this patient have

Clavicle fracture

How do you manage diverticulitis

Clear liquid diet, Ciprofloxacin or Bactrim + Metronidazole

How do you treat hand-foot-mouth disease

Clear ups within 10 days, recommend good hygiene

How do you treat MSSA osteomyelitis in patients >4 months old in patients allergic to penicillin

Clindamycin or Vancomycin

How do you diagnose varicose veins

Clinical but can use duplex ultrasonography

How do you diagnose Parkinson's disease

Clinical impression, neuropathologic exam is gold standard, can test response to dopamine

What is the Well's criteria for PE

Clinical signs of DVT, PE is number 1 diagnosis, heart rate >100, immobilization > 3 days or surgery in previous 4 weeks, history of DVT/PE, hemoptysis, history of malignancy within past 6 months

What is the drug of choice for hypertensive urgency

Clonidine

What is type of diarrhea is usually due to iatrogenic factors, especially by taking clindamycin

Clostridium Difficile

What type of headache more commonly presents in middle age males with unilateral periorbital/temporal sharp, lancinating temporal pain lasting <2 hours

Cluster

Bacterial pneumonia associated with valley fever, common in dry states

Coccidioides

What fungal pneumonia presents as a patient with non-remitting cough/bronchitis non-responsive to conventional treatments

Coccidioides (valley fever)

A CD4 count of < or = 250 suggest what opportunistic infection

Coccidioidomycosis

How do you manage concussion syndrome

Cognitive and physical rest

What is the diagnostic test of choice for suspected colorectal cancer

Colonoscopy

What test should you order for hematochezia

Colonoscopy

What is the USPSTF colorectal screening guidelines for those who had a first degree > or = 60 with colorectal cancer

Colonoscopy every 10 years starting at age 40

What is the USPSTF colorectal screening guidelines for those who had a 1st degree relative <60 with colorectal cancer

Colonoscopy every 5 years starting at age 40 or 10 years before the age the relative was diagnosed

Patient is a 54-year-old African American male presenting with a complaint of rectal bleeding and inability to pass stools for the past 3 days. Patient notes that his eats a lot of steak and burgers. You order a CBC and note iron deficiency anemia. What does this patient likely have

Colorectal cancer

How do you diagnose cervical cancer

Colposcopy with biopsy

How do you treat AML

Combination chemotherapy vs bone marrow transplant

How do you treat Hodgkin's lymphoma

Combination chemotherapy, radiation (low risk patients)

How do you treat ALL

Combination chemotherapy, stem cell transplant if relapse

Describe stage I acne vulgaris

Comedones +/- papules and pustules

What is the common etiology of hepatocellular carcinoma

Commonly metastatic from lung or breast malignancies

Lobar consolidation is seen in what type of pneumonia

Community acquired

How do you diagnose compartment syndrome

Compartment pressure > 30-45 mmHg, elevated CK and myoglobin

Patient is a 33-year-old man who has undergone ORIF of the left tibia. Fifteen hours postoperatively, the patient complains of increased pain and swelling of his left leg. His pain is unrelieved by medication, he is experiencing numbness, tingling, and loss of function in the extremity. Physical examination demonstrates decreased sensation and painful paralysis of his toes along with diminished pedal pulses on the affected side and coolness with a loss of color in the area. What does this patient have

Compartment syndrome

What should you watch for postoperatively after reperfusion of a limb

Compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI

EEG shows interictal spikes with slow waves in the temporal area plus aura plus consciousness impaired, what type of seizure is this

Complex partial

How do you manage prepatellar bursitis

Compressive wraps + NSAIDs +/- aspiration and immobilization for 1 week, +/- corticosteroid injection

Patient is a 40-year-old married promiscuous male patient who admits to having recent intercourse with a male prostitute during a recent trip to Las Vegas. On physical exam you note several raised, cauliflower-like lesions in clusters on the shaft of his penis. What does this patient have

Condyloma acuminatum: genital warts

A primigravida (women who is pregnant for the 1st time) patient with bilateral painful breast engorgement most likely has

Congestive mastitis

How do you treat avascular necrosis of hip

Conservative treatment, joint replacement, bisphosphonates

How do you manage LCL tear

Conservatively with bracing and therapy vs surgery if grade III injury

What is the common cause of salmonella typhi (enteric fever)

Consumption of fecally contaminated food or water

How do you definitively diagnose Boerhaave syndrome

Contrast esophagram preferably with Gastrografin looking for leakage

What non-hormonal therapies can you recommend to menopausal women

Cool temps, heat avoidance, avoid: spicy foods, beverages, avoid ETOH, soy

What is the most effective emergency contraception that also provides long lasting contraception

Copper IUD

What is the appearance of Diffuse Esophageal Spasm on esophagram

Corkscrew

What is the gold standard/definitive in diagnosing angina

Coronary angiography

What is the gold standard for diagnosing Prinzmetal angina

Coronary angiography with injection of provocative agents into the coronary artery

What causes the transient ST-segment elevation seen with prinzmetal angina

Coronary artery vasospasms

What can you use in a patient with mono that develops airway obstruction due to lymphadenopathy, hemolytic anemia or severe thrombocytopenia

Corticosteroids

How does acute bronchitis present

Cough that persists > 5 days.

What is the cause of hand-foot-mouth disease

Coxsackievirus type A

Hereditary unconjugated hyperbilirubinemia characterized by either no glucuronosyltransferase (UGT) activity - Type I or little UGT activity (< or = 10% of normal) - type II, is called

Crigler-Najjar Syndrome

Patient is a newborn presenting with a complaint of jaundice which has seem to be worse during the 2nd week. You note signs of kernicterus (bilirubin induced encephalopathy: hypotonia, deafness, lethargy, oculomotor palsy). What does this newborn likely have

Crigler-Najjar Syndrome Type I

Patient is a 25-year-old while female complaining of RLQ pain and weight loss. What does this patient likely have

Crohn disease

How do you test for AC joint separation

Cross chest test

How is shigella commonly spread

Crowded conditions such as day cares

How do you manage DIC

Cryoprecipitate, fresh frozen plasma, platelet transfusion if <30K, heparin

How do you treat verrucae

Cryotherapy or salicylic acid

Which fungal pneumonia is found in soil and can disseminate causing meningitis

Cryptococcus

What is the most common cause of chronic diarrhea in patients with AIDs

Cryptosporidium Superficial inflammation/irritation of the stomach mucosa with mucosal injury is called? Gastritis

Within regard to acute pancreatitis, what is periumbilical ecchymosis called

Cullen's sign

How do you diagnose cellulitis

Culture if purulent and follow up in 48 hours

How do you diagnosis salmonella

Culture: blood, stool, urine; will see elevated WBC and low platelets

What is the most common cause of bronchiectasis

Cystic fibrosis

Patient is a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn't fully emptied after urinating. What does this patient have

Cystocele: bladder hernia

What is the gold standard for diagnosing bladder cancer

Cystoscopy with biopsy

What is the recommendation for cervical cancer screening in women ages 21-29 years old

Cytology alone every 3 years

What test can be used to rule out a negative D-dimer in low risk patients

D-dimer

How do you manage von Willebrand disease

DDAVP: desmopressin vs transfusion of blood clotting factors containing vWF if excessive bleeding

Abnormal activation of the coagulation cascade leading to the formation of microthrombi leading to simultaneous bleeding and thrombosis

DIC

Patient is a 78-year-old female complaining of generalized pain and edema in her left leg. She denies chest pain, shortness of breath, and hemoptysis. She takes 2.5 mg warfarin daily for atrial fibrillation and her INR is 2.6. On physical examination the patient experience calf pain with dorsiflexion of the left foot. What does this patient likely have

DVT

Localized urticaria appearing where the skin is rubbed is called

Darier's sign

How do you manage stage 3-4 pressure ulcer

Debridement of necrotic tissue (scalpel if dry, mechanical if wet), if wet use absorptive dressings (calcium alginates, foams, hydrofibers), if dry use occlusive dressing (hydrocolloids and hydrogels) +/- wound vacuum

How do you manage Achalasia

Decrease LES pressure via botulinum injection, nitrates, CCBs, pneumatic dilation of LES

How do you manage a SAH

Decrease mechanism of straining (provide stool softeners, bedrest, antianxiety meds), manage hypertension, surgery: clipping or wrapping of aneurysm

How do you workup early pregnancy bleeding

Decreased beta HCG and ultrasound findings

What labs are seen with hypocalcemia

Decreased calcium, decreased PTH, increased phosphate

How does pneumothorax present on chest x-ray

Decreased peripheral lung markings

How do you diagnose HUS

Decreased platelets + anemia + renal failure

How do you diagnose TTP

Decreased platelets + anemia + schistocytes + negative coombs test

How do you diagnose DIC

Decreased platelets, increased bleeding time, increased PT/PTT, positive d-dimer

What causes Parkinson's disease

Degeneration of the basal ganglia in the substantia nigra

Patient is a 77-year-old female who for the past 4 days, has been crying easily, confused, and rambling incoherently. Her medical history is remarkable for mild dementia and well-controlled hypertension. She has never had anything like this in the past and she has not had any recent changes to her medications. When questioned, she has no difficulty articulating a sentence but difficulty remembering what she was asked. Laboratory testing is significant for leukocytosis. What is this patient experiencing

Delirium

What is a Hill-Sachs lesion

Dent in the humeral head or more properly a compression chondral injury of the posterior superior humeral head following glenoid impaction

The prognosis of melanoma is strongly associated with what

Depth of lesion

In patients with mono what can happen if you treat them with Ampicillin

Development of maculopapular or petechial rash

What comorbidity puts patients at the highest risk of having coronary artery disease

Diabetes

Low urine sodium, high serum sodium, urine osmolality <250 and polyuria indicate

Diabetes insipidus

What are common causes of hypernatremia

Diarrhea, burns, diuretics, hyperglycemia, diabetes insipidus

What should be on your ddx for Achalasia

Diffuse Esophageal Spasm - non-peristaltic esophageal contractions and Zenker's diverticulum

What can be used for elective abortion in up to 18 weeks

Dilation and evacuation (D&E)

What causes Alzheimer

Diminished acetylcholine, loss of brain cells, beta-amyloid plaques and neurofibrillary tangles

What is the most common mechanism of injury for clavicle fracture

Direct fall on the shoulder, direct blow to lateral aspect of the shoulder, birth trauma (newborns)

What type of inguinal hernia is medial to inferior epigastric artery, found within Hesselbach's triangle and doesn't reach the scrotum

Direct inguinal hernia

What is the mechanism of LCL tear

Direct-force trauma to the inside of the knee causing varus stress

What components make up the female athlete triad

Disorder eating, amenorrhea, osteoporosis

What are some signs seen on physical exam with suspected SBO

Distention, hyperactive bowel sounds early, hypoactive bowel sounds late

How do you manage Meniere's disease

Diuretics, salt restriction, unilateral CN 8 ablation in severe cases

How do you manage Zenker's Diverticulum

Diverticulectomy, cricopharyngeal myotomy

Patients is a 48-year-old male complaining of LLQ pain. When asked about his diet patient states that he doesn't get a lot of fiber and is usually constipated. He has an in-office temperature of 38 C. You notice leukocytosis on CBC and positive guaiac. What does this patient likely have

Diverticulitis

What is the most common cause of lower GI bleeding

Diverticulosis

How do you diagnose benign positional vertigo

Dix-hallpike maneuver

How do you treat Lyme disease in early stage

Doxycycline BID x 10-21 days (Azithromycin or Erythromycin if Doxy contraindicated or PCN allergic)

What are triggers of TTP

Drugs (quinine, clopidogrel, cyclosporine), SLE, infections, AIDs, malignancies

What are other causes of secondary amenorrhea

Drugs, herbals, hormonal meds, stress, weight changes, eating disorders, exercise, premature ovarian failure (FSH is >40)

Hereditary conjugated hyperbilirubinemia due to decrease hepatocyte excretion of conjugated bilirubin (gene mutation MRP2) is called

Dubin-Johnson Syndrome

What are the top 3 cause for nipple discharge

Duct ectasia, intraductal papilloma and carcinoma

What is the most common type of pancreatic carcinoma and what part of the pancreas is it most commonly found

Ductal adenocarcinoma and head of pancreas

What part of the small intestine is responsible for most SI absorption and rate control of gastric emptying

Duodenum

How do you diagnose carotid disease

Duplex doppler ultrasound (>50% stenosis is moderate and >70% is severe)

Patient is a 35-year-old woman with concerns about heavy menstrual periods for the past year that occur at irregular intervals. She explains that sometimes her menses comes twice a month, but other times will skip two months in a row. Her menses may last 7 to 10 days and require 10 to 15 thick sanitary napkins on the heaviest days. She admits to some fatigue, but she denies any lightheadedness. She has no pain with menses or intercourse and denies any vaginal discharge. She has had normal Pap smears in the past. She is in a stable monogamous relationship with her husband and denies a history of STIs. On physical examination, her blood pressure is 120/ 80 mm Hg and her body mass index (BMI) is 32. Her pelvic examination is normal. What does this patient have

Dysfunctional uterine bleeding

Patient is a 13-year-old with a pruritic vesicular eruption comprised of clear, deep-seated vesicles without erythema erupting on the lateral aspects of fingers, the central palm, and plantar surfaces. What does this patient have

Dyshidrosis also called pompholyx

Patient is a 19-year-old nulligravid college female who complains of dull, throbbing, cramping lower abdominal pain during menses for the past three years. She reports nausea and vomiting during menses but denies irregular or heavy periods, pain with intercourse, or abdominal pain outside of menses. Pain tends to peak 24 h after onset of menses and subsides after 2 to 3 days. A pelvic exam is normal. What does this patient have

Dysmenorrhea

What are some ALARM symptoms associated with GERD

Dysphagia, odynophagia, wt loss, bleeding (suspect malignancy)

How does emphysema present

Dyspnea most common symptom, cachectic, pursed lip breathing, hyperresonance, barrel chest, absent breath sounds

What is the most common bacterial cause of cholecystitis

E. Coli

What are the most common causes of bacterial meningitis in neonates

E. coli (gram negative rods) and S. agalactiae (group B streptococcus)

What is the initial test of choice in someone with angina

ECG

What should your workup of syncope include

ECG, pulse ox, possibly echocardiography, tilt table testing

How do you treat lead poisoning

EDTA

What test should you order for melena

EGD

What is the diagnostic test of choice for Mallory-Weiss tears, peptic ulcer disease and suspected malignancies

EGD (Esophagogastroduodenoscopy)

What should your workup of unstable angina include

EKG and stress testing, but angiography is gold standard

How do you acutely manage NSTEMI

EKG within first 10 minutes, MONA: morphine, oxygen (4L/min), nitroglycerin (sublingual), aspirin (160-325 mg)

What test is used to screen for HIV

ELISA test

What is the diagnostic test of choice in suspected choledocholithiasis

ERCP

What is the most sensitive test for chronic pancreatitis

ERCP

What study is used to dx & tx disorders of the bile ducts or the pancreatic ducts (gallstones, tumors, infex, cholangitis)

ERCP - Endoscopic Retrograde Cholangiopancreatography

What is the gold standard for diagnosing cholangitis

ERCP or percutaneous transhepatic cholangiography

How do you manage choledocholithiasis

ERCP stone extraction

How do you manage inoperative pancreatic carcinoma

ERCP with stent placement

What are risk factors for developing cervical cancer

Early sex, multiple partners, cigarette smoking

What should your workup of right heart failure include

Echo and doppler, gold standard is right heart cardiac catheterization

What is the best test for diagnosing CHF

Echocardiogram

What does the above image show

Ecthyma (type of impetigo)

All women with early pregnancy bleeding and pain are assumed to have what until otherwise excluded

Ectopic pregnancy

Patient is a pruritic dry scaly areas on the flexure surfaces of both hands. The skin is thickened and edematous with papules and plaques as well as erosions and some crusts. The patient states he has had similar lesions since he was a child. What does this patient have

Eczema

What does the atopic triad include

Eczema, allergic rhinitis, asthma

Name 3 examples of nucleoside reverse transcriptase inhibitors (NRTI)

Efavirenz (Sustiva), Delavirdine (Rescriptor), Etravirine (Intelence)

Patient is a 43-year-old female complaining of intermittent rectal bleeding and perianal pain that is made worse with defecation. What does this patient likely have

Either external or internal hemorrhoid

Explain Hawkins test

Elbow is flexed at 90 degrees, shoulder is abducted at 90 and there is anterior shoulder pain with internal rotation

When are antibiotics indicated in the treatment of acute bronchitis

Elderly, underlying cardiopulmonary diseases + cough > 7-10 days, immunocompromised

How do you diagnose Graves disease

Elevated T3 and presence of anti-thyrotropin antibodies

What labs are associated with osteomyelitis

Elevated WBC, elevated ESR, elevated CRP

What lab values are seen with acute pancreatitis

Elevated lipase, Amylase x 3, elevated ALT, hypocalcemia, leukocytosis, elevated triglycerides, elevated bilirubin, elevated glucose

What are the CSF findings of bacterial meningitis

Elevated protein, decreased glucose, markedly increased opening pressure

How do you manage epidural hematoma

Emergent surgical craniotomy + managing of intracerebral pressure with mannitol, hyperventilation, steroids/ventricular shunt

How do you treat psoriasis

Emollients, vitamin D analogs, topical retinoids

Patient is a 65-year-old male complaining of fatigue and shortness of breath with exertion. The patient reports minimal cough. On physical exam you note a thin, barrel chested man with decreased heart and breath sounds, pursed-lip breathing, end-expiratory wheezing, and scattered rhonchi. Chest X-ray reveals a flattened diaphragm, hyperinflation and a small, thin appearing heart. PFTs show a decreased FEV1 / FVC ratio. What does this patient have

Emphysema: COPD

What test are used for supraspinatus tear or inflammation

Empty can: best, full can, drop arm

Viral infection of the brain parenchyma is known as

Encephalitis

What are some PPI examples

End with Azoles (omeprazole, pantoprazole, esomeprazole)

What are some examples of H2 receptor antagonists

End with Tidines (cimetidine, ranitidine, famotidine)

What is the initial treatment of choice for volvulus

Endoscopic decompression, 2nd line is surgical correction

How do you manage esophageal webs & rings

Endoscopic dilation if no reflux, antireflux surgery if reflux present

What is the treatment of choice for esophageal varices

Endoscopic ligation

How do you treat bladder carcinoma

Endoscopic resection with cystoscopy every 3 months

What is the gold standard for diagnosing PUD

Endoscopy

What is the gold standard for diagnosing gastritis

Endoscopy

How do you diagnose esophageal varices

Endoscopy (enlarged veins)

What is the gold standard for diagnosing H. pylori

Endoscopy with biopsy (use urea breath test if endoscopy unavailable)

How do you workup heartburn/dyspepsia

Endoscopy, manometry, 24-hour pH probe, barium esophagography

What is the initial test for diagnosing GERD

Endoscopy, use manometry if endoscopy is normal

What is the underlying pathophysiology of emphysema

Enlarged air spaces due to destruction of alveolar septae

Patient is a 43-year-old Caucasian male who spent the past month on a business trip in the Caribbean. Two weeks following his return, he began experiencing pea soup diarrhea, pain in his abdomen, and a headache. He presents to the hospital and is noted to be febrile with discrete, blanching, rose-colored spots on his back, chest, and abdomen. What does this patient have

Enteric fever salmonellosis

How do you manage a TIA

Enteric-coated aspirin or clopidogrel (Plavix), control modifiable factors

What type on invasive diarrhea is caused by undercooked ground beef, unpasteurized milk/apple cider and daycare centers

Enterohemorrhagic E. Coli 0157:H7

What is the most common cause of traveler's diarrhea

Enterotoxigenic E. Coli (eating unpeeled fruits and drinking unsanitary water)

What is the most common cause of viral meningitis

Enterovirus family (echovirus, coxsackie)

What are the causes of aseptic meningitis

Enterovirus, HSV, TB, fungus

What is considered a 4th degree burn

Entire skin into underlying fat/muscle/bone, painless

How do you diagnose Coccidioides pneumonia

Enzyme-linked immunoassays (EIA) for IgM and IgG followed by confirmatory immunodiffusion if EIA positive

Describe a stage 2 pressure ulcer

Epidermal damage extending into the dermis, looks pink or like a blister/abrasion

What is considered a 2nd degree partial thickness burn

Epidermis + superficial portion of dermis (papillary), erythematous, pink, blistering, moist, weeping, very painful, cap refill intact

What is considered a 2nd degree deep partial thickness burn

Epidermis into deep portion of dermis (reticular), red/yellow/white/dry/blistering not usually painful burn

What is considered a 1st degree burn

Epidermis only, think sunburn, cap refill intact

Patient is a 24-year-old snowboarder strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely. His CT scan demonstrates a lens-shaped, biconvex hyperdensity which does not cross the suture lines. What does this patient have

Epidural hematoma

A brain bleed on CT that is convex (lens shaped) is called

Epidural hematoma (arterial bleed)

How do you treat benign positional vertigo

Epley maneuver and meclizine

What virus is associated with Hodgkin's lymphoma

Epstein-Barr virus

A distinct form of cellulitis notable for acute, well-demarcated, raised superficial bacterial skin infection with lymphatic involvement is called

Erysipelas

Patient is a 4-year-old who is brought to the office by his mother. The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past 2 days has spread to the trunk, arms, and legs. What does this patient have

Erythema infectiosum

Type IV hypersensitivity reaction associated with herpes simplex virus that presents as non-pruritic target-like lesions that presents on extremities

Erythema multiforme

How do you manage C. jejuni diarrhea if severe

Erythromycin

How do you treat anemia of chronic disease

Erythropoietin if hemoglobin <10 (stop once hemoglobin reaches 11) and treat underlying case

How do you manage Stanford type n/Debakey III aortic dissections

Esmolol/labetalol are 1st line: target systolic blood pressure is 100-120 mmHg and pulse <60 bpm in 20 minutes, add nitroprusside if necessary

Patient is a 60-year-old African American female with a 10 year 1.5 ppd history of smoking and alcohol abuse complaining of initial difficulty swallowing solid food which has now progressed to fluids as well. ROS is positive for weight loss, hoarseness and chest pain. You note an enlarged left cervical node (Virchow's node) on physical exam. What does the patient likely have

Esophageal cancer

What is the diagnostic test of choice for Achalasia, nutcracker esophagus and can also be used to dx GERD

Esophageal manometry

What is the GOLD STANDARD for diagnosing Achalasia

Esophageal manometry, > 40 mmHg

How do you manage esophageal cancer

Esophageal resection, radiation therapy, chemotherapy (5-FU)

Thin membranes in the mid-upper esophagus are called

Esophageal webs

What are some complications of GERD

Esophagitis, strictures, barret's esophagus, esophageal adenocarcinoma

Patient is a 65-year-old patient with shaking that occurs with simple tasks such as tying his shoelaces, writing, or shaving. According to his wife, the symptoms are aggravated by stress, fatigue, caffeine, and changes in temperature. The patient reports his dad had the same symptoms. On physical examination, there is a 4-10 Hz tremor elicited when both of his arms are outstretched forward. There is no tremor at rest. What does this patient have

Essential tremor

How do you manage menopause

Estrogen and progesterone in symptomatic women, if uterus present use estrogen + progesterone, if no uterus use estrogen therapy

How do you manage absence (petit mal) seizures

Ethosuximide

How do you diagnose melanoma

Excision biopsy

How do you treat stage 0 cervical cancer

Excision via LEEP vs ablation vs TAH-BSO (Hysterectomy with bilateral oophorectomy)

What test is performed after completing an ECG in someone with angina

Exercise stress testing or pharmacologic stress test (adenosine or dipyridamole)

How do you diagnose pneumothorax

Expiratory chest films

What is considered a 3rd degree full thickness burn

Extend through entire skin, waxy, white, leathery, painless

Describe stage 4 pressure ulcer

Extends into muscle, tendon or bone

How do you manage anaplastic thyroid carcinoma

External beam radiation, chemotherapy, palliative tracheostomy

Inferior hemorrhoid veins distal to the dentate line is called

External hemorrhoid

How do you definitively diagnose menopause

FSH >30 mIU/mL

Burns of what location of the body are considered major burns

Face, hands, perineum, feet, cross major joints or circumferential

How does rosacea present

Facial erythema, telangiectasis, rhinophyma, no comedones due to heat, alcohol or spicy foods

Name 2 x-linked bleeding disorders

Factor VIII and factor IX (hemophilia)

What is the mechanism of injury for AC joint separation

Fall directly to the shoulder or outstretched hand

What is the mechanism of injury for anterior shoulder dislocations

Fall on an outstretched arm (full abduction and extension)

True or false, the pancreas only functions as an endocrine gland

False, it functions as exocrine and endocrine

True or false, a femoral hernia is superior to the inferior inguinal ligament

False, it is inferior to the inferior inguinal ligament

What are some genetic risk factors for the development of colorectal cancer

Familial adenomatous polyposis, Lynch syndrome (Hereditary nonpolyposis colorectal cancer), Peutz-Jehgers

If bilirubin is elevated without elevated LFTs, what should you suspect

Familial bilirubin disorders such as Dubin-Johnson Syndrome and Gilbert Syndrome

How do you treat compartment syndrome

Fasciotomy and decompression of pressure

What foods/drinks should you recommend pt's with GERD avoid

Fatty, spicy, citrus, chocolate, caffeine, peppermint, alcohol

What is the most common cause of appendicitis

Fecalith

How is hepatitis A transmitted

Feco-orAl (homosexual men, contaminated water, shellfish)

What are the risk factors for postoperative nausea and vomiting

Female, nonsmoker, history of motion sickness or previous post-op nausea/vomiting, post-op opioids

What type of hernia is seen more commonly in women as opposed to men

Femoral

How do you treat iron deficiency anemia

Ferrous sulfate 30 minutes prior to meals, along ascorbic acid to increase absorption

What is the class triad of Epstein Barr mononucleosis

Fever + posterior cervical lymphadenopathy + pharyngitis

What is the classic triad of meningitis

Fever >38 C, nuchal rigidity, headache

How does bacterial pneumonia present

Fever, dyspnea, tachycardia, tachypnea, cough +/- sputum

How does TB present

Fever, night sweats, anorexia, weight loss

How does osteomyelitis present

Fever, restriction of movement of involved extremity, pain/tenderness/inflammation of joint

Patient is a 27-year-old female with a painless mass in the left breast. She discovered this mass three months ago while showering and reports it has been unchanged since that time. Her last menstrual period was 10 days ago. There is no family history of breast cancer. On physical exam, you palpate a 3 cm, firm, and non-tender mass in the upper lateral quadrant of the left breast. The mass is smooth, well-circumscribed, and mobile. There are no skin changes, nipple discharge, or axillary lymphadenopathy. What does this patient have

Fibroadenoma

Patient is a 30-50-year-old female complaining of painful/tender, swollen lumpy breast. Patient notes that the lumps tend to increase/decrease in size depending on her menstrual period. On physical exam you note multiple, mobile, well defined lumps that are tender to touch. What does this patient likely have

Fibrocystic breast disorder

What is the most common cause of unilateral or bilateral green, straw-colored or brown nipple discharge in premenopausal women

Fibrocystic disease

How do you rule out cancer in a cold thyroid nodule

Fine needle aspiration

How do you diagnose fibrocystic breast disorder

Fine needle aspiration (strawberry colored fluid, no blood) + ultrasound/mammogram

What is the treatment of choice for fibroadenomas

Fine needle biopsy or excision biopsy, most small tumors absorb with time

2 separate fractures in 3 or more consecutive ribs is called

Flail chest

What is the classic triad of renal cell carcinoma

Flank pain, hematuria, palpable abdominal/renal mass

Describe actinic keratosis

Fleshed-colored, pink or yellow brown lesion with rough sandpaper feel that occurs on sun-exposed surfaces

What is the diagnostic test of choice for ulcerative colitis

Flex sigmoidoscopy

What area does atopic dermatitis most commonly occur

Flexor creases

What is the most common viral cause of viral pneumonia

Flu

What is the treatment for Coccidioidomycosis

Fluconazole

How do you treat candida vaginitis

Fluconazole 150 mg PO x 1 then repeat in 7 days

How do you treat Coccidioides pneumonia (valley fever)

Fluconazole or itraconazole

How do you treat pulmonary aspergillosis

Fluconazole or itraconazole

What is the 1st line treatment for Cryptococcus

Fluconazole, 2nd line is Amphotericin

How do you manage vibrio cholerae diarrhea

Fluid replacement, tetracyclines or fluoros

How do you manage diarrhea

Fluid repletion (PO preferred), bland low-residue diet (BRAT), anti-motility agents [(bismuth subsalicylate (pepto), opioid agonists (Lomotil, Immodium), Anticholinergics], antiemetics [(ondansentron) or dopamine blockers (prochlorperazine (Compazine), promethazine (Phenergan), Metoclopramide (Reglan)]

How do you treat giardia lamblia

Fluids + metro (fluoros in children)

How do you manage Enterotoxigenic E. Coli

Fluids +/- bismuths, fluoros if severe

How do you treat shigella

Fluids, if severe: Bactrim is 1st line, can use fluoroquinolones or cipro or ceftriaxone

How do you manage salmonella

Fluids, if severe: fluroquinolones (cipro or levofloxacin), ceftriaxone or azithromycin or Bactrim

How do you manage salmonella diarrhea if severe

Fluoros

How do you treat folate deficiency anemia

Folate 400 to 1000 micrograms per day

Patient is a 43-year-old alcoholic man who arrives at the hospital with alcohol withdrawal. He confabulates and trembles uncontrollably. He is started on supportive therapy for now. Bloodwork comes back with macrocytic megaloblastic anemia, an increased homocysteine, normal methylmalonic acid. What does this patient have

Folate deficiency anemia

What is the most common type of thyroid nodule

Follicular, >90% of thyroid nodules are benign

What is the mechanism of injury for PCL injury

Force to knee while flexed: dashboard knee

Patient is a 2-year-old male child who is brought to the emergency department by his mother with a sudden onset of choking, gagging, coughing, and wheezing. Vital signs are temperature 37 ° C; pulse 120/ min; and respirations 28/min. The physical examination reveals decreased breath sounds over the right lower lobe with inspiratory rhonchi and localized expiratory wheezing. The chest X-ray reveals normal inspiratory views but expiratory views show localized hyperinflation with mediastinal shift to the left. What has likely occurred in this patient

Foreign body aspiration

What is a Bankart lesion

Fracture of the anterior inferior glenoid, post humeral head impaction to glenoid

What are common causes of compartment syndrome

Fractures, crush injuries, burns, tight casts

How do you treat asymptomatic hyponatremia

Free water restriction

What is Boerhaave syndrome

Full thickness rupture of the distal esophagus due to repeated forceful vomiting or perforation during endoscopy

Describe stage 3 pressure ulcer

Full thickness/dermal loss of skin extending into subcutaneous layer

Rapid liver failure + hepatic encephalopathy is called

Fulminant Hepatitis (Acute Hepatic Failure)

What is the most specific test for hemophilia

Functional assay for factor 8 or 9

Infection of the hair follicle that has a small collection of pus

Furuncle

How do you diagnose G6PD deficiency

G6PD assay shows Heinz bodies and bite cells

Patient is a 20-year-old healthy male was treated 4 days ago for an MRSA skin infection with sulfamethoxazole-trimethoprim (Bactrim). The infection is improving but he is increasingly weak and his sclera have turned yellow. Today his hemoglobin is 11 g/ dL (13.5 to 18 g/ dL) and his MCV is 85 (80 to 100 fL); the corrected reticulocyte count is elevated, he has an increased indirect bilirubin and decreased haptoglobin. The peripheral smear demonstrates bite cells and Heinz bodies. What does this patient have

G6PD deficiency

What is the MC cause of erysipelas

GABHS

What is the difference in CSF findings for Guillain-Barre Syndrome as compared to meningitis

GBS has normal glucose and increased protein

Transient relaxation of lower esophageal sphincter due to increased gastric acid, LES incompetence, esophageal motility disorders, delayed gastric emptying or hiatal hernia is called

GERD

What are the most common causes of heartburn and dyspepsia

GERD or PUD

What are the 2 most common causes of acute pancreatitis

Gallstones and alcohol

How do you manage gastric carcinoma

Gastrectomy, radiation and chemotherapy

What type of PUD is worse with meals (1-2 hours after) and common in 55-70 yo

Gastric

Patient is a >40-year-old male complaining of dyspepsia, weight loss, early satiety and abdominal pain. Patient's history is notable for alcohol and tobacco use. When asked about his diet patient states that he eats a lot of sandwich meat. Patient also reports dark stools. What does this patient likely have

Gastric carcinoma

Hormone that stimulates stomach acid secretion and motility

Gastrin

What 3 hormones are responsible for the stimulation of parietal cells

Gastrin, Histamine, Acetylcholine

Superficial inflammation/irritation of the stomach mucosa with mucosal injury is known as

Gastritis

Patient is a 21-year-old bodybuilder presents with complaints of diarrhea, cramps, and low-grade fever for 24 hours. He has been training for a competition, eating large amounts of protein, including shakes made with raw eggs. He reports three stools with blood and mucous in the commode today. What does this patient have

Gastroenteritis salmonellosis

What should your workup include in a case of recurrent, spontaneous abortions (2-3 consecutive abortions)

Genetic testing of parents, thyroid (hypo/hyper), autoimmune (SLE and anticardiolipin antibodies)

What type of protozoan causes frothy, greasy, foul diarrhea after ingesting contaminated water from remote streams/wells

Giardia Lamblia (aka Beaver's fever or Backpacker's diarrhea) - boil water x 1 minute

Hereditary unconjugated hyperbilirubinemia characterized by reduced UGT activity (10-30% of normal) and decreased bili uptake is called

Gilbert's Syndrome

How do you treat CML

Gleevec (Imatinib)

Patient is a 66-year-old male with chronic right shoulder pain and crepitus. On physical exam his rotator cuff strength is 5/5. He has pain with both passive and active range of motion. An MRI is performed and shows no evidence of a rotator cuff tear. What does this patient have

Glenohumeral joint osteoarthritis

What does the mnemonic GALAW for Ranson's criteria upon admission stand for

Glucose >200 mg/dL, Age >55, LDH >350 IU/L, AST >250 IU/dL, WBC >16,000

What are patients with polycythemia predisposed to

Gout, DVT, PE, stroke

How do you treat varicose veins

Graduated compression stockings, leg elevations, exercise, Unna boot for large ulcers, endovenous radiofrequency or laser ablation, compression sclerotherapy, surgical stripping of saphenous tree

What are the most common bacterial causes of acute cholangitis

Gram negative E. Coli (1st) and Klebsiella (2nd)

Pt is reported to have tonic-clonic like movements with a postictal state, what type of seizure is this

Grand mal

What is the most common cause of hyperthyroidism

Graves disease

What is indicative of stable angina on ECG

Greater than 1 mm ST depression +/- T wave flattening or inversion

Within regard to acute pancreatitis, what is flank ecchymosis called

Grey Turner's sign

What is the most common cause of septic arthritis in neonates

Group b strep

Pt presents with a complaint of weakness/paresthesias that started in feet and have now seemed to work its way up. Pt also reports tachycardia and difficulty breathing. What does this patient most likely have

Guillain Barre syndrome

What are the common bacterial causes of cellulitis in adults

H. influenzae or strep pneumonia

What is the most common cause of gastritis

H. pylori

What are the 1st and 2nd most common causes of gastritis

H. pylori and NSAIDs/Aspirin

What is the most common cause for PUD

H. pylori, followed by NSAIDs

What is the 3rd stage in managing GERD

H2RA, PPI & prokinetic agents (Cisapride)

How do you manage HIV

HAART therapy for patients with CD4 <350 or viral load by PCR-RNA >55,000

What is my mnemonic for child pugh classification staging for cirrhosis

HAPTS (Hepatic encepatholopathy, Ascites, PT INR, total bilirubin, serum albumin)

What acronym identifies the 5 most important independent factors for increased likelihood of melanoma

HARMM: History of prior melanoma, Age >50, absence of a Regular dermatologist, a changing Mole, Male gender

Presence of what in the serum indicates active replication in liver

HBV DNA

Indicates acute hepatitis b infection

HBcAb (core antibody) - IgM

Indicated waning viral replication of hepatitis B and decreased infectivity

HBeAB (envelope antibody)

Increased viral replication and infectivity is signified by

HBeAg (envelope antigen)

Distant resolved infection (recovery) or vaccination (sole serologic marker) is signified by

HBsAb (surface antibody)

What is the 1st evidence of HBV infection

HBsAg (surface antigen)

What are some typical symptoms of GERD

HEARTBURN (pyrosis), regurgitation (sour taste in mouth), dysphagia, cough at night

There is a slightly increased risk for what with spermicide use

HIV

Patient is a 25-year-old white male who was recently discharged from the hospital with a diagnosis of bacterial pneumonia. His past medical history is significant for a nephrectomy after a motor vehicle accident 10 years ago, aseptic meningitis 12 months ago, and one prior episode of bacterial pneumonia 5 months ago. His physical examination is remarkable for oral thrush. A CD4 T-lymphocyte cell count was 30. What does this patient have

HIV (Human Immunodeficiency Virus)

What is used to monitor infectivity and treatment effectiveness in patients diagnosed with HIV

HIV RNA viral load

What is the recommendation for ages 30-65 years old

HPV & cytology every 5 years: preferred vs cytology alone every 3 years: acceptable

What HPV strain causes genital warts

HPV 6 and 11

Bell palsy is strongly associated with the reactivation of what

HSV

What is the most common cause of encephalitis

HSV

What is the most common cause of erythema multiforme

HSV

Bacterial pneumonia associated with COPD, smokers, postsplenectomy

Hamemophilus influenzae

Patient is a 2-year-old who is brought to the office by his mother. The child has had a low-grade fever, rash, and loss of appetite for the past two days. On physical exam, there are multiple 2-3-mm grey vesicular lesions on the bilateral palms and soles and several vesicles and ulcers on the oral mucosa. What does this patient have

Hand-foot-mouth disease

What is the rule of 9's in terms of burns

Head 9%, each arm 9%, chest 9%, abdomen 9%, anterior leg 9%, upper back 9%, lower back 9%, genitals 1%

What are some S/E of PPIs

Headache, diarrhea, B12 deficiency, increases levels of warfarin via C450 inhibition

What are some examples of minor criteria for diagnosing endocarditis

Heart condition, IV drug use, fever, vascular phenomena, immunologic phenomena

Swelling of distal interphalangeal joint is called

Heberden's node

How do you diagnosis beta thalassemia major

Hemoglobin A2 and F (minor only has A2)

How do you diagnose alpha thalassemia

Hemoglobin H

Patient is a 3-year-old boy whose mom is concerned about his prolonged nosebleeds. Ever since he was about 2 years old, he has had multiple episodes of nosebleeds that stopped only after hours. On physical exam, his right elbow is slightly swollen and tender to palpation. There is a family history of unexplained bleeding in the patient's maternal uncle. Lab results reveal increased PTT that corrects after mixing studies. Lateral radiograph of the knee shows swelling of the soft tissues from blood accumulation in the knee. What does this patient have

Hemophilia

How do you differentiate hemophilia from von Willebrand deficiency

Hemophilia has hemarthrosis while vWF does not

Menses that involve more blood loss > 7 days or > 80 mL during menses

Hemorrhagic or hypermenorrhea

What is the different for hematochezia

Hemorrhoids, anal fissures, polyps, proctitis, colorectal cancer

What is the treatment for PE

Heparin with bridging to LMWH or warfarin for a minimum of 3 months

Patient is a 50-year-old male with a history of alcohol abuse and hepatitis (B/C/D) complaining of abdominal pain. Patient states that he has been really tired and has noticed some weight loss. On exam you note jaundice and hepatosplenomegaly. What does this patient likely have

Hepatocellular carcinoma

What should you monitor in patients being treated for TB

Hepatoxicity and renal function

How does pityriasis rosea present

Herald patch, Christmas tree rash, URI prodrome thought to be associated with herpes virus 7

Patient a 42-year-old man with chest pain, difficulty swallowing, and heartburn after meals, especially when reclining. What does this patient likely have

Hiatal hernia

What is the gold standard for diagnosing acute cholecystitis

Hida scan = nonvisualization of the gallbladder

Patient is a 27-year-old obese female with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material. What does this patient have

Hidradenitis suppurativa

How do you treat severe persistent asthma

High dose ICS + LABA (Step 5) vs high dose ICS + LABA + oral steroids (step 6)

How do you manage diverticulosis

High fiber diet, fiber supplements, vasopressin if bleeding continues

How do you manage noncomplicated hemorrhoid

High fiber diet, increased fluids, sitz baths, topical corticosteroids

How do you treat nummular eczema

High or ultra high potency topical corticosteroids, phototherapy

What is the first line treatment for dyshidrosis

High strength topical steroids, second line is oral steroids, recommend avoidance of stress or direct contact with irritants

Hormone that is produce by ECL cells in response to gastrin release

Histamine

What is the MOA of H2 blockers

Histamine receptor blocker, reduces acid/pepsin secretion

Bacterial pneumonia associated with bat droppings and looks like sarcoidosis on CXR

Histoplasma capsulatum

What fungal pneumonia is characterized by pulmonary lesions that are often apical resembling TB, cough, dyspnea

Histoplasma capsulatum

A CD4 count of < or = 150 suggest what opportunistic infection

Histoplasmosis

Patient is a 21-year-old male presents with a cough and mild shortness of breath for three days. The cough is occasionally productive of yellowish mucus. He reports a low-grade fever with this episode but says that he has otherwise been healthy. He has spent the last month working in bat caves. He denies tobacco or alcohol use. What does this patient have

Histoplasmosis pneumonia (fungal)

How do you diagnose premenstrual syndrome

History and physical exam show 1 or more symptoms such as breast tenderness, abdominal bloating, headache, irritability, depression

What is a risk factor for developing testicular carcinoma

History of cryptorchidism

How do you diagnose delirium

History, CT or MRI, CBC, cultures, chest x-ray, plasma glucose

Your workup of palpitations should include

History, ECG, echo, CMP, CBC, TSH, urine toxicology

What are some atypical symptoms of GERD

Hoarseness, aspiration pneumonia, asthma, noncardiac chest pain

What is Epstein Barr virus associated with

Hodgkin lymphoma and Burkitt's lymphoma

Explain Neer test

Hold shoulder down, arm is fully pronated, and pain is elicited with forward flexion

Elevation of what is highly suggestive of progression of peripheral arterial disease

Homocysteine

Within regard to cluster headaches, ipsilateral ptosis, miosis, anhidrosis is called

Horner's syndrome

What is Kaposi sarcoma associated with

Human herpesvirus 8 and is an AIDs-defining cancer

What is another name for Epstein Barr virus

Human herpesvirus-4

How do you treat malignant hypertension

Hydralazine

What is secreted by parietal cells

Hydrochloric acid

What are some other common symptoms of Mallory Weiss syndrome

Hydrophobia, hematochezia, melena

What is the cause of acanthosis nigricans

Hyperinsulinemia and insulin resistance causing hyperpigmentation and hyperkeratotic plaques

Patient is a 62-year-old female complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The patient reports a history of recurrent kidney stones and depression. Radiographs show osteopenia and subperiosteal resorption on the phalanges (Bones, stones, abdominal groans and psychic moans). What does this patient likely have

Hyperparathyroidism

What is the cause of melasma

Hyperpigmentation due to increased estrogen

Milky discharge from multiple ducts in a woman who is nonlactating could be due to

Hyperprolactinemia or medications

How do you diagnose B12 deficiency anemia

Hypersegmented neutrophils, macrocytosis, normal folate, increased methylmalonic acid and homocysteine

What is the most important modifiable risk factor within regard to stroke

Hypertension

What is the most important predisposing factor for aortic dissection

Hypertension

Patient is a 34-year-old female complaining of irritability and nervousness, heat intolerance with increased sweating, and weight loss despite an increase in appetite. On physical exam, you note exophthalmos and pretibial myxedema. She has a pulse of 110, a fine tremor and 4+ deep tendon reflexes. Her hair is fine in texture and you note a palpably enlarged thyroid gland. What does this patient have

Hyperthyroidism

How do you treat severe hyponatremia

Hypertonic (3%) saline

What are some endocrine causes of tremor

Hypoglycemia, thyrotoxicosis, pheochromocytoma, adrenocorticosteroids

Muscle cramps, constipation, flattened/inverted T waves, U waves suggests

Hypokalemia

Muscle weakness, hyperreflexia, prolonged QT, PR and wide QRS, ventricular tachycardia, torsades de pointes suggests

Hypomagnesemia

What is a side effect of carbamazepine

Hyponatremia, SJS, blood dyscrasias

What are the 4 stages of hemorrhoids

I - doesn't prolapse, II - prolapses and spontaneously reduces, III - prolapses with straining and requires manual reduction, IV - Irreducible and may strangulate

Anterior wall infarction is indicated by q waves or ST elevation in what leads

I, AVL, V2-V6

Lateral wall infarction is indicated by ST elevation in what leads

I, AVL, V5-6 and reciprocal ST depression in inferior leads

Inferior wall infarction is indicated by q waves or ST elevation in what leads

II, III, AVF

How do you treat PID outpatient

IM ceftriaxone plus oral doxy vs IM cefoxitin + oral probenecid + doxy

How do you treat B12 deficiency anemia

IM or sublingual B12 replacement

What is 2nd line HAART regimen therapy for HIV patients considered to be naïve

INSTI + 2 NRTIs

What is the difference between TTP and ITP

ITP is insidious and chronic while TTP is acute febrile disease with multiple organ thrombosis

How do you treat hypernatremia

IV D5W

How do you treat hypocalcemia

IV calcium gluconate or calcium chloride

How do you treat PID inpatient

IV cefotetan or IV cefoxitin + doxy vs IV clindamycin + IV gentamicin

What is the treatment of choice for late/severe Lyme disease (AV block, syncope, CP, meningitis)

IV ceftriaxone or cefotaxime or penicillin G

How do you manage an extremely high calcium level

IV fluids + furosemide or calcitonin

How do you treat hyperkalemia

IV fluids, insulin, sodium bicarbonate, glucose, calcium gluconate

How do you treat DVT

IV heparin and switch to warfarin

How do you treat hypermagnesemia

IV isotonic saline

How do you treat hypomagnesemia

IV magnesium sulfate (acute) or magnesium oxide (chronic)

How do you treat moderate hyponatremia

IV normal saline +/- loop diuretics

How do you treat hypercalcemia

IV normal saline and furosemide

How do you treat hypophosphatemia

IV phosphate replacement

How do you manage cellulitis if MRSA

IV vancomycin or Linezolid, PO Bactrim

How do you treat patellar tendinitis

Ice, rest, activity modification, physical therapy, surgical excision + suture repair, cortisone injections contraindicated

How do you treat syncope

Identify and fix underlying cause

How do you treat delirium

Identify and treat underlying cause + supportive care

After completing ultrasound of a 1cm thyroid mass what should you do next

Identify if it's malignant or not: cancerous lesions don't take up iodine (COLD Nodule) vs non-cancerous lesions takes up iodine (HOT nodule)

Patient is a 42-year-old male complaining of easy bruising and gingival bleeding. He reports his symptoms began one day prior to presentation and has never occurred before. Medical history is significant for a recent diagnosis of hepatitis C infection. On physical exam, there is mild bleeding of the gums. There are petechiae throughout the chest, arms, and legs. There is no evidence of splenomegaly on abdominal exam. A complete blood count is significant for a platelet count of 24,000/μL (normal 150,000 - 400,000/μL) and peripheral blood smear demonstrates enlarged platelets. He has a + Direct Coombs Test. What does this patient have

Idiopathic thrombocytopenic purpura

What are some causes of constipation

Idiopathic, colorectal cancer, DM, hypothyroidism, opioids, hirschsprung's dz

How do you manage Parkinson's disease

If <65: dopamine agonists such as bromocriptine or pramipexole, if >65: levodopa/carbidopa

When should you administer antihypertensive medications in stroke patients

If BP >220/120 mmHg, use labetalol to lower by 15% in first 24 hours

When should you transfuse someone who has experienced hematemesis

If hemoglobin is <9 in high risk patients or <7 in low risk patients

How do you manage pancreatic pseudocyst

If lasting 4-6 weeks, percutaneous drainage and surgical decompression: pancreaticogastrostomy

When should you aspirate in suspected subacromial bursitis

If patient has fever, is diabetic or immunocompromised

How do you manage Boerhaave syndrome

If small: IV fluids, NPO, abx, H2 blockers/Surgical repair if large or severe

How do you treat influenza A and B

If symptom onset < 48 hours can use Oseltamivir and Zanamivir (think Dr. OZ)

In patients with peripheral arterial disease what question is important to ask

If they're experiencing rest pain which could be a sign of limb-threatening ischemia

How do you see past exposure to hepatitis A

IgG HAV Ab with negative IgM

How do you diagnose acute hepatitis A

IgM HAV Ab

How do you diagnose hepatitis E virus

IgM anti-HEV

What is the underlying cause of premenstrual syndrome

Imbalance of estrogen and progesterone along with excess prostaglandin production

How do you manage condyloma acuminatum

Imiquimod, podofiloc, cryotherapy, surgery or TCA

How do you manage n aorta > or = 5.5 cm or >0.5 cm expansion in 6 months

Immediate surgical repair even if asymptomatic

How do you manage shoulder fractures

Immobilize for 2-3 weeks, progress to gentle passive ROM + modalities, progress to light strengthening after 6 weeks

What is the cause of vitiligo

Immune cells destroy the melanocytes causing melanin loss

What does the above image show

Impetigo

What is the common cause of salmonella typhimurium, enteritidis, and Newport (Gastroenteritis)

Improperly handled food

How does a patient with knee dislocation present

Inability to extend knee

How do you treat breast abscess

Incision and drainage + antibiotics: Dicloxacillin, Nafcillin, Oxacillin, Cefazolin + metronidazole + continued expression of milk but discontinued breastfeeding from affected breast, fluconazole if fungal, alternative is Vancomycin

How do you manage an anorectal abscess

Incision and drainage followed by WASH: warm-water cleansing, Analgesics, Sitz baths, High fiber diet

How do you manage acute paronychia

Incision and drainage, warm compresses, soaks and antistaphylococcals

Dilated cervical os with passage of some but not all products of conception before 20 weeks of gestation is called

Incomplete abortion

What is considered a positive response to bronchodilator treatment in terms of PEFR

Increase >15 % from initial attempt

How does hypernatremia present

Increased Bun/Cr ratio >20:1, poor skin turgor, hypotension,

What are some S/E of PPIs

Increased LFTs, gynecomastia, impotence

What labs are seen with hypercalcemia

Increased PTH, increased calcium, decreased phosphorus

How do you diagnose hemophilia

Increased PTT, normal platelet count, normal PT, normal bleeding time

What lab values are seen with acute cholecystitis

Increased WBC, increased bilirubin, increased Alkaline phosphatase, increased LFTs

What labs will you see on a patient with cirrhosis

Increased ammonia levels, SAAG >1.1 g/dL if spontaneous bacterial peritonitis, decreased coags (means more bleeding)

How do you diagnose fulminant hepatitis

Increased ammonia, increased PT/INR > or = 1.5, increased LFTs, hypoglycemia

What are 3 other actions are mediated by Cholecystokinin

Increased bicarbonate release, gallbladder contraction, bile salt release

How do you manage constipation

Increased fiber, bulk forming laxatives (psyllium), osmotic laxatives (polyethylene glycol), stimulant laxatives (Dulcolax)

How does pneumothorax present on physical exam

Increased hyperresonance to percussion, decreased fremitus, decreased breath sounds

What are common causes of high output cardiac failure

Increased metabolic demand (demand higher than heart can pump): hyperthyroidism, severe anemia, beriberi or thiamine deficiency

What are the contraindication for hormonal therapy in treatment of menopause

Increased triglycerides, endometrial cancer, history of breast cancer, CVD, DVT or PE

What is the underlying cause of pneumothorax

Increasingly positive pleural pressure causes collapse of lungs

What type of inguinal hernia is found lateral to the inferior epigastric artery

Indirect inguinal hernia

Dilated cervical os without passage of tissue before 20 weeks of gestation is called

Inevitable abortion

Patient is a 35-year-old G3P2 with cervical dilatation >3 cm, ruptured membranes, bleeding >7 days, and the presence of cramping. What does this patient have

Inevitable abortion

What are some precipitating factors of thyroid storm

Infection, trauma, surgery, embolism, DKA, preeclampsia

What is the most common type of breast carcinoma

Infiltrating intraductal carcinoma (associated with lymphatic METS especially axillary, starts as ductal carcinoma)

What causes subacromial bursitis

Inflammation due to trauma or overuse

Explain the pathophysiology of acute bronchitis

Inflammation of trachea/bronchi most commonly due to virus: adenovirus most common.

Patient is a 5-year-old with sudden onset of fever, chills, malaise, sore throat, headache, and coryza. The child is also complaining of myalgia, especially in her back and legs. On physical exam, the patient appears lethargic, has a temperature of 102.5 F, and palpable cervical lymph nodes. Breath sounds are distant with faint end-expiratory wheezes. What does this patient have

Influenza

What type of bacterial pneumonia is associated with a precipitous onset and fulminant course

Influenza pneumonia

Describe constipation

Infrequent bowel movements (<2/week), straining, hard stools, feeling of incomplete evacuation

What are the other actions of somatostatin

Inhibition of insulin, glucagon, gallbladder contraction, pancreatic enzymes

How does avascular necrosis of hip present

Insidious onset of dull ache or throbbing localized to the groin, lateral hip pain or buttocks

How do you diagnose rectocele

Inspection, order colonoscopy/rectal studies if concern for cancer

Describe murphy's sign

Inspiratory arrest with palpation of RUQ after asking patient to take a deep breath

Irritability, diaphoresis, weakness, tremulousness and palpitations suggests

Insulinoma

Superior hemorrhoid vein proximal to the dentate line is called

Internal hemorrhoid

What are some complications of bariatric surgery

Internal hernia, anastomotic leak, esophageal dilation, malnutrition

What are the indications for surgery in someone with heartburn and dyspepsia

Intractability, respiratory problems, severe esophageal injury: uclers, hemorrhage, stricture, Barrett's

How does Enteric fever (salmonella typhi) present

Intractable fever, GI symptoms, headache, pea soup diarrhea, Rose spots on trunk, bradycardia

Patient is an 18-year-old woman with right breast bloody nipple discharge increasing in severity over the last three weeks. What does this patient likely have

Intraductal papilloma

What is the first line treatment for hidradenitis suppurativa

Intralesional triamcinolone

What is the most common type of cervical cancer

Invasive squamous cell

What other drugs can be used as quick relief for asthma exacerbation

Ipratropium (anticholinergic), prednisone (corticosteroid)

Patient is a 30-year-old obese white female presents with fatigue and generalized weakness for several weeks. Physical exam reveals pale nail beds, spoon nails, mucosal pallor and an atrophic tongue. Upon further questioning, the patient reveals a "craving for ice and inanimate objects." Laboratory data shows a microcytic, hypochromic appearance to the RBCs, an elevated TIBC, low serum iron of 16 µg/dl, and a low plasma ferritin of 12 µg/dl. What does this patient have

Iron deficiency anemia

Both iron deficiency anemia and thalassemia are hypochromic, microcytic, how do you differentiate the 2

Iron deficiency anemia has low RBC while thalassemia has high RBC

How does nicotine withdrawal present

Irritability, headache, anxiety, weight gain, craving

Patient presents with LLQ pain and blood diarrhea. You decide to due a colonoscopy and note no signs of diverticula, but you do see segmental ischemic changes in areas of low perfusion (splenic flexure). What does this patient likely have

Ischemic colitis

Which type of stroke is most common ischemic or hemorrhagic

Ischemic: thrombotic

How do you diagnose Gilbert's disease

Isolated indirect bilirubin with normal LFTs

How do you diagnose Crigler-Najjar Syndrome

Isolated indirect hyperbilirubinemia, type I: 20-50 mg/dL and type II: 7-10 mg/dL

In an HIV positive patient what is the 1st line agent for treating TB

Isoniazid (INH), Rifampin is 2nd line

How do you treat latent TB

Isoniazid x 9 months+ vitamin B6 (pyridoxine) to prevent neuropathy

What is the underlying mechanism of HIV

It is a retrovirus, which means it changes RNA into DNA via reverse transcriptase

What is the 1st line treatment for Histoplasmosis

Itraconazole, 2nd line is Amphotericin B

Patient is a 27-year-old obese female with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material. What does this patient have

Kaposi sarcoma

How do you treat cystocele conservatively

Kegel exercises, pelvic floor retraining, behavioral modifications, pessary

How do you manage stage I acne vulgaris

Keratinolytic agent such as alpha-hydroxy acids, salicylic acid and azelaic acid

What are some physical exam signs you can use in someone suspected of meningitis

Kernig's sign: knee extension causes neck pain, Brudzinksi's sign: bending of neck causes leg raise, bulging fontanelle of a baby

How do you treat seborrheic dermatitis

Ketoconazole shampoo or selenium sulfide, low-potency steroid cream if on face

Bacterial pneumonia associated with alcohol abuse, currant jelly sputum, aspiriation

Klebsiella

Patient is a 23-year-old male who is the front seat passenger in a motor vehicle accident. There is a noticeable deformity in his knee. Examination reveals an inability to extend the knee and weak foot pulses. After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable, and the foot is cool. What does this patient have

Knee dislocation

Minor trauma causing new lesions is called

Koebner's phenomenon

Patient is a 26-year-old college football player is brought to the emergency department after being hit on the lateral side of the left knee. He reports hearing a pop and then his knee buckled. He is now in severe pain and if having difficulty walking. On examination, there is swelling over the medial aspect of the left knee. There is laxity when a valgus stress test is performed on the knee. What does this patient have

LCL tear

How do you diagnose GBS

LP (CSF shows high protein w/normal WBC)

How do you definitively diagnose meningitis

LP (shows 100-10,000 PMN, decreased glucose <45, increased total proteins, increased ICP)

Acute self-resolving episodes of vertigo

Labyrinthitis

What physical exam test are used to test for ACL tear

Lachman: most sensitive and anterior drawer test

How do you manage encephalopathy caused by cirrhosis

Lactulose (pulls ammonia into gut/causes diarrhea) or Rifaximin (decreases ammonia-producing flora), Neomycin 2nd line (reduces ammonia producing flora) and reduce protein intake

How do you manage fulminant hepatitis

Lactulose, Rifaximin/Neomycin (bacteria that decreases ammonia in GI tract), protein restriction

What syndromes are associated with small cell carcinoma

Lambert-Eaton: weakness that improves with continued use, SVC syndrome: dilated neck/chest veins, facial plethora, Cushing's syndrome, SIADH/hyponatremia

How do you diagnose Osgood Schlatter disease

Lateral radiograph of knee

What radiographic imaging view are patella fractures best seen

Lateral x-ray

What are the indications for coronary artery bypass graft

Left main coronary artery disease, symptomatic, >70% stenosis, 3-vessel disease, ejection fraction <40%

Patient is a 60-year old Caucasian male with shortness of breath and fatigue on exertion. On physical exam, you note an S3 heart sound, crackles on pulmonary auscultation, and a displaced left apical impulse. He undergoes an echocardiogram and is found to have a dilated left ventricle and an ejection fraction of 35%. What is the patient likely experiencing

Left ventricular heart failure

Avascular necrosis presenting as persistent painless limp in children is called

Legg-Calve' Perthes disease

Bacterial pneumonia associated with air conditioning, aerosolized water, hyponatremia, diarrhea and high fever

Legionella

What labs values are seen with acute cholangitis

Leukocytosis, elevated alkaline phosphatase with increased GGT, elevated bilirubin > elevated ALT and AST

What options are available for emergency contraception

Levonorgestrel: Plan B within 3 days of unprotected sex or Ulipristal: Ella within 5 days

Patient is a 16-year-old female with an acute eruption of violaceous, pruritic, polygonal, shiny, flat-topped papules involving the flexor surfaces. What does this patient have

Lichen planus

Patient is a 34-year-old male with a very itchy skin lesion on the front of the ankle of his left foot. The itching is paroxysmal and severe. On examination, there is a well-defined, thickened and hyperpigmented large plaque spreading across the front of left ankle. What does this patient have

Lichen simplex chronicus

What is the 1st stage in managing GERD

Lifestyle modifications - elevate head of bed 6 inches, avoid recumbency after eating, small meals, wt loss, smoking cessation

What test is used for subscapularis tear or inflammation

Lift off test: Gerber's lift off test

What is diffuse thickening of the stomach wall called

Linitis plastica

What lab value is most specific for acute pancreatitis

Lipase

Patient is a 30-year-old male being seen for a non-painful mass on the upper back which has grown slowly over the past year. He denies previous trauma, drainage from the area or history of dermatologic diseases. Examination reveals a four-centimeter firm, but highly mobile subcutaneous mass with no overlying skin discoloration or punctum with drainage. What does this patient have

Lipoma/epithelial inclusion cyst

What are the more common causes of bacterial meningitis in patients >50-60 years old or immunocompromised

Listeria or Cryptococcus

What should you monitor for when treating onychomycosis

Liver function tests

How do you definitively manage cirrhosis

Liver transplant

How do you definitely manage fulminant hepatitis

Liver transplantation

What are other types of breast carcinoma

Lobular, medullary, mucinoid, tubular, papillary, mammary Paget's disease of the breast

What is Nexplanon

Long acting progesterone implanted in upper arm that lasts 3 years

What is depo-provera

Long acting progesterone injection that lasts 3 months

What drug will likely be the first choice in treatment of a patient reporting to the ER in acute CHF

Loop diuretics

How do you manage status epilepticus

Lorazepam or diazepam phenytoin phenobarbital

How do you diagnosis hyperthyroidism

Low TSH with high T3 and T4

How does an adrenal adenoma present on CT

Low attenuation (<10), rapid washout (>60% washout at 15 minutes postcontrast), smooth borders

How do you treat moderate persistent asthma

Low dose ICS + long acting beta2 agonist/LTRA/theophylline (step 3) vs medium dose ICS (step 4)

How do you treat mild persistent asthma

Low dose inhaled corticosteroids (step 2)

What is patella baja

Low riding patella

What test is indicated for the evaluation of IBD, diverticulosis, colon cx, dx & tx of intussusception and colitis

Lower GI series - Barium Enema

How does Shigella present

Lower abdominal pain, explosive watery diarrhea that progresses to mucoid/blood diarrhea, tenesmus, fever, chills

How do you diagnose meningitis

Lumbar puncture, but get a CT and check for papilledema to ensure patient doesn't have increased intracranial pressure

What is the recommended treatment for breast carcinoma

Lumpectomy with breast irradiation

What is the gold standard for diagnosing chronic bronchitis

Lung biopsy: shows increased Reid index

Patient is a 65-year-old woman with a 40 pack-year history of smoking presents with a 7kg weight loss over the last 3 months and recent onset of streaks of blood in the sputum. PE reveals a thin, afebrile woman with clubbing of the fingers, an increased anteroposterior diameter, scattered and coarse rhonchi and wheezes over both lung fields, and distant heart sounds. What does this patient likely have

Lung carcinoma

When do premenstrual syndrome symptoms occur

Luteal phase (1-2 weeks before menses)

Patient is a 38-year-old New Jersey resident who went for a jog in the woods and found a tick while showering. His wife successfully removed it using a pair of tweezers. Now 7-10 days after the bite he has developed a strange red rash with clearing between the center and periphery. What does this patient have

Lyme disease

A CD4 count of >500 suggest

Lymphadenopathy

Patient is a 21-year-old male with fever, chills, and night sweats for 1-month. Exam reveals painless enlarged posterior cervical and supraclavicular lymph nodes bilaterally. CBC, HIV, and RPR are normal. Excisional biopsy of lymph node demonstrates Reed-Sternberg cells (owl-eye appearance). What does this patient have

Lymphoma

What is the most common bacterial causes of acute bronchitis

M. Catarrhalis followed by H. flu and S. Pneumoniae

Patient is a 26-year-old college football player is brought to the emergency department after being hit on the lateral side of the left knee. He reports hearing a pop and then his knee buckled. He is now in severe pain and if having difficulty walking. On examination, there is swelling over the medial aspect of the left knee. There is laxity when a valgus stress test is performed on the knee. What does this patient have

MCL tear

What are major contraindications toe curative surgical resection of a lung tumor

MI within past 3 months, superior vena cava syndrome, bilateral endobronchial tumor, contralateral lymph node metastases, malignant pleural effusion, liver metastases

How do you prevent rubeola

MMR vaccine at 12-15 months and 4-6 years old

How do you confirm diagnosis of ACL tear

MRI

How do you definitively diagnose LCL tear

MRI

How do you definitively diagnose PCL tear

MRI

How do you definitively diagnose an MCL tear

MRI

What is the study of choice if concussion symptoms persist past 7-14 days

MRI

What is the study of choice for early detection of avascular necrosis of hip

MRI (order x-ray first then MRI then bone scan)

What is the gold standard for evaluation of aortic dissection

MRI angiograph

What are some causes of increased anion gap

MUDPILES: Methanol, Uremia, DKA, Paraldehyde, Infection, Lactic acidosis, Ethylene glycol, salicylates

Mild shortness of breath, palpitations and systolic murmur with midsystolic ejection click suggests

MVP

How do you treat outpatient community acquired pneumonia

Macrolides or doxycycline are 1st line

How do you diagnose acute bronchitis

Mainly clinical but can order a chest x-ray if uncertain or patient has fever

What is the most common cause of large bowel obstruction

Malignancy

What is hypercalcemia associated with

Malignancy and hyperparathyroidism

A 22 yo female is brought in by her friends after a night out drinking. Pt's friends state pt was vomiting a lot and later started spitting/throwing up blood. Based off the pt's hx what does she most likely have

Mallory-Weiss syndrome (tears)

How do you treat peripheral arterial disease

Manage risk factors, exercise, platelet inhibitors

What is the recommended treatment for large diffuse breast carcinoma

Mastectomy

Patient is a breastfeeding woman 3 weeks postpartum complaining of a painful area of the breast that is reddened and warm. The patient feels very fatigued with a fever generally > 101 ° F and chills. She reports a burning pain present constantly or at times only while breastfeeding. On exam, the patient appears ill. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation. What does this patient have

Mastitis

What test are used on physical exam for meniscus tear

McMurray and Apley

Pain at 1/3 the distance from the anterior superior iliac spine and navel is called

Mcburney's point tenderness

How do you manage labyrinthitis

Meclizine + steroids

Patient is a 35-year-old man with complaints of swelling and pain in left knee. The patient states that he sustained a twisting injury in a football game 3 days ago. The injury did not take him out of the game; he was able to continue participating with minimal difficulty. Over the last 2 days, the pain has progressed. He notes a catching sensation and pain that is more medially located. On physical examination, the patient is found to have tenderness over the medial joint line and limited range of motion. Forced flexion and circumduction of the joint cause a painful click. What does this patient have

Medial Meniscus tear

What are the 3 borders of Hesselbach's triangle

Medial is rectus abdominis, lateral is inferior epigastric vessels, inferior is poupart's ligament

How does histoplasmosis look on chest x-ray

Mediastinal or hilar lymphadenopathy

How does aortic dissection appear on chest x-ray

Mediastinal widening

Patient is a 67-year-old man of Irish descent who presents to your dermatology clinic for the first time. When asked why he was referred to the clinic, the patient reports that his wife has been nagging him to have his skin checked for years. On exam, you notice an asymmetric, elevated, blue-tinged lesion with irregular, scalloped borders on his shoulder. When discussing the risk factors for skin malignancy, the patient proudly asserts that he was a lifeguard in Australia for 15 years from his late teens to his early 30s. What does this patient likely have

Melanoma

Patient is a 35-year-old female who complains of worsening hyperpigmentation to her face, particularly her cheeks. Physical examination of the face reveals diffuse light-to-dark brown macules to bilateral upper cheeks. The patients has no significant past medical history and her only medication is Ortho Tri-Cyclen which she takes for birth control. What does this patient have

Melasma also called chloasma

Chronic remitting and relapsing episodes of vertigo

Meniere's disease

Patient is a 34-year-old man who is brought by his wife because she believes her husband is very ill. The patient initially had a headache that progressed to neck stiffness and an inability to look at bright lights. His temperature is 103.1° F, blood pressure is 134/82 mmHg, and respirations are 20/min. Extreme pain is elicited upon flexion of the patient's neck and the patient's legs. What does this patient have

Meningitis

What vaccines should someone with sickle cell receive

Meningococcal, pneumococcal, H. influenzae, influenza

More blood loss during menses and frequent irregular bleeding between menses

Menometrorrhagia

Patient is a 52-year-old female with no menses for 12 months she also complains of hot flushes and dyspareunia. What does this patient have

Menopause

Patient is a 56-year-old male two days post-bilateral ureterosigmoidostomy for bladder resection due to cancer. He complains of increasing shortness of breath. The patient denies cough, chest pain, or fever. Physical examination is unremarkable except for an increased respiratory rate of 30 breaths/min. Arterial blood gas reveals pH of 7.28, pCO2 22 mmHg, and HCO3 13 mEq/L. What does this patient have

Metabolic acidosis

A patient with the following ABG has what type of acid-base disorder, ph 7.52, PCO2 40, Bicarb 38 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)

Metabolic alkalosis

What does stage IV mean with regards to breast cancer

Metastatic breast cancer

How do you treat Amebiasis

Metro or tinidazole + intraluminal agent (Paromomycin)

How do you treat trichomonas vaginitis

Metronidazole 2 g PO x 1 dose, treat partner as well

How do you treat bacterial vaginosis

Metronidazole 500 mg PO BID x 7 days, second line is clindamycin

Uterine bleeding that occurs frequently and irregularly between menses

Metrorrhagia

What is the most common route of infection for pneumonia

Microaspiration of oropharyngeal secretions

How do you diagnose iron deficiency anemia

Microcytic, hypochromic cells, MCV low, TIBC high, ferritin low, MCH high

How do you diagnose lichen simplex chronicus

Microscopy via KOH prep or culture

What is the most common clavicle fracture location

Middle 3rd

What is the most common artery involved in epidural hematoma

Middle meningeal artery

What type of headache is characterized by pulsatile/throbbing lateralized pain associated with N/V, photophobia, phonophobia

Migraine

How do you treat alpha thalassemia

Mild: no treatment, moderate: folate + avoid oxidative stress, severe: blood transfusions, iron chelating agents: deferoxamine, splenectomy

How do you diagnose Alzheimer

Mini mental status exam, clock drawing test, definitively with autopsy

Death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine is called

Missed abortion

Patient is a 6-year-old male is brought to the clinic by his mother complaining of a rash. On physical exam, you observe dozens of discrete 5-15 mm, pink, flesh-colored, waxy, dome-shaped, umbilicated pearly papules with central umbilication on the lower abdomen and genital area. What does this patient have

Molluscum contagiosum

What neoadjuvant endocrine therapy is helpful in patients with HER2 positivity (Human epidermal growth factor receptor)

Monoclonal Ab treatment: Trastuzumab - Herceptin

Patient is a 14-year-old boy with 3-days of sore throat, fever, and generalized malaise. On exam, he has a temperature of 102.2 F (39.0 C), BP 96/50, and a diffuse exudate on both tonsils. He also is noted to have palpable splenomegaly, swollen painful lymph nodes, and mild hepatomegaly. Labs show leukocytosis of 12,000/mm3 with 50% neutrophils, 12% monocytes, and 38% lymphocytes. What does this patient have

Mononucleosis

How do you diagnosis Epstein Barr mononucleosis

Monospot for heterophile antibodies (positive within 4 weeks) and >10 % Atypical lymphocytes

How often should you recommend breast self-examination

Monthly > or = 20 years immediately after menstruation or on days 5-7 of menstrual cycle

What is the recommended prenatal schedule for pregnant patients

Monthly between weeks 4-28, twice per month between weeks 28-36, weekly after week 36

What type of rash is seen above

Morbilliform (MC skin eruption)

How do you manage acute pancreatitis

Most recover in 3-7 days, NPO, IV fluids, analgesia with Meperidine (Demerol), ERCP if biliary sepsis suspected

How do you treat fibrocystic breast disorder

Most resolve spontaneously, can fine needle aspirate for symptomatic relief, recommend support bra, NSAIDs, heat or ice, avoidance of caffeine or chocolate

How does trichomonas vaginitis present on wet prep

Motile flagellated protozoa

Production of what 2 things protects the mucus layer of the stomach

Mucus and bicarbonate

What can be underlying causes of essential tremor

Multiple sclerosis or Wilson disease

What is the drug of choice for impetigo

Mupirocin (Bactroban)

How do you treat folliculitis

Mupirocin ointment and topical benzoyl peroxide

What is the underlying cause of compartment syndrome

Muscle and nerve ischemia secondary to tissue perfusion when closed muscle compartment pressure is > perfusion pressure

How does hyponatremia present

Muscle cramps and seizures, decreased Bun/Cr, JVD, pulmonary edema, peripheral and presacral edema

How does hypokalemia present

Muscle cramps, constipation, flattened/inverted T waves, U waves

How does hypomagnesemia present

Muscle weakness, hyperreflexia, prolonged QT/PR/wide QRS, VT, torsades de pointes

How does hypermagnesemia present

Muscle weakness, prolonged QT/PR, wide QRS

A CD4 count < or = 50 suggest what opportunistic infections

Mycobacterium avium complex (MAC) or CMV retinitis

What is the organismal cause of TB

Mycobacterium tuberculosis

Bacterial pneumonia associated with young people living in dorms, bullous myringitis, low temp, walking pneumonia, + cold agglutinins

Mycoplasma

How do you diagnose AML

Myeloblasts with Auer rods + 20% blasts and pancytopenia

Sustained eye blinking in response to repetitive tapping just above the nasal bridge between the eyes is called

Myerson sign or glabellar reflex, associated with Parkinson's disease

What are causative agents of PID

N. gonorrhea, C. trachomatis, anaerobes, gram-negative bacteria and streptococci

What is the most common bacterial cause of meningitis in those 1mo-18y

N. meningitidis

What is the 1st line HAART Regimen treatment for HIV patients considered to be naïve

NNRTI + 2 NRTIs or PI + 2 NRTIs

How do you manage SBO

NPO + IV fluids + nasogastric tube if nonstrangulated, surgical intervention if strangulated

How do you manage acute cholecystitis

NPO, IV fluids, antibiotics (Ceftriaxone + Metronidazole), cholecystectomy within 72 hours

What treatment can be considered for osteoarthritis is acetaminophen fails

NSAIDs

How do you treat premenstrual syndrome

NSAIDs for pain, SSRI's 2 weeks prior to menstrual cycle, OCPs

What drugs can precipitate an acute asthma attack

NSAIDs or Aspirin

What is the 1st line treatment for dysmenorrhea

NSAIDs, 2nd line is hormonal contraception

How do you manage biceps tendonitis

NSAIDs, PT strengthening and steroid injections

How do you manage glenohumeral joint osteoarthritis

NSAIDs, PT, corticosteroid injections vs total shoulder arthroplasty if unresponsive to conservative treatment

What is the 1st line tx for tension headaches

NSAIDs, aspirin, acetaminophen

What drugs should be avoided in patients with heart failure

NSAIDs, calcium channel blockers, antiarrhythmic agents

What are the most common drugs that cause bruising/bleeding

NSAIDs, glucocorticoids, antidepressants (fluoxetine, sertraline, paroxetine), antibiotics (PCN, cephalosporins), antiplatelets and anticoagulants

What is first line tx for mild symptoms of migraines

NSAIDs/acetaminophen

What is the second most common cause of gastritis

NSAIDs/aspirin

Patient is a 58-year old obese male who is brought to the emergency department with severe substernal chest pain of one hour's duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals T-wave inversions in leads II, III, and aVF and ST depressions in V5 and V6. The basic metabolic panel and complete blood count were within normal limits. A point-of-care troponin I level was elevated at 1.8 ng/mL (normal ≤ 0.06 ng/mL). This patient is experiencing what

NSTEMI

How do you manage ascites caused by cirrhosis

Na restriction, diuretics (spironolactone, furosemide), paracentesis

What antibiotics are used in gram positive cocci septic arthritis

Nafcillin but vancomycin if MRSA suspected

How do you treat MSSA osteomyelitis in patients >4 months old

Nafcillin or Oxacillin or Cefazolin: Ancef

How are peripheral lung lesions diagnosed

Needle aspiration

How do you manage tension pneumothorax

Needle aspiration placed in 2nd intercostal space midclavicular line followed by chest tube placement

What 3 physical exam tests are used to test for subacromial impingement

Neer, Hawkins and drop arm

What is the most common cause of septic arthritis in sexually active young adults

Neisseria gonorrhea

What is another name for wilm's tumor

Nephroblastoma

What type of diabetes insipidus is caused by kidneys that unresponsive to normal vasopressin levels

Nephrogenic

Patient is a 45-year-old woman who presents to the ED with sharp, severe, colicky right flank pain radiating to the groin that she reports started suddenly several hours ago. She also reports discolored urine when she last voided, along with nausea and vomiting. Vital signs are within normal limits. On exam, the patient is visibly in pain and shifts positions every few minutes. Costovertebral tenderness is elicited on percussion. What does this patient have

Nephrolithiasis

What are the 2 causes of thoracic outlet syndrome

Nerve compression or vascular compression

Patient is a 70-year-old gentleman is brought to his primary care provider by his son. He states that it seems like he has struggled more and more with every day living. Initially, he forgot simple things such as dates and addresses, but this has progressed over the last few years to an inability to pay his own bills. He has even gotten lost coming home from the library which is two blocks away from his house. What does this patient have

Neurocognitive disorder: most commonly Alzheimer disease

What is pheochromocytoma associated with

Neurofibromatosis type 1, MEN 2A/2B and Von Hippel-Lindau disease

What type of diabetes insipidus is caused by deficient secretion of vasopressin (ADH) from the posterior pituitary

Neurogenic (central)

What is the differential diagnosis of lower extremity claudication

Neurogenic (nerve entrapment/disc), arthritis, coarctation of aorta, popliteal artery syndrome, chronic compartment syndrome, neuromas, anemia, diabetic neuropathy pain

How does glenohumeral joint osteoarthritis present

Night pain and with activities, glenohumeral joint tenderness and crepitus, flattening of anterior shoulder

Epidermal detachment seen with SJS is known as

Nikolsky sign

What are some causes for recurrent mastitis

Nipple cracks, fissures, fungal infection

What is the treatment for refractory GERD

Nissen fundoplication

How do you treat Prinzmetal angina

Nitrates and calcium channel blockers (diltiazem or verapamil) for prophylaxis

How do you manage Diffuse Esophageal Spasm and Nutcracker Esophagus

Nitrates, CCBs, botox, sildenafil

Define primary amenorrhea

No menses by age 13 in absence of secondary sexual characteristics or no menses by age 15 in presence of normal growth and secondary sexual characteristics

How do you treat seborrheic keratosis

No treatment needed, can use cryotherapy or electrodessication and curettage

In stable angina are troponin and CK-MB abnormal

No, they are normal

What is the difference between a pulmonary nodule and pulmonary mass

Nodule is a well circumscribed coin shaped lesion <3 cm, a mass is >3cm

Describe stage IV acne vulgaris

Nodulocystic and severe scarring

What are the 2 categories of lung carcinoma

Non-small cell (85%) and Small cell (15%)

How do you treat Legg Calve Perthes disease

Non-weight bearing initially to progressed weight bearing followed by ortho, revascularization in 2 years. Pelvic osteotomy if severe

What is the gold standard for diagnosing nephrolithiasis

Noncontrast CT of abdomen and pelvis

How do you diagnose strokes

Noncontrast head CT

How do you diagnose a subarachnoid hemorrhage

Noncontrast head CT, LP if CT unremarkable, cerebral angiography after diagnosing confirmed

How do you manage Dubin-Johnson Syndrome

None needed

How do you manage Gilbert's syndrome

None needed

Are adrenal masses more commonly functional or nonfunctional

Nonfunctional adenomas are most common (functional = pheochromocytomas, aldosteronoma, cortisol-producing adenomas

How do you diagnose von Willebrand deficiency

Normal PT/PTT but decreased von Willebrand factor

How does CSF look with viral meningitis

Normal glucose, lymphocytes, normal protein

What are the lab values of anemia of chronic disease

Normal or low MCV, low TIBC, high ferritin, low serum erythropoietin

What are the CSF findings of viral meningitis

Normal pressure, increased WBC: lymphocytes

What is the most common cause of gastroenteritis in adults in America

Norovirus (vomiting in predominant sx in most noninvasive diarrhea)

How do you manage beta thalassemia

Nothing if minor, if severe: blood transfusions, iron chelating agents: Deferoxamine, splenectomy, bone marrow transplant

How do you confirm diagnosis of condyloma acuminatum

Nucleic acid amplification tests (NAAT)

Coin-shaped eczema is called

Nummular eczema

Sharply defined discoid/coin-shaped lesions are known as

Nummular eczema

Excessive contractions of esophagus during peristalsis is known as

Nutcracker Esophagus

How do you manage acute exacerbations of chronic bronchitis

O2, beta-agonists: albuterol, anticholinergics: ipratropium or tiotropium, inhaled/IV steroids, antibiotics

What is the difference between osteoarthritis and rheumatoid arthritis

OA pain worsens with use and improves with rest, RA has morning stiffness >30 minutes and pain improves with use

How do you manage primary and secondary amenorrhea

OCPs if no desire to become pregnant vs cyclic progesterone or ovulation inducers if pregnancy desired

How do you treat alopecia areata

Observation +/- topical steroids

How do you treat erythema infectiosum

Observation and symptomatic care

How do you treat CLL

Observation if indolent, chemotherapy if lymphocytes >100,000 or patient is symptomatic

How do you manage ITP

Observation if platelets >30K and no bleeding vs corticosteroids if platelets <30K or intravenous immunoglobulins in refractory cases or corticosteroids contraindicated

How do you treat actinic keratosis

Observation, many spontaneous resolve, cryosurgery, 5 FU cream or Imiquimod

How do you manage small pneumothorax (<15-20% the diameter of the hemithorax or < or = 2-3 cm btw the chest wall & lung on CXR)

Observe at least 6 hours with repeat chest x-ray + 24-48 follow up, spontaneously resolves within 10 days (oxygen shown to speed up recovery)

Within regard to appendicitis pain in the RLQ with internal and external hip rotation with flexed knee is called

Obturator's sign

How do you manage stage 2 pressure ulcer

Occlusive dressing, transparent films, hydrocolloids

How do you manage acute bleeding due to esophageal varices pharmacologically

Octreotide

How does CLL present

Often asymptomatic, most common form of leukemia in adults, fatigue, splenomegaly, lymphadenopathy

What are the risk factors for rotator cuff tendinopathy/tear

Old age, smoking, repetitive overhead reaching

What can be noted on physical exam in a patient with pyloric stenosis

Olive-shaped nontender mass upon abdominal palpation

How do you prophylactically treat Lyme disease

One 200 mg dose of Doxycycline within 72 hours if the tick is present > or = 36 hours

Patient is a 29-year-old field worker with a rash on his nails. The patient has a history of tinea pedis and tinea manuum and thought that this might be related. On physical exam, mild paronychia, loss of the cuticle of some nails, dirt-like yellowish-green nail pigmentation, subungual debris and dystrophy of some nails is seen. What does this patient have

Onychomycosis

How does acne vulgaris present

Open comedones (blackheads), closed comedones (whiteheads), papules, pusteles, nodules or cysts

How do you treat morbilliform rashes

Oral antihistamines

How do you manage erythema multiforme

Oral antihistamines and topical corticosteroids, help lessen duration with acyclovir

How do you manage chronic pancreatitis

Oral pancreatic enzyme replacement, alcohol cessation, pain control

How do you treat onychomycosis

Oral terbinafine PO x 6 week for fingernails and 12 weeks for toenails

How do you manage testicular carcinoma

Orchiectomy (seminomatous tumors are radiosensitive while nonseminomatous are radioresistant)

How do you diagnose nipple discharge

Order mammogram or ultrasound, prolactin levels (pituitary tumor), TSH (hypothyroidism)

How do you manage knee dislocations

Orthopedic emergency: Early reduction is ESSENTIAL, check distal pulses and peroneal nerve function

Patient is a 71-year-old man with a history of BPH is hospitalized for an ST-elevation myocardial infarction and undergoes percutaneous coronary intervention. Upon discharge, he is prescribed aspirin, clopidogrel, prazosin, isosorbide mononitrate, carvedilol, enalapril, and atorvastatin. One week after discharge her presents to your office with complaints of faintness, lightheadedness, dizziness, confusion, and blurred vision that occur within seconds to a few minutes of standing and resolve rapidly on lying down. On physical examination you note a drop of > 20 mm Hg systolic and 10 mmHg diastolic after change from supine to standing. What does this patient have

Orthostatic hypotension

How do you treat influenza

Oseltamivir: Tamiflu or Zanamivir both treat influenza A and B, must be given within 48 hours

Patient is a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension. What does this patient have

Osgood Schlatter disease

Patient is a 65-year-old woman with left knee pain. The pain has been present in both knees for approximately 5 years and has been steadily getting worse. She describes stiffness, sticking and grinding of the right knee. Over the last 2 weeks, she has been taking ibuprofen almost every day, requiring an increasing frequency of doses for adequate pain control. On physical exam, there is swelling of the right knee and tenderness to palpation. There is palpable crepitus. What does this patient have

Osteoarthritis

Patient is a 54-year-old male with fever, chills, and pain in the left foot. His symptoms progressively worsened over the course of a week. Medical history is significant for poorly controlled type II diabetes mellitus. On physical exam, there is tenderness to palpation of the left foot. Laboratory testing is significant for an elevated erythrocyte sedimentation rate and C-reactive protein; as well as, a leukocytosis. What does this patient have

Osteomyelitis

Bony projections that form along joints is called

Osteophytes

How do you treat asthma acutely

Oxygen, nebulized SABA, ipratropium bromide and oral corticosteroids

What lab value is positive in someone with ulcerative colitis

P-ANCA

How can the medical treatment of claudication be remembered

PACE: Pentoxifylline (increases flexibility of RBC), Aspirin, Cessation of smoking, Exercise

Patient is a 22-year-old recreational soccer player who sustained a right knee injury 6 months ago. He has been treated with rest and rehabilitation but is unable to play at his previous level due to his knee "giving way." Physical exam reveals 10° varus alignment when standing and a varus thrust with walking. Strength is full compared to the other side. Ligamentous exam reveals a stable ACL and MCL but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30° and 90° degrees of flexion. What does this patient have

PCL tear

Patient is a 68-year-old woman who underwent hip replacement surgery two weeks ago. The postoperative period was complicated by pneumonia, and the patient has been bed-ridden ever since. A nurse calls you to the patient's room due to vital sign abnormalities and complaints of chest pain. The patient's HR is 105 bpm, BP is 90/60 mmHg, RR is 35 rpm, and T is 100.2F. You note jugular venous distension and profound dyspnea. Upon auscultation you notice tachypnea and crackles. What does this patient likely have

PE

How do you manage PUD if H. pylori negative

PPI, H2 blocker, misoprostol, antacids, bismuth compounds, sucralfate

When should you begin PT and light strengthening in a patient with a clavicle fracture

PT after 4 weeks and light strengthening after 6 weeks

Is PT extrinsic or intrinsic

PT is extrinsic and PTT is intrinsic

What is the preferred treatment of hyperthyroidism in a pregnant patient

PTU

What is the most common cause for upper GI bleed

PUD

Chronic eczematous itchy, scaling ash on the nipples and areola is called

Paget's disease of the nipple

How does subacromial impingement present

Pain with reaching, lifting or overhead movements

How does Osgood Schlatter present on physical exam

Pain with resisted knee extension, lump below knee and prominent tibial tuberosity

Explain Yergason's test

Pain with resisted wrist supination while elbow is flexed at 90 degrees

What are the classic signs/symptoms of acute arterial occlusion

Pain, Paralysis, Pallor, Paresthesia, Poikilothermia and Pulselessness

What are the 6 P's of compartment syndrome

Pain, paresthesias, pallor, paralysis, pulselessness, Poikilothermia

How does Hodgkin's lymphoma present

Painless cervical lymphadenopathy + reed-Sternberg cells, bimodal age distribution: 15-35 or >60, b symptoms: fever, weight loss, night sweats

How do you treat stage 4b or recurrent cervical cancer

Palliative radiation or chemotherapy

What physical exam sign is pathognomonic for pancreatic carcinoma

Palpable nontender gallbladder also known as Courvoisier's sign

When evaluating a Wilm's tumor on physical exam, it's important to not do what

Palpate abdomen, could cause rupture

Patient is a 62-year-old obese African American male with a history of tobacco and alcohol use complaining of abdominal pain that radiates to his back, yellowing of eyes and skin, 15 lbs weight loss, and itchy skin. What does this patient likely have

Pancreatic carcinoma

Patient is a 46-year-old man with a known history of chronic pancreatitis comes to your office because he says he can feel a mass in his stomach. His records show that he has a persistently elevated serum amylase and urine amylase. What does this patient likely have

Pancreatic pseudocyst

What is a side effect of valproic acid

Pancreatitis, hepatotoxicity

How do you screen for cervical cancer

Pap smear with cytology

What is the most common thyroid carcinoma

Papillary, think P for popular

Describe stage II acne vulgaris

Papular lesions and mild scarring

What causes measles

Paramyxovirus

How do you manage hyperparathyroidism due to adenoma

Parathyroidectomy

How is hepatitis C virus transmitted

Parenteral (IVDU)

How is hepatitis B virus transmitted

Parenteral, sexual, perinatal, percutaneous

How do you manage refractory PUD

Parietal cell vagotomy or Bilroth II

Patient is a 51-year-old male with involuntary movements of the left hand, which occur only at rest. The symptom has been obvious to his wife for two months. Exam reveals a resting tremor, a significant lack of arm movement while walking, and cogwheeling of the shoulder joints with passive ROM. What does this patient have

Parkinson's disease

What formula is used to calculate intravenous fluid resuscitation in burn patients

Parkland formula: lactated ringer 4 mL/kg/% TBSA IV, half in 1st 8 hours, other half over the remaining 16 hours

Patient is a 32-year-old female with a painful index finger. She obtains regular manicures, changing colors every 2 weeks. She recently had one a week ago and started feeling pain near the nail on her left index finger. Physical exam reveals redness, warmth, and pain along the nail margin of the index finger. When applying pressure to the nail plate, some pus drains from the nail. What doe this patient have

Paronychia

What is the case of erythema infectiosum

Parvovirus B-19

What is the most common bacterial cause of osteomyelitis due to cat or dog bite

Pasteurella multocida

Patient is a 39-year-old female who sustained a knee injury after falling from a step ladder onto her flexed knee. On physical exam, there is a palpable patellar defect, significant hemarthrosis and she is unable to extend the knee. What could this patient have

Patella fracture

Patient is a 22-year-old college basketball player with chronic anterior pain of her right knee. The patient has had over 6 months of physical therapy without improvement. It initially only bothered her during training, but she is now no longer able to compete and has pain with daily activities. Physical exam reveals swelling of the anterior knee and tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at distal pole of the patella in full flexion. What does this patient have

Patellar tendinitis: jumper's knee

Described Apley test

Patient prone, knee to 90 degrees and axial load with rotation causes pain

Explain McMurray test

Patient supine, knee flexed and externally rotated and extended for medial meniscus vs knee flexed and internally rotated then extended for lateral meniscus

Describe Apley scratch test

Patient tries internal shoulder rotation, external shoulder rotation and reaching across body to opposite shoulder

What can be used to monitor asthma after it has been diagnosed or to assess severity and patient response

Peak flow levels

How does hyperkalemia present

Peaked T waves, prolonged QRS, muscle fatigue, paralysis

Skin changes that looks like the peel of an orange due to lymphatic obstruction is called

Peau d'orange, associated with a poor prognosis

Malformation of the chest characterized by a protrusion of the sternum and ribs, also known as pigeon chest is called

Pectus carinatum

A structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally, producing a caved-in or sunken appearance of the chest is called

Pectus excavatum

How do you manage hepatitis C virus

Pegylated interferon alpha-2b and ribavirin and screen for hepatocellular carcinoma

What is the classic triad of symptoms and signs in PID

Pelvic pain, increased vaginal discharge and fever

How does a rectocele present

Pelvic pressure, defecatory dysfunction, vaginal bulge, low back pain

What is the treatment of choice for bacterial meningitis

Penicillin G + Dexamethasone, can use Chloramphenicol or 3rd generation cephalosporin

How do you manage erysiPelas

Penicillin G or erythromycin or clindamycin if PCN allergic, vancomycin if severe

What can be used to treat pneumocystis jiroveci if patient allergic to Bactrim

Pentamidine

HCl acid converts pepsinogen into what

Pepsin

Patient is a 54-year-old male with a history of chronic NSAID use complaining of dyspepsia which he describes as a burning/gnawing hunger like epigastric pain. He stats that his symptoms have been worse at night. What does this patient likely have

Peptic ulcer disease

What is the differential for melena

Peptic ulcer, esophageal ulcer, Mallory-weiss tear, malignancy, variceal hemorrhage

What is the gold standard for treatment of STEMI

Percutaneous coronary intervention in 90 minutes but no later than 3 hours of symptom onset + BBs, nitro, aspirin, heparin, ACE inhibitors

How does a rectal fistula present

Perianal drainage, perirectal abscess and diaper rash/itching

How does chronic bronchitis look on chest x-ray

Peribronchial, perivascular markings, increased right hear border, bullae, blebs,

Vertigo due to ear trauma

Perilymph fistula

The transition between reproductive capability and menopause hallmark is irregular menstrual function, lasts 3-5 years

Perimenopause

Papulopustular plaques and scales around the mouth is called

Perioral dermatitis

What symptoms does right ventricular failure cause

Peripheral and abdominal fluid accumulation

Patient is a 63-year-old male complaining of bilateral leg pain, which has been increasing gradually over the past several months. It worsens when he walks but improves with rest. Past medical and surgical history is significant for hypertension, hyperlipidemia, and coronary artery bypass graft (5 years ago). He has a 60-pack-year smoking history. Vital signs are as follows: Temp 37 C, HR 70, BP 143/89, and RR 18. Physical exam of the lower extremities reveals palpable but weak posterior tibial and dorsalis pedis pulses bilaterally; they are warm and well perfused. Ankle-brachial indices are 0.7 and 0.8. What does this patient likely have

Peripheral arterial disease

What is the most common cause of claudication

Peripheral arterial disease which is usually due to atherosclerosis

How do you diagnose CLL

Peripheral smear shows fragile B-cells: Smudge Cells

What is bronchiectasis

Permanent dilation or destruction of the bronchial walls

How do you treat lice

Permethrin

What is the most common cause of B12 deficiency anemia

Pernicious anemia (antibody to intrinsic factor)

What nerve should you check for in a displaced tibial plateau fracture in order to avoid foot drop

Peroneal nerve (can confirm with CT/MRI)

What is the common etiology of an indirect inguinal hernia

Persistent patent process vaginalis

How does Lyme disease present in late disease

Persistent: synovitis, arthritis, neurological symptoms

How do you treat rectocele

Pessary, conservative therapy: Kegel exercises, pelvic floor retraining vs surgery

What are small bleeding lesions that suggest problems with platelet number or function

Petechiae

Hypertension, diaphoresis (episodic) and palpitation suggests

Pheochromocytoma

Patient is a 43-year-old female with high blood pressure unresponsive to therapy. She complains of headaches, palpitations, and sweating.She has a history of neurofibromatosis type 1, though without any neurological deficits. She has multiple café-au-lait spots on her body. ECG demonstrates sinus tachycardia. She is found to be hypertensive to 154/121 mmHg. What does this patient likely have

Pheochromocytoma

How do you diagnose CML

Philadelphia chromosome (translocation of 9 and 22) + striking elevated WBC

How do you diagnose PID

Physical exam shows abdominal pain, cervical motion tenderness, adnexal tenderness plus 1 of the following? Fever, WBC > 10k or pelvic abscess found on manual exam

How do you manage an ACL tear

Physical therapy and lifestyle modifications for low demand patients vs surgical reconstruction for young active patients with high demand¬

How do you manage thoracic outlet syndrome

Physical therapy is 1st line, avoid strenuous activity, ortho consult

How do you manage rotator cuff tendinopathy/tear

Physical therapy, NSAIDs, steroid injections, surgical repair for failed response to 3-6 months of conservative management

What is the classic tremor associated with Parkinson's disease

Pill-rolling 4-6 Hz tremor seen at rest, often asymmetric

Results from an abscess or sinus tract in the upper part of the natal (gluteal) cleft

Pilonidal disease

What is another name for patients with emphysema

Pink puffers due to the fact that they are constantly trying to blow off retained CO2 and they have a cachectic appearance

Patient is a one-week-old infant with a wide-scale symmetrical papular eruption over his trunk. Lesions align along skin folds. He had a mild upper respiratory infection last week prior to presenting to the clinic. What does this patient have

Pityriasis rosea

Describe lift off test

Place arm into internal rotation with dorsal surface against back and ask patient to push away from back, positive test is pain or weakness

What imaging should be order in a shoulder fracture

Plain x-rays as well MRI to rule out rotator cuff tear

How do you diagnose knee dislocations

Plain x-rays, MRI for soft tissue

What is the treatment of choice for TTP

Plasmapheresis + corticosteroids for adults or eculizumab with refractory HUS

How do you manage GBS

Plasmapheresis or IV immune globulin

How do you treat claudication caused by peripheral arterial disease

Platelet inhibitors: cilostazol, aspirin, clopidogrel; treat lipids: statins, revascularization: PTA, bypass grafts, stenting; exercise

What syndrome is characterized by dysphagia, esophageal webs, iron deficiency anemia and atrophic glossitis

Plummer-Vinson syndrome

A CD4 count of < or = 200 suggest what opportunistic infection

Pneumocystis (PCP)

Fungal pneumonia common is HIV patients with a CD4 < 200

Pneumocystis Jiroveci

Bacterial pneumonia associated with HIV CD4 <200 and immunocompromised

Pneumocystis jiroveci

What causes the crepitus to be heard on auscultation with suspected Boerhaave syndrome

Pneumomediastinum

Patient is a 62-year-old female presents to the emergency room with complaints of severe, whole-body itching. She states that she first noticed her symptoms while in the bathtub at home. Over the previous several months she has had episodes of severe joint swelling and pain in her hands as well as redness, burning pain, and swelling of her hands and feet. Her past medical history is significant for type II diabetes mellitus, hypertension, and osteoporosis for which she takes metformin, enalapril, and alendronate, respectively. In addition, she was found to have a deep vein thrombosis of her right leg five months prior to presentation. The patient's laboratory tests demonstrate elevated RBC count, hemoglobin, and hematocrit of 54%, leukocytosis with a WBC count of 19,000 cells/mm^3 with normal differential, and thrombocytosis with a platelet count of 900,000/mm^3. What does this patient have

Polycythemia

Menses that occur more frequently: menses < 21 days apart

Polymenorrhea

How do you diagnose sleep apnea

Polysomnography (can consider home sleep apnea testing in patients without comorbidities)

How does an MCL tear present

Pop, medial joint line pain of knee due to valgus stress injury + knee instability or inability to walk

Injury to what artery in knee dislocations should you worry about

Popliteal artery, diagnose with CT angiogram

What are some examples of major criteria for diagnosing endocarditis

Positive blood cultures, positive echocardiogram

Patient is a 30-year-old male arrives at the emergency room after a motor vehicle accident. Upon arrival, he has difficulty breathing and reports shoulder pain. On physical exam, he has decreased breath sounds on the right side and significant tenderness of his right shoulder. There is overlying ecchymosis, swelling, and erythema over his right scapula and limited range of motion. What does this patient have

Possible scapular fracture

How does cervical cancer present

Post-coital bleeding and vaginal discharge

What type of stroke is associated with brainstem dysfunction such coma, drop attacks, vertigo, nausea, vomiting, ataxia

Posterior circulation involvement

How do you test for PCL tear on physical exam

Posterior drawer sign, sag sign: tibia sagging posteriorly, active quad test

What is the most common location of an anorectal abscess

Posterior rectal wall

How do you treat hypokalemia

Potassium repletion with products not containing dextrose, +/- magnesium replacement

TB that spreads to the spine is called

Potts disease (type of miliary TB)

What is the cause of molluscum contagiosum

Poxvirus

What does stage 0 mean within regards to breast cancer

Precancerous DCIS or LCIS

What is Barret's Esophagus

Precancerous metaplastic columnar cells replace normal esophageal squamous epithelium

What is the most common cause of secondary amenorrhea

Pregnancy

How do you workup dysmenorrhea

Pregnancy + pelvic ultrasonography

What are causes of primary amenorrhea

Pregnancy, imperforate hymen, gonadal dysgenesis: turner's syndrome (46 XO) - short web neck, HPO axis abnormalities: eating disorders or excessive exercise

What are the risk factors for the development of varicose veins

Pregnancy, prolonged standing or sitting, obesity, OCPs

Menopause onset <40 years old is due to

Premature ovarian failure

Patient is a 25-year-old female who complains of abdominal bloating, headache, irritability, depression, poor sleep quality, and breast tenderness. These symptoms occur on a monthly basis 5 days before menses. Her symptoms greatly improve within 4 days of the onset of menses. What does this patient have

Premenstrual syndrome

Patient is a 40-year-old carpet installer who spends his working day on his knees, fitting carpets. In the past few months, he had been aware of a dull ache over his right knee, which had seemed to be aggravated by pressure and on flexion of the knee. He had been wearing kneepads, using a soft mat and trying to avoid kneeling on that knee. However, he was alarmed to wake one morning with a large, tender, fluctuant swelling over the kneecap. What does this patient have

Prepatellar bursitis: Housemaid's knee

Patient is an 80-year-old bed-boundwoman with a temperature of 104°F who you are called to see in the nursing home. The patient is disoriented and confused. On physical examination, the patient's blood pressure is 110/ 80 mm Hg, and her pulse is 72 beats/ minute and regular. You notice a purulent, foul-smell in the room. What does this patient most likely have

Pressure ulcer

How do you manage stage 1 pressure ulcer

Preventive measures, thin film dressings for protection

How does oral contraception work

Prevents ovulation by inhibiting mid-cycle LH surge, thickens cervical mucus and thins endometrium

Patient is a 17-year-old female who is concerned that she has not yet had her period. She reports being sexually active and uses condoms consistently. She denies pelvic pain. On physical exam, there is normal breast development; however, her uterus is not palpable. This is confirmed by pelvic ultrasound. Karyotype returns as 46, XX and serum testosterone level is appropriate for a female. What does this patient have

Primary amenorrhea

What are the 2 causes of hyperparathyroidism

Primary: increased PTH due to PTH secreting parathyroid adenoma vs Secondary: increased PTH due to hypocalcemia of vitamin D deficiency

Patient is a 65-year old man who presents to the ED at 1 am with 90 minutes of central chest pressure that awoke him from sleep. He says he thinks he has 'indigestion.' The pain is non-radiating, with mild shortness of breath but no nausea, vomiting or diaphoresis. He is an ex-smoker with a 20 pack-year history. There is no previous history of CAD, diabetes, hypertension or high cholesterol. On arrival, he looks well, with normal heart rate (54 bpm), blood pressure (127/86) and oxygen saturation (98% on room air). His pain has improved slightly with sublingual nitrates in the ambulance, although he still has some ongoing chest discomfort. His ECG is shown below. Troponins are positive. He is admitted to hospital and undergoes emergent cardiac catheterization, where he is without obstructive coronary disease, but his symptoms can be provoked with the administration of intravenous ergonovine. What is this patient likely experiencing

Prinzmetal angina

What are some absolute contraindications for fibrinolytic use in STEMI

Prior intracranial hemorrhage, cerebral vascular lesion, malignant intracranial neoplasm, ischemic stroke within 3 months, aortic dissection, active bleeding

What are some rescue antiemetics

Prochlorperazine and droperidol

How do you diagnose a fistula

Proctoscope

What imaging studies can be used to diagnose hemorrhoids

Proctosigmoidoscopy or colonoscopy

What are the 3 phases of measles

Prodrome of cough/coryza/conjunctivitis, enanthem showing kolpik spots (bluish-white central dots in mouth), exanthema of rash that begins on face and spreads cephalocaudally

How does chronic bronchitis present

Productive cough > or = 3 months x 2 consecutive years, wheezing, rales, rhonchi

What contraceptive pill is safe to use during lactation

Progestin-only mini pill

How does Alzheimer present

Progressive cognitive decline

What is the underlying pathophysiology of COPD

Progressive, largely irreversible airflow obstruction due to loss of elastic recoil and increased airway resistance

How do you manage septic arthritis

Prompt antibiotics guided by gram stain and arthrotomy with joint drainage

How do you manage essential tremor

Propranolol or primidone (anticonvulsant)

How do you treat vitiligo

Protect against sun and topical corticosteroids

How do you manage an isolated grade I (partial) or II (complete isolated) PCL tear

Protected weight bearing and physical therapy vs surgical repair for PCL + ACL or PCL + grade III MCL/LCL

What are nutritional causes of easy bruising/bleeding

Protein malnutrition, vitamin c deficiency, vitamin k deficiency

Pepsin is responsible for the breakdown of what

Proteins

What are the 5 P's of lichen planus

Pruritic, purplish, polygonal, plain-topped papules

How does polycythemia present

Pruritis after hot baths, gout, headache, blurred vision, dizziness, rubor of hands and feet

Bacterial pneumonia associated with ventilators and cystic fibrosis

Pseudomonas

What infection is common in bronchiectasis in patients >18 years old

Pseudomonas

What is the most common cause of septic arthritis in IV drug abusers

Pseudomonas

Within regard to appendicitis RLQ pain with right hip flexion/extension is called

Psoas sign

Patient is a 75-year-old female with patches of chronic, inflammatory, well-demarcated, erythematous, silvery scaly plaques which involves the scalp and extensor surfaces. What does this patient have

Psoriasis

What is the gold standard for definitive diagnosis of PE

Pulmonary angiography

Fungal pneumonia that occurs in people with underlying illnesses such as TB or COPD but with otherwise healthy immune systems

Pulmonary aspergillosis

What is the gold standard for diagnosing COPD

Pulmonary function testing/spirometry

What is the gold standard for diagnosing asthma

Pulmonary function tests: decreased FEV1 and FEV1/FVC

What skin abnormality can be seen with thrombocytopenia or coagulation cascade disorders

Purpura

Describe stage III acne vulgaris

Pustular lesions >25% and moderate scarring

How does hypocalcemia present

QT prolongation, trousseaus sign, chvostek's sign

How do you diagnose primary amenorrhea

Quantitative beta HCG, FSH, prolactin, TSH, T3, free T4, progesterone

How do you diagnose secondary amenorrhea

Quantitative beta HCG, TSH, prolactin, progesterone challenge, FSH

How do you treat active TB

RIPE: Rifampin (causes red/orange body fluids), Isoniazid, Pyrazinamide (causes gout), Ethambutol (causes optic neuritis)

What is a common cause of viral pneumonia in children

RSV

How do you treat stage 2b-4a cervical cancer

Radiation + chemo: cisplatin

What is the most common risk factor for thyroid carcinoma

Radiation exposure

How do you manage renal cell carcinoma

Radical nephrectomy

How do you definitively manage WPW

Radiofrequency ablation

Name 2 examples of integrase strand transfer inhibitor (INSTI)

Raltegravir (Isentress), Dolutegravir (Tivicay)

What criteria is used for the prognosis of acute pancreatitis

Ranson's criteria and APACHE score

How does Non-Hodgkin lymphoma present

Rapid onset, common in HIV patients, painless lymphadenopathy, GI symptoms: bowel obstruction, intussusception

What is a side effect of phenytoin

Rash: erythema multiforme, SJS, gingival hyperplasia

What FEV1/FVC ratio indicates chronic bronchitis

Ratio < 0.7

What can happen to HLA-B27 individuals who have shigella

Reactive arthritis

How do you treat carotid disease

Recommend smoking cessation, provide antiplatelet therapy (clopidogrel, aspirin + dipyridamole, statins)

Patient is a 50-year-old female with pelvic pressure reports a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence. What does this patient have

Rectocele

How do you treat orthostatic hypotension

Reduce venous pooling, increase sodium intake, fludrocortisone or midodrine

How do you manage a shoulder dislocation

Reduce, postreduction films, sling + swath + physical therapy

How do you diagnose Hodgkin's lymphoma

Reed sternberg cells, CT, bone biopsy

How do you manage adhesive capsulitis

Rehab for range of motion therapy, anti-inflammatories, steroidal joint injection, heat vs surgery if failure to conservative treatment

How do you manage pyloric stenosis

Rehydration with IV fluids (potassium repletion if low) vs definitive management via pyloromyotomy

What drugs should you avoid in WPW

Remember ABCD: Adenosine, Beta blockers, Calcium channel blockers, Digoxin

What is the first line step in the management of cutaneous drug reactions

Removal of offending agent

How do you treat contact dermatitis

Remove offending agent, burrow's solution, zinc oxide for diaper rash

What is the gold standard for diagnosing renal vascular disease

Renal arteriography

Patient is a 65-year-old man who noticed blood in his urine earlier this morning. This has never happened before and he denies any new medications or prior infection. He also reports to having flank pain for the past few weeks. Medical history is significant for hypertension. He has a 40 pack-year smoking history. On physical examination there is a firm, nontender, and homogeneous mass in the right flank. What does this patient have

Renal cell carcinoma

What is the most common type of renal cell carcinoma

Renal clear cell followed by transitional cell

Patient is a 69-year-old man with a 55-pack-year smoking history, diabetes type II, and hyperlipidemia presents to his primary care clinic for an annual exam. He has no complaints. He reports that his blood glucose has been under tight control and that he has not smoked a cigarette for the past 5 months. Vital signs are HR 69 bpm, BP 180/100 mmHg, RR 12/min, and O2 saturation 99% on room air. Physical examination is notable for bruits bilaterally just lateral of midline near his umbilicus. You initiate an anti-hypertensive medication, but his blood pressure continues to be suboptimal. Creatinine is 3.5. What does this patient have

Renal vascular disease

How do you manage polycythemia

Repeated phlebotomy to lower hematocrit to < or = 42%, patients >60 treat with hydroxyurea +/- aspirin

How do you treat hemophilia

Replace factor 8 or 9

How do you treat secondary hyperparathyroidism

Replace vitamin D and calcium

How do you prevent development of pressure ulcers

Repositioning every 2 hours

How is hepatitis D virus transmitted

Requires hepatitis B virus (HbsAg) to cause coinfection or superimposed infection

How do you test for teres minor/infraspinatus tear or inflammation

Resisted external rotation with elbow at 90 degrees

How do you manage Bell palsy

Resolves in 1 month w/o tx, prednisone if started w/n 1st 72 hours of sx onset, artificial tears

What ABG/Labs are found in chronic bronchitis

Respiratory acidosis, elevated hemoglobin and hematocrit due to chronic hypoxia (stimulates erythropoiesis)

A patient with the following ABG has what type of acid-base disorder, ph 7.52, PCO2 25, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)

Respiratory alkalosis

What is seen on ABG in emphysema

Respiratory alkalosis

What finding is seen on ABG in those with PE

Respiratory alkalosis secondary to hyperventilation

What are the 3 cardinal features of Parkinson's disease

Rest tremor, cogwheel rigidity and bradykinesia

How do you treat subacromial bursitis

Rest, NSAIDs, prevention of precipitating factors, cortisone injections

How do you manage subacromial impingement

Rest, ice, activity modification, NSAIDs, corticosteroid injections vs surgery if refractory to conservative measures

How does nicotine intoxication present

Restlessness, insomnia, anxiety, arrhythmias

How do you manage ischemic colitis

Restore perfusion and observe for signs of perforation

How do you manage peripheral arterial disease if conservative measures fail

Revascularization with PTA, bypass grafts, stenting

Explain pathophysiology of asthma

Reversible tracheobronchial tree hyperirritability causing airway inflammation and bronchoconstriction

Fulminant hepatitis MC seen in children associated with aspirin use during viral infections, accompanied with rash on hands/feet, intractable vomiting, liver damage, encephalopathy, dilated pupils is called

Reye syndrome

How does Lyme disease present in early disseminated stage, 1-12 weeks post-bite

Rheumatologic: arthritis; Neurologic: headache, meningitis, weakness, facial nerve palsy; Cardiac: AV block, pericarditis

Patient is a 64-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and type II diabetes with increasing shortness of breath and ankle swelling over the past month. On physical examination, you note jugular venous distention, increased hepatojugular reflex, and hepatomegaly. His lungs are clear to auscultation. What is this patient likely experiencing

Right ventricular heart failure

How do you treat Non-hodgkin lymphoma

Rituximab, chemotherapy

Patient is a 46-year-old white woman presents with facial flushing that she notes is worse when she has her morning coffee and when she is stressed at work. Physical examination reveals the presence of localized facial erythema, telangiectasias as well as several scattered papules and pustules on her cheeks. What does this patient have

Rosacea

What is the difference between Rosacea and acne vulgaris

Rosacea doesn't have comedones

Only childhood exanthem that starts on the trunks and spreads to the face

Roseola also called sixth disease

Patient is a 69-year-old male with right shoulder pain for the past several months. He reports that he cannot reach above his head without severe pain. As a retired carpenter, he reports that this has significantly impacted his quality of life. Additionally, he is unable to lie on his left side at night due to shoulder pain. On physical exam, there is focal tenderness over the left anterolateral shoulder. Radiography reveals reduced space between the acromion and humeral head. What could this patient have

Rotator cuff tendinopathy/tear

What is the most common cause of diarrhea in children

Rotavirus

What syndrome is a similar to a mild form of Dubin-Johnson, associated with conjugated and unconjugated bilirubin but not associated with black liver on biopsy

Rotor's syndrome

What bariatric surgery is considered malabsorptive and restrictive

Roux-en-Y gastric bypass

Within regard to appendicitis pain in the RLQ with palpation of the LLQ is called

Rovsing's sign

How do you manage hemorrhoids that are unresponsive to conservative treatment

Rubber band ligation, sclerotherapy, hemorrhoidectomy (for all persistent hemorrhoids or stage IV)

3-day rash that spreads from the face to the trunk and extremities

Rubella also called german measles (spreads much more rapidly than rubeola)

Patient is a 6-year-old child who is brought to the emergency room for a complaint of high fevers and a rash. His mother reports that she thought he had "just a cold" approximately one week ago—he had a mild fever, runny nose, conjunctivitis, and cough. Then he developed a rash that started on his face and gradually spread downward. On examination, the child appears lethargic and has a temperature of 104.3. There is a mild injection of his conjunctiva and a generalized macular rash. White macules are noted on his buccal mucosa. What does this patient have

Rubeola also known as measles

What is the most common cause of cellulitis

S. aureus and GABHS

What are the common bacterial causes of cellulitis in adults

S. aureus and group A strep

What is the most common bacterial cause of meningitis in those >1 month

S. pneumo

Bacterial pneumonia that presents with rust colored sputum and common in patients who have had a splenectomy

S. pneumoniae

What are the causes of bacterial meningitis

S. pneumoniae (gram + diplococci), N. meningitidis (gram negative diplococci)

What is the most common Shigella species causing bacillary dysentery in the US

S. sonnei

How do you treat intermittent asthma

SABA PRN (step 1)

What are some major exclusion criteria to thrombotic management of stroke patients

SAH, head trauma, recent stroke or MI within past 3 months, BP >185/110, active bleeding,

What are causes of euvolemic hyponatremia

SIADH, steroids, hypothyroid

What EKG findings are indicative of PE

SIQ3T3

How does hepatitis A present clinically

SPIKED fever, decreased smoking, URI sx, N/V, alcoholic stools, hepatomegaly, jaundice

Patient is a 70-year-old male complaining of left-sided crushing substernal chest pain that began suddenly while he was walking his dog. He denies any past medical history, has not seen a physician recently and has smoked one pack per day for the past 50 years. Vital signs are BP 85/50 mmHg, HR 50 bpm, RR 22, T 99.1 deg F. Physical exam shows an obese, nervous man with jugular venous distension and clear lung fields. An electrocardiogram shows ST elevations in II, III, and aVF. What is this patient experiencing

STEMI, inferior infarct

What areas are most often affected by pressure ulcers

Sacrum and hip

What supportive medication should be avoided in children below 18 years of age with influenza and why

Salicylates, associated with Reye's syndrome

What is the common bacterial cause of osteomyelitis in patients with sickle cell

Salmonella spp.

How do you manage emphysema

Same as chronic bronchitis: Ipratropium (also albuterol inhaler), O2, oral steroids, antibiotics

What is the most common cause of scabies

Sarcoptes scabiei hominis

Patient is an 11-year-old male complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend who he had a sleepover with this past weekend is also having similar symptoms. What does this patient have

Scabies

Lower esophageal webs/constrictions @ the squamocolumnar junction MC associated w/sliding hiatal hernias is called

Schatzki ring

How do you diagnose pernicious anemia

Schilling test

How do you manage postoperative nausea and vomiting

Scopolamine patch, ondansetron, dexamethasone

TB that spreads to the cervical lymph nodes is called

Scrofula (type of miliary TB)

Erythematous, yellowish greasy scales, crusted lesions seen on scalp is called

Seborrheic dermatitis (cradle cap)

Patient is a 67-year-old male concerned about skin cancer. He notes that over the past several years, several greasy moles have cropped up on his back. His wife had died of melanoma and he is scared that these moles are melanomas. On exam you note several small flesh colored, grey brown and black papules/plaques with a velvety warty texture and a greasy, "stuck on" appearance. What does this patient have

Seborrheic keratosis

What is first line treatment for urticaria

Second generation antihistamine such as fexofenadine or loratadine

Patient is a 23-year-old female who is concerned that she has not had her menses over a period of four months. She is also very distressed about increased hair growth. She reports having to shave frequently above the lip, chin, chest, and lower back. Prior to this, she had a regular menses. The patient's weight is 168 lbs (76.2 kg) and height 5 feet and 1 inch (154.9 cm). She has acne on the cheeks and forehead. Hyperpigmented plaques of the skin are found on the nape of her neck. Bilateral enlarged ovaries are palpated on pelvic examination. β-hCG is negative and LH: FSH is 3. What does this patient have

Secondary amenorrhea

What hormone released by the duodenum inhibits parietal cell production and causes pancreatic release of bicarbonate

Secretin

What is the more common cause for posterior shoulder dislocation

Seizure

How do you treat tinea versicolor

Selenium sulfide

How do you treat tinea capitis

Selenium sulfide or ketoconazole shampoo

How do you manage pityriasis rosea

Self limiting but can use topical or systemic steroids + antihistamines + emollients to help with itching and scales

How do you treat molluscum contagiosum

Self-limiting

How do you treat telogen effluvium

Self-limiting

What is the most common type of testicular carcinoma

Seminoma

What does the radiograph show

Sentinel loop (localized ileus) seen with acute pancreatitis

What is another name for acromioclavicular separation

Separated shoulder

Patient is a 24-year-old male presents with abrupt onset of swelling, pain, redness, and increased warmth in his right knee. He denies any injury or previous joint issues. The symptoms began yesterday along with generally not feeling well and possible low-grade fever. He is sexually active with a recent new partner. On physical examination, T: 100°F, right knee is edematous and erythematous with increased warmth and ROM decreased by pain. Right knee synovial fluid analysis reveals increased leukocytes and absence of crystals. What does this patient have

Septic arthritis

What should your workup of NSTEMI include

Serial EKGs and first one within first 10 minutes, serial cardiac markers: 3 sets every 8 hours (troponin best marker)

What serum folate level is indicative of folate deficiency anemia

Serum folate <3

How do you diagnose basal carcinoma

Shave or punch biopsy

What invasive diarrhea presents with explosive diarrhea, febrile seizures, possible reiter's syndrome

Shigella

Patient is a 23-year-old prison inmate was brought in from the detention clinic with a 3-day history of crampy abdominal pain and diarrhea. Patient reports the stools were small volume and bloody. On examination his abdomen is tender, he has decreased skin turgor, and temperature was found to be 101.5°F (38.6°C). Stool microscopy reveals numerous RBCs and WBCs and a stool culture was ordered. What does this patient have

Shigellosis (gram negative)

What symptoms does left ventricular failure cause

Shortness of breath and fatigue

Patient is a 9-year-old boy who is brought to the emergency department by his mother. She reports that, as of this morning, he has had difficulty walking and seems unable to communicate with her. On exam, you note a thin, African American boy with mild conjunctival pallor. Vital signs reveal the following: T 36.2 C, BP 105/60 mmHg, HR 95 bpm, RR 16 rpm. Neurologic exam reveals weakness of the right arm and leg as well as expressive aphasia. What does this patient have

Sickle cell disease

Patient is a 21-year-old African-American male with "reddish urine" at his morning void. There was no pain when voiding. He has never had any symptoms like this before. He stated that he had moderate alcohol intake two nights before, but otherwise, he did not take any prescription or non-prescription medications. His past medical history is unremarkable, and he has had no recent infections. On physical exam, his vital signs are all within normal limits. He is well-appearing and in no distress. There was no costovertebral angle or suprapubic tenderness. What does this patient have

Sickle cell trait

What is the most common area for the occurrence of diverticulosis/diverticulitis

Sigmoid colon

What parts of the colon does a volvulus commonly occur

Sigmoid colon and cecum

How does septic arthritis present

Single, swollen, warm, painful joint most commonly knee, fever

How does adrenal cortical cancer present on CT

Size >4 cm, calcifications

What is the appearance of Crohn disease on colonoscopy

Skips lesions and cobblestone appearance

Patient is a 48-year-old man is brought to his physician by his wife, who is concerned about his daytime sleepiness. Last week, he fell asleep while stopped at a red light. She says that he snores loudly and sometimes stops breathing for a few seconds while sleeping. His past medical history is significant for hypertension. He has a 20-pack-year history of smoking. His temperature is 37 C (98.6 F), heart rate is 86/min, blood pressure is 156/95 mm Hg, respiratory rate is 12/min. On physical exam, he is obese, but chest auscultation and extremity exam are within normal limits. What does this patient have

Sleep apnea

What are the 2 types of hiatal hernia

Sliding and paraesophageal

What percent body area is considered to be TEN

Sloughing of skin >30%

Patient is a 26-year old with no specific underlying or family disease. Six months ago, he experienced an episodic attack of distending pain in his left lower quadrant, nausea, and vomiting; he was treated with oral drugs at a local hospital. However, his symptoms were not completely relieved and were later aggravated. A normal abdominal X-ray suggested incomplete small bowel obstruction. Physical examination revealed a soft abdomen with tenderness in the left lower quadrant. No mass was palpated in the abdomen. Examination of tumor-associated antigens showed prominent high levels of carcinoembryonic antigen (CEA). Abdominal CT scans showed many swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space but no discernible mass. Double-balloon enteroscopy (DBE) and the following biopsy revealed at the upper jejunum that most of the lumen was obstructed by an irregular protrusive tumor of gastrointestinal origin. What does this patient have

Small bowel carcinoma

Patient is a 68-year-old female with a history of cholecystectomy, appendectomy and C-section complaining of cramping abdominal pain and distention. Patient notes vomiting and states that she has been unable to pass gas or stool. What does this patient most likely have

Small bowel obstruction

What type of lung cancer metastasizes early, associated with smoking/ACTH/ADH/hyponatremia/hypercalcemia, Lambert-Eaton myasthenic syndrome and mediastinal mass or lymph nodes on one side

Small cell

What type of bronchogenic carcinoma metastasizes early

Small cell (oat cell) carcinoma

How does folliculitis present

Small, white-headed pimples

What is the most significant risk factor in renal cell carcinoma

Smoking

What is the most common cause of bronchogenic carcinoma

Smoking (Asbestosis is 2nd)

What management is indicated for chronic disease bronchitis

Smoking cessation, ambulatory O2, bronchodilator, steroids, vaccines (pneumococcal and flu)

What is the number one risk factor for developing prinzmetal angina

Smoking, cocaine use is also important

What are the risk factors for the development of peripheral arterial disease

Smoking, diabetes, hypertension, hypercholesterolemia, advanced age, sedentary lifestyle

What are risk factors for the developing an aneurysm

Smoking, hypertension, hypercholesterolemia and heavy alcohol use

What are causes of hypovolemic hyponatremia

Sodium loss

What is the drug of choice for hypertensive emergency

Sodium nitroprusside

What hormone is released by pancreatic delta cells, inhibiting the secretion of gastrin

Somatostatin

How do you test for biceps tendonitis

Speed and Yergason's test

What is the initial method of identifying pulmonary embolus

Spiral CT

How do you manage refractory ITP

Splenectomy

How do you treat hereditary spherocytosis

Splenectomy

Expulsion of all or part of the products of conception before 20 weeks of gestation is called

Spontaneous abortion

How do you diagnose TB

Sputum for Acid fast blood smears and cultures + chest x-ray + biopsy

What type of lung cancer presents as a smoker with hemoptysis and an abnormal chest x-ray showing a large central solitary tumor

Squamous cell

Which type of bronchogenic carcinoma is associated with central location, cavitary lesions hyperCalcemia and Pancoast syndrome

Squamous cell

Actinic keratosis is a precursor to what

Squamous cell carcinoma

Patient is a 63-year-old male who comes to your office for a lesion on his lip of 8-10 months duration. His past medical history is significant for multiple actinic keratoses, treated with cryotherapy. On physical exam, you note a scaly, crusted, keratotic nodule about one cm diameter on the lateral part of the lower lip. What does this patient have

Squamous cell carcinoma

What is the most common type of esophageal cancer worldwide

Squamous cell, occurs in the upper 1/3 of esophagus

How does Diffuse Esophageal Spasm present clinically

Stabbing CP made worse w/ hot or cold liquids/foods

Patient is a 50-year-old woman with a history of hyperlipidemia and diabetes type 2complaining of "chest pain attacks." She says that these attacks tend to occur while walking up five flights of stairs to get to her apartment, they last for 15-20 minutes and are relieved by rest. She describes the pain as sharp and substernal. A baseline EKG is unremarkable. Suspecting the diagnosis, you perform an exercise stress EKG and observe transient ST depressions in the anterolateral leads after significant exertion. What is this patient experiencing

Stable angina

What are the 3 stages of pregnancy

Stage 1: onset of contraction to full dilation, stage 2: full dilation to delivery of baby, stage 3: after delivery of baby to expulsion of placenta

What infection is common in bronchiectasis in patients <18 years old

Staph

What enterotoxin cause of diarrhea is usually due to food contamination

Staph Aureus

What are the most common bacterial causes of hospital acquired meningitis

Staph and aerobic gram-negative bacteria

What is the most common bacterial cause of breast abscess

Staph aureus

What is the most common cause of septic arthritis

Staph aureus

What are the most common bacterial causes of anorectal abscess

Staph aureus and E. Coli

What is the common cause of folliculitis

Staph aureus, pseudomonas is seen in hot tub users

Bacterial pneumonia that presents with salmon colored sputum, lobar, post-flu

Staph aureus: if MRSA treat with vancomycin

What is the most common bacterial cause of osteomyelitis

Staphylococcus aureus

What is the USPSTF colorectal screening guidelines for those of average risk

Starting at age 50 colonoscopy every 10 years or flex sigmoidoscopy every 5 years + fecal occult blood testing every 3 years

What is Virchow's triad

Stasis (post-surgical, immobility, venous insufficiency), Hypercoagulable states (Factor V Leiden, cancer, OCP + smoking, pregnancy), Trauma (surgery, cellulitis)

What are indications for revascularization in carotid disease

Stenosis >70%, post-TIA or stroke

How do you treat renal vascular disease (stenosis)

Stenting: percutaneous transluminal angioplasty plus stent

How does vascular disease dementia present

Stepwise deterioration with periods of clinical plateaus, can cause sudden decline

How do you treat autoimmune hemolytic anemia

Steroids or splenectomy for severe cases

What are some risk factors for avascular necrosis of hips

Steroids, SLE, hypercoagulable states, irradiation, trauma, hematologic diseases, sickle cell, dysbaric disorders (the bends)

How does hypercalcemia present

Stones, bones, abdominal groans, psychiatric overtones, shortened QT interval

How do you dx C. jejuni diarrhea

Stool culture shows, S, comma or seagull shaped organisms

How do you diagnosis shigella

Stool cultures positive for leukocytes, leukemoid reaction: >50,000 uL, sigmoidoscopy shows punctate areas of ulceration

How do you treat melasma

Stop estrogen agent or hormone therapy, treat with sunscreen and topical hydroquinone

How do you treat aplastic anemia

Stop offending agent, provide bone marrow transplant if <50 or immunosuppressive agent if >50

What are the common causes of ACL tear

Stopping movement and changing direction, valgus stress of the knee, sports

What sign can be seen on barium studies with ulcerative colitis

Stovepipe sign, meaning loss of haustral markings

What is the most common cause of endocarditis

Streptococcus viridans

How does C. diff diagnosed

Strikingly high lymphocytosis, fever, pseudomembranous colitis

How does Crohn disease appear on barium study

String sign

Patient is a 69-year-old woman who is brought in to the emergency department by ambulance after her husband noticed that she began slurring her speech and had developed facial asymmetry during dinner approximately 30 minutes ago. Her past medical history is remarkable only for hypertension. On physical exam, vital signs are within normal limits except for a heart rate of 105 bpm. She is noted to have distinct right facial paralysis. Non-contrast head CT is performed, which is negative for blood. What is this patient experiencing

Stroke

Patient is a 42-year-old man with complaints of right shoulder pain. He does not remember any specific injury but has been playing a lot of tennis during the past 4 months. It has become difficult and painful for him to reach overhead and behind him. Even rolling onto his shoulder in bed is painful. On examination of the right shoulder, there is full range of motion in all planes with obvious discomfort at end ranges of flexion, abduction, and internal rotation. There is significant pain when you place the shoulder in a position of 90 degrees flexion and then internally rotate. There is also moderate weakness with abduction and external rotation of the shoulder. The rest of the musculoskeletal examination is normal. What does this patient have

Subacromial bursitis

Patient is a 70-year-old male with an insidious onset of left shoulder pain that is exacerbated by overhead activities and while lifting objects away from his body. He is a retired mechanic of 35 years. The patient reports that over the last several months he has been having difficulty sleeping because of the pain. On physical examination, there is notable tenderness over the left anterolateral shoulder and passive forward flexion >90°causes severe pain. An x-ray reveals proximal migration of the humeral head and calcification of the coracoacromial ligament. What does this patient have

Subacromial impingement

Patient is a 44-year-old female arrives at the emergency room with a stiff neck, photophobia, and severe headache that began while she was just sitting down to enjoy a box of Kentucky Fried Chicken. She states her symptoms came on immediately and she is in severe distress. What does this patient likely have

Subarachnoid hemorrhage

How does glenohumeral joint osteoarthritis present on x-ray

Subchondral sclerosis, osteophytes, joint narrowing

Patient is a 74-year-old female who is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the emergency department. Her daughter states that the patient fell in her kitchen 2 days ago but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient's left pupil is dilated. CT shows crescent shaped, concave hyperdensity. What does this patient likely have

Subdural hematoma

Brain bleed on CT that is concave (crescent shaped) is called

Subdural hematoma (venous bleed)

What can be used for elective abortion in 12 weeks or less

Suction curettage

What are some common causes of acute mesenteric ischemia

Sudden decrease blood supply to the bowel because of embolus, thrombosis, shock, and cocaine which commonly occurs at the splenic flexure

What is the most common cause of SJS

Sulfa and anticonvulsant meds

What areas of the body does basal carcinoma normally appear

Sun-exposed areas such as face, trunk, lower legs

How do you diagnose Mallory Weiss syndrome

Superficial longitudinal mucosal erosions seen on upper endoscopy

Describe a stage 1 pressure ulcer

Superficial non-blanching area of erythema

What vein is commonly involved with varicose veins

Superficial saphenous vein

How do you manage Mallory Weiss syndrome

Supportive care and acid suppression to promote healing, if severe bleeding: epi injections, sclerosing agent, band ligation, hemoclipping or balloon tamponade

How do you treat rubeola

Supportive with anti-inflammatories, isolation 1 week post rash

How do you treat mononucleosis

Supportive: rest, analgesics, antipyretics, fluids, warm salt water gargles, fluids, avoidance of contact sports for at least first 3-4 weeks of illness

What are some metastatic signs of gastric carcinoma

Supraclavicular lymphadenopathy (Virchow's node), Umbilical lymphadenopathy (Sister Mary Joseph's node), palpable node on rectal exam (Blumer's shelf), Left axillary lymph node (Irish sign), ovarian METS (Krukenburg tumor)

Name the 4 rotator cuff muscles

Supraspinatus, infraspinatus, teres minor, subscapularis

How do you definitively manage ulcerative colitis

Surgery

How do you treat cystocele if conservative treatment failed

Surgery with mesh augmentation

How do you treat stage 1a1 cervical cancer

Surgery: TAH-BSO

How do you manage Stanford type A/Debakey I and II or acute distal type III aortic dissections with complications

Surgical

What is the differential for postoperative bleeding

Surgical bleeding: bleeding from a major artery, medications, inherited coagulation disorders, liver disease, renal failure, DIC

What can be used for elective abortion in up to 16 weeks

Surgical curettage (D&C)

How do you manage lipomas

Surgical excision

How do you manage stage 1-3 melanoma

Surgical excision

How do you treat squamous cell carcinoma

Surgical excision +/- Mohs or radiotherapy/cryotherapy/electrodessication and curettage

How do you manage bronchial carcinoid tumors definitively

Surgical excision and octreotide for symptom reduction

How do you treat pilonidal disease

Surgical excision, can empirically treat with cefazolin + metro or augmentin

What are the treatment options for severe peripheral vascular disease

Surgical graft bypass, angioplasty, endarterectomy, surgical patch angioplasty

How do you manage acoustic neuroma

Surgical intervention

How do you treat biceps tendonitis refractory to conservative treatment

Surgical release of biceps tendon

How do you manage inguinal hernias

Surgical repair

How do you manage perilymph fistula

Surgical repair

How do you manage stage 1-2 non-small cell bronchogenic carcinoma

Surgical resection

How do you treat Wilm's tumor

Surgical resection and chemo

How do you manage hepatocellular carcinoma

Surgical resection if confined to a lobe and not associated with cirrhosis

How do you manage colorectal cancer

Surgical resection if stage I-III, chemotherapy (5FU/Fluorouracil) if stage III and metastatic

How do you manage acute mesenteric ischemia

Surgical revascularization (angioplasty with stenting or bypass) vs surgical bowel resection if not salvageable

How do you manage basal carcinoma

Surgically (photodynamic therapy, tissue scraping, electrosurgery, Mohs surgery, wide local excision) + fluorouracil or imiquimod to the affected area

How do you diagnose ITP

Suspect with isolated thrombocytopenia (platelets <100,000) and + direct coombs test

How does thoracic outlet syndrome present due to vascular compression

Swelling/discoloration of arm especially with abduction of the arm

How do you treat aseptic meningitis

Symptomatic or IV acyclovir for HSV

What is the treatment of choice for acute bronchitis

Symptomatic: fluids, expectorants, analgesics, B2-agonists, cough suppressants (not recommended in children)

How do you treat viral pneumonia

Symptomatic: fluids, rest, beta 2 agonists

Describe intermittent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function

Symptoms < or = 2 days/week, nighttime symptoms < or = 2 times/month, SABA use < or = 2 days/week, no activity interference, normal lung function test

Describe mild persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function

Symptoms > 2 days/week, nighttime symptoms 3-4 times/month, SABA use > 2 days/week, minor activity limitations, normal lung function tests

Describe moderate persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function

Symptoms daily, nighttime symptoms > or = 1 time/week, SABA use daily, some limitation of activity, FEV1 > 60% but <80%, FEV1/FVC reduced 5 %

Describe severe persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function

Symptoms throughout the day, nighttime symptoms nightly/week, SABA use several times/day, extremely limited normal activity, FEV1 <60%, FEV1/FVC reduced >5%

How do you treat unstable WPW

Synchronized cardioversion

Patient is a 68-year-old female with a syncopal episode that lasted less than 1 minute. She states she felt nauseous prior to losing consciousness. She has no significant past medical history. Resting blood pressure is 132/84 mm Hg. ECG is normal. This patient has likely experienced

Syncope

How do you manage bullous pemphigoid

Systemic corticosteroids

What are the common causes of ischemic colitis

Systemic hypotension or atherosclerosis involving the superior & mesenteric arteries

What is the pathophysiology behind atopic dermatitis

T cell mediated and increased IgE production

How do you treat stage 1 or 2a cervical cancer

TAH-BSO vs XRT + chemo: cisplatin

Patient is a 78-year-old man with a 3-month history of weight loss, fever, fatigue, night sweats, and cough. He is a former smoker. A recent HIV test was negative. A CT scan of the chest reveals a 3 cm lesion in the upper lobe of the left lung and calcification around the left lung hilus. A sputum smear was positive for acid-fast organisms. What does this patient have

TB

What should all patients with HIV be screened for

TB via interferon gamma release assay or tuberculin skin testing

A CD4 count of 500-200 suggest what opportunistic infections

TB, Kaposi sarcoma, thrush, lymphoma, zoster

What is the tx for severe or recurrent cases of tension headaches

TCAs (amitrypline) or BBs

Patient presents with monocular vision loss, contralateral hand weakness and speech changes that have gotten better over the last 30 minutes. What does this patient have

TIA

What neodjuvant endocrine therapy is helpful in women that are estrogen receptor (ER) positive

Tamoxifen

What can be used as a preventive measure in postmenopausal or women >35 years with high risk for breast cancer

Tamoxifen or Raloxifene for 5 years

How does dyshidrosis present

Tapioca vesicles on hands and feet following stress or hot humid weather

What type of cells can be seen with iron deficiency anemia

Target cells

Scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle)

Telogen effluvium

What is delirium

Temporary rapid onset AMS due to medical condition, substance intoxication or withdrawal

How does a clavicle fracture present on physical exam

Tenderness to palpation, swelling, erythema, tenting

What type of headache presents with bilateral tight band-like pain worsened with stress, fatigue, but has no N/V or focal neurologic symptoms

Tension

Patient is a 32-year-old male who noticed a mass on his right testicle while showering. He reports this has never happened before and denies any pain or discomfort. On physical examination, there is a firm and fixed mass on the left testicle. What does this patient have

Testicular carcinoma

Patient is a 10-year-old boy with chief complaint of paleness refer to your office. On physical exam he has splenomegaly (3 cm BCM) and lab data show these results: Hb: 8.5 (normal 12-17.5), MCV 79 (normal 80-100), MCH 22.5 (normal 25-34), WBC: 50,000, Plt: 650,000 (normal 150,000 - 400,000). What does this patient have

Thalassemia

What labs are seen with polycythemia

The 4 H's: Hypervolemia (elevated RBC), Histaminemia (increased histamine), Hyperviscosity (increased hematocrit), Hyperuricemia + Positive Jak2 tyrosine kinase mutation

What is patella alta

The pull of the patella upward due to quad muscles

How does sleep apnea present

Thick necked patient, obese or nonobese, enlarged tonsils, snoring daytime sleepiness, personality changes, decreased libido

What is Leriche's syndrome

Think CIA: Claudication of buttock/thighs, Impotence, Atrophy

What factors does PTT include

Think TENET: 12, 11, 9, 8, 10

What factors does the common pathway include

Think dollar bills below 20: 10, 5, 2 (thrombin), 1 (fibrinogen)

Patient is 35-year-old female complaining of ulnar sided arm/forearm pain and paresthesias. What does this patient have

Thoracic outlet syndrome

Bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix is called

Threatened abortion

How do you manage stroke patients

Thrombolysis via IV tPA within 3-4.5 hours of symptom onset and maintain BP to <185/105

What treatment option is available if cath lab is not accessible

Thrombolytic therapy (TPA and streptokinase)

How do you manage a stroke

Thrombolytics (alteplase) within 3 hours, antiplatelet therapy if >3 hours

Patient is a child with renal failure + Escherichia coli O157:H7 infections and diarrhea. What does this patient have

Thrombotic thrombocytopenic hemolytic uremic syndrome

Patient is a 34-year-old woman who arrives at the ED with acute-onset fatigue, fever, palpitations, and blurry vision. On chart review, it is revealed that she was recently diagnosed with AIDS and was on multiple antiretroviral medications. On physical exam, her skin is mildly jaundiced. She has multiple purpura over her extremities. A complete blood count is significant for a platelet count of 37,000/μL (normal 150,000 - 400,000/μL) and mild anemia. Her peripheral smear reveals schistocytes. She has a negative Coombs test. What does this patient have

Thrombotic thrombocytopenic purpura

What is the most common benign thyroid nodule

Thyroid adenoma

Patient is a 40-year-old woman who is otherwise healthy presents to your office complaining of a lump in her neck. On examination, she is found to have a firm 2-cm nodule associated with the left lobe of the thyroid gland. What does this patient likely have

Thyroid carcinoma

What is the extreme form of hyperthyroidism called

Thyroid storm

How do you treat thyroid nodules

Thyroidectomy if malignant, follow up in 6 months if benign, repeat FNA in 1-4 weeks if unsatisfactory specimen

Patient is a 28-year-old man who arrives in your ER complaining of severe right knee pain after falling from a ladder. The patient arrives in a wheelchair and physical exam is extremely difficult secondary to pain. What could this patient have

Tibial plateau fracture

Hair loss secondary to fungal infection is called

Tinea capitis

Hypo or hyperpigmented macules that do not tan and is caused by Malassezia furfur

Tinea versicolor

Your patient with anal fissures has tried all of your supportive care recommendations and still has no improvement, what 2nd line treatment do you now provide

Topic vasodilators such as nitroglycerin or Nifedipine ointment

How do you treat chronic paronychia

Topical clotrimazole or nystatin

How do you treat atrophic vaginitis

Topical conjugated estrogen creams

How do you treat atopic dermatitis

Topical corticosteroids and emollients

How do you manage atopic dermatitis

Topical corticosteroids, antihistamines for itching

What is the first line treatment for rosacea

Topical metronidazole

How do you treat perioral dermatitis

Topical metronidazole or erythromycin, steroids contraindicated

How do you treat androgenic alopecia

Topical minoxidil and oral finasteride

How do you treat scabies

Topical permethrin or oral ivermectin if severe

What is the first line treatment for > mild acne vulgaris

Topical retinoid + topical antibiotic

How do you treat lichen planus

Topical steroid ointments

How do you treat lichen simplex chronicus

Topical steroids such as high potency 0.05% betamethasone dipropionate cream or 0.05% clobetasol propionate cream

What treatment is indicated in advanced cases of osteoarthritis

Total joint replacement

How do you manage medullary thyroid carcinoma

Total thyroidectomy

How do you manage papillary or follicular thyroid carcinoma

Total thyroidectomy vs partial + radioiodine therapy

Patient presents with fever, abdominal pain, nausea, vomiting, tachycardia and rigidity. You order an abdominal x-ray and see dilated loops of colon >6cm. What does this patient likely have

Toxic megacolon

A CD4 count of < or = 100 suggest what opportunistic infections

Toxoplasmosis or Cryptococcus

Hair loss caused by pulling force

Traction alopecia

What is the most common type of bladder cancer

Transitional cell carcinoma

How do you manage acanthosis nigricans

Treat underlying case, metformin and topical retinoids or topical vitamin d analogs

How do you manage pectus excavatum or carinatum

Treatment usually not required but can use orthotic bracing or physical therapy

How do you manage Crigler-Najjar syndrome type II

Treatment usually unnecessary but can use phenobarbital to increase UGT activity

Vaginitis that presents in a sexually active woman with copious malodorous greenish discharge, dyspareunia, dysuria, strawberry cervix

Trichomonas vaginitis

How do you manage migraine headaches

Triptans or Ergotamines, Dopamine blockers (metoclopramide, promethazine, prochlorperazine) - give with Benadryl

True or false, fecal occult blood testing should be done annually

True

What procedure is used as sterilizing contraception

Tubal ligation

What is Pancoast syndrome

Tumor at superior sulcus lead to: shoulder pain, Horner's syndrome (miosis, ptosis, anhidrosis), atrophy of hand/arm muscles

What is a side effect of chemotherapy treatment in patients with AML

Tumor lysis syndrome, treat with allopurinol and manage acute renal failure

What labs can be used to diagnose pancreatic carcinoma

Tumor markers CEA and CA 19-9

How do you treat hiatal hernias

Type 1 hiatal hernias are handled medically (antacids, small meals, head elevation) vs nonresponsive or type 2 hernias with elective surgery: nissen fundoplication

What are the 2 different types of aortic dissections

Type A: proximal aortic dissection and Type B Distal Aortic dissection

What mechanism causes urticaria or angioedema

Type I IgE mediated

Describe the 5 types of AC joint dislocations

Type I: normal x-ray + ligamental strain, type II: AC ligament rupture + slight widening, type III: AC and coracoclavicular ligament rupture + significant widening, type IV: AC & CC rupture + displacement of clavicle into/through trapezius, type V: class IV + disruption of the clavicular attachments

What mechanism causes serum sickness

Type III immune antibody-antigen complex

What mechanism causes erythema multiforme

Type IV delayed (cell mediated)

What type of salmonella presents with cephalic phase characterized by headache, pharyngitis, pea soup stools (brown-green), intractable fever, bradycardia, blanching rose spots

Typhoid (enteric) fever

What are the 2 broad categories of Salmonella

Typhoid or enteric fever vs primarily gastroenteritis

Is adenocarcinoma of the lungs peripherally or centrally located

Typically peripherally

How do you diagnosis Wilm's tumor

US + CT abdomen + biopsy + resection

How do you diagnose renal cell carcinoma

US or CT + biopsy

How do you diagnosis cirrhosis

US, definitively with liver biopsy (screen for HCC with US + alpha-fetoprotein)

Patient is a 25-year-old white male complaining of LLQ pain, bloody diarrhea, and crampy rectal pain (tenesmus). What does this patient likely have

Ulcerative colitis

What is the initial imaging study of choice for abdominal aortic aneurysm

Ultrasound

What is the initial test used in suspected choledocholithiasis

Ultrasound

What is the recommended initial modality to evaluate breast masses in women <40 years old

Ultrasound

What is the test of choice for diagnosing cholelithiasis

Ultrasound

How do you diagnose thyroid masses

Ultrasound + biopsy if >1cm

How should you work up a thyroid nodule

Ultrasound - thyroid uptake scan - fine needle aspiration

How do you diagnose hepatocellular carcinoma

Ultrasound and will see increased alpha-fetoprotein

How do you diagnose fibroadenomas

Ultrasound or mammogram + fine needle biopsy or excision biopsy

How do you diagnose breast abscess

Ultrasound or mammogram in nonlactating women

How do you workup dysfunctional uterine bleeding

Ultrasound, FSH, LH, prolactin, estradiol, testosterone, TSH, T3, T4, DHEAS

What is the 1st line for diagnosing pyloric stenosis

Ultrasound, but Upper GI with contrast will show string sign

What is the initial test of choice for suspected cholecystitis

Ultrasound, thickened gallbladder >3 mm

What additional imaging can you order in suspected patellar tendinitis

Ultrasound: shows hypoechoic areas, MRI: shows tendon thickening in chronic cases

When should you order a PTT

Unexplained bleeding or bruising, or to monitor heparin use

Patient is a 58-year-old man with a history of coronary artery disease, hypertension, and hyperlipidemia presents to an emergency department for evaluation of chest pain. He reports somewhat suddenly experiencing dull left-sided chest discomfort while at rest at home that was not relieved with taking nitroglycerin. His vital signs are T 37.1, HR 94 beats per minute, BP 133/87, and O2 saturation 97% on room air. His ECG shows no ST-segment changes; serum troponin is not elevated. His chest pain subsequently resolves, and he is admitted to the cardiac service for further management. What did this patient experience

Unstable angina

What is test is indicated for evaluation of Chron's, esophageal motility disorders/webs/rings, peristalsis, scarring/strictures/lesions of upper GI tract

Upper GI Series (Barium swallow, esphogram)

What is the test of choice for Crohn disease

Upper GI series

How do you diagnose hiatal hernias

Upper GI series and endoscopy

How do you diagnose gastric carcinoma

Upper endoscopy with biopsy

What is the diagnostic test of choice in suspected esophageal cancer

Upper endoscopy with biopsy

Patient is a well-appearing 9-month-old male with a rash that comes and goes. According to the mother, citrus was recently added to the patient's diet. On physical exam, you observe a widespread rash composed of blanchable, edematous, pink, papules and wheels on the face, trunk, and lower extremities. What does this patient have

Urticaria

How long does it take rib fractures to heal

Usually 4-6 weeks with rest, analgesia and cessation of inciting activity

How does Dubin-Johnson Syndrome present clinically

Usually asymptomatic but can have mild icterus

How do you manage nipple discharge

Usually benign but can perform proximal duct excision to eliminate and diagnosis nipple discharge

How do you diagnose Lyme disease

Usually clinical, can use ELISA followed by Western blot if positive, can use IgM or IgG antibodies to B. burgdorferi

How do you diagnose influenza

Usually clinical, rapid antigen test in clinic

What is the gold standard for diagnosing dysfunctional uterine bleeding

Uterine dilation and curettage

What are alternative treatments for sleep apnea

Uvulopalatopharyngoplasty vs tracheostomy for failed conservative therapy or life-threatening sleep apnea

Posterior wall infarction is indicated by ST depression in what leads

V1-V3

How do you conservatively manage WPW

Vagal maneuvers, Class 1A antiarrhythmics such as procainamide

How do you treat vaginal dryness in menopausal women

Vaginal lubricants, lose dose estrogen creams

What is the 1st line treatment for CMV retinitis

Valganciclovir, 2nd line is Ganciclovir + Foscarnet

How do you manage grand mal seizures

Valproic acid, phenytoin, carbamazepine, lamotrigine

How do you treat MRSA osteomyelitis in patients >4 months old

Vancomycin or linezolid

What agents are available for tobacco cessation

Varenicline: Chantix, bupropion

Patient is a 77-year-old Hispanic female with a dull ache in her legs that is worsened with prolonged standing and relieved with rest and elevation of her legs. She has 14 grown children and a past medical history of obesity and hypertension. On physical exam, her bilateral lower legs are edematous with multiple dilated, tortuous superficial veins. What does this patient have

Varicose veins

Patient is a 59-year-old man presents with a visual disturbance that occurred one day ago. He reports that he experienced a "curtain coming down" over his left eye that lasted a few minutes. His past medical history includes long-standing type 2 diabetes mellitus, hypertension, coronary artery disease, and a 20 pack-year smoking history. On physical exam, he has bilateral carotid bruits. An ultrasound duplex of his carotids shows bilateral stenosis with 40% on the right and 75% on the left. What does this patient likely have

Vascular carotid disease

What is the second most common cause of dementia

Vascular disease

What are the most common causes of syncope

Vasovagal or idiopathic

What is the gold standard for diagnosing DVT

Venography

What is the first line imaging test for DVT

Venous duplex ultrasound

What small risk comes with the transdermal patch

Venous thrombus embolism

Patient is a 71-year-old male who was admitted to the acute care hospital two days following a massive CVA with possible brainstem infarct. Because he was also experiencing secondary respiratory failure, he was intubated and placed on mechanical ventilation. He was subsequently transferred to the neurointensive care unit where he was stabilized. His present vital signs are: respiratory rate 14 (ventilator rate), temperature 100.4 F. His SpO2 is 95%. His rating on the Glasgow Coma Scale is 5. What does this patient have

Ventilator associated pneumonia

Herniation through a weakness is the abdominal wall is called

Ventral (incisional) hernia

What is first line for prophylactically treating cluster headaches

Verapamil

Patient is a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet. What does this patient have

Verrucae

How do you rapidly test for HIV

Via blood or saliva test

What enterotoxin cause of diarrhea is usually due to contaminated food/water and overcrowding

Vibrio cholerae

Patient is a 45-year-old male with a one-week history of hacking non-productive cough, low grade fever, malaise and myalgias. The chest x-ray reveals bilateral interstitial infiltrates and a cold agglutinin titer that is negative. Examination reveals scattered rhonchi and rales upon auscultation of the chest. What does this patient have

Viral pneumonia

What causes influenza

Viral respiratory infection caused by orthomyxovirus

How do you diagnose adrenal carcinoma

Virilizing features, plasma fractionated metanephrines/24-hour urine metanephrines, serum potassium, 24-hour urinary free cortisol or dexamethasone suppression test, high levels of DHEA-S

How do you diagnose pectus excavatum or carinatum

Visual inspection and chest x-ray

How do you diagnose an anal fissure

Visual inspection with anoscopy

How do you diagnose hemorrhoids

Visual inspection, DRE, fecal occult blood testing

Patient is a 38-year-old man with a history of a gastric bypass for morbid obesity comes to your office with a hemoglobin level of 10 g/ dL. His MCV is 88 mm3. His ferritin level is 35 mcg/ L, and his red cell distribution width is high. His reticulocyte count is high. Further questioning reveals mild anorexia, diarrhea, glossitis, and distal paresthesia. On exam you notice she has a swollen red tongue. What does this patient have

Vitamin B12 deficiency anemia

Patient is a 7-year-old female with large patches of depigmentation affecting the neck, upper back and the chest of three years duration. The whitish patches are sharply demarcated with some residual brownish areas within. Some hairs in the involved areas have become white as well. Wood's light examination reveals a "milk-white" fluorescence over the lesion. What does this patient have

Vitiligo

How do you diagnose a cystocele

Voiding studies and urodynamic studies

What can be a complication of compartment syndrome

Volkmann contracture

Twisting of the any part of the bowel at its mesenteric attachment site is called

Volvulus

What are causes of low anion gap (<16)

Vomiting (loss of hydrogen), bulimia, antacid overdose, bicarbonate addition

Patient is a 30-year-old woman with a recurrent history of nosebleeds and heavy menses. She recently read that taking a baby aspirin was good for the heart. However, ever since she started taking aspirin, she has been experiencing more and more nosebleeds. Her father and paternal uncle similarly have histories of prolonged nosebleeds. Labs show increased PTT, normal PT, and increased bleeding time. What does this patient have

Von Willebrand factor deficiency

What is the most common congenital disorder of hemostasis

Von Willebrand factor deficiency (autosomal disorder)

Short PR interval and a delta wave on EKG suggest

WPW

How do you treat mastitis

Warm compresses, breast pump, anti-staphylococcal antibiotics: dicloxacillin (250 mg QID x 10 days), nafcillin, cefazolin + encouragement to continue breastfeeding + NSAIDs for inflammation

What are the 3 main functions of the large intestine (cecum & colon)

Water absorption from undigested food, waste removal, vitamin absorption (Vit K & biotin)

Upper GI series is contraindicated if perforation is suspected, what contrast can be used to avoid this contraindication

Water soluble - gastrografin

How does hypophosphatemia present

Weakness, muscle and bone pain, osteomalacia, rickets

How do you diagnose osteoarthritis

Weight-bearing films of affected joint show joint narrowing, osteophytes, subchondral sclerosis

What findings can be seen on chest x-ray in someone with a PE

Westermark sign or Hampton Hump

How do you confirm the diagnose of HIV if ELISA test is positive

Western blot

Where is Coccidioides most commonly found

Western states due to fungal inhalation

How do you manage pancreatic carcinoma if the cancer is only confined to the head or duodenal area

Whipple procedure = radical pancreaticoduodenal resection

How dose lice present

White oval-shaped egg capsules at the base of the hair shafts

How do you manage small bowel carcinoma

Wide segmental surgical resection and adjuvant chemo for patient with positive lymph nodes

How do you diagnose aplastic anemia

Will see pancytopenia: lower WBC, RBC, platelets, retic, normal MCV

Patient is a 15-month-old male who is brought in to your office for his routine exam. On exam, you notice that he has no irises, consistent with aniridia. He is also found with a palpable, non-tender mass on the left side of his abdomen. On further questioning, his mother reveals that her cousin had a similar abdominal mass at a young age. What does this patient have

Wilm's tumor

When should you calculate anion gap

With metabolic acidosis: Na - (Cl + HCO3)

How soon HIV postexposure prophylaxis be started

Within 72 hours

What does stage I-III mean within regards to breast cancer

Within breast/regional lymph nodes

What is the USPSTF recommendation on screening for breast carcinoma with mammography

Women 50-74 years should undergo yearly to biennial screening (ACS says 45-54 annually and >55 biennial)

The efficacy of the transdermal patch is slightly decreased in what patients

Women > 198 pounds

Combined estrogen and progesterone OCPs should not be used in what patients

Women >35 years of age that smoke, have history of bloods clots, breast cancer or migraines with aura

How do you diagnose melasma

Wood's lamp shows unchanged appearance

How do you treat brown recluse bites

Wound care and delayed excision

How do you treat black widow bites

Wound care, opioids or benzos, anti-venom for elderly and children

What is the 1st line imaging of osteomyelitis

X-ray showing demineralization, periosteal reaction and bone destruction (MRI shows changes before bone scan)

What imaging is required to appropriately grade acromioclavicular separations

X-ray with patient holding a weight

What imaging is required in patients with suspected rotator injury

X-ray, MRI is most accurate

What imaging can be order for biceps tendonitis

X-ray, ultrasound can show thickened tendon, MRI is definitive

Patient is a 3-12-week-old male newborn presenting with complaints of non-bilious projectile vomiting

You note the patient to be dehydrated and have hypochloremic metabolic alkalosis. What does this patient likely have? Pyloric stenosis

Pt presents c/o of dysphagia, regurgitation of undigested food, cough, globus, and halitosis. On esophagram you see a collection of dye behind esophagus at the pharyngoesophageal junction. What does this pt have

Zenker's Diverticulum

Name 3 examples of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Zidovudine (Retrovir), Emtricitabine (Emtriva), Abacavir (Ziagen)

What syndrome is associated with no suppression of gastrin levels with the Secretin test

Zollinger-Ellison syndrome

How does an anterior shoulder dislocation present clinically

abducted and externally rotated, squaring of the shoulder, sharp prominence of the acromion

How does influenza present clinically

abrupt onset of headache, fever, coryza (catarrhal inflammation of mucous membrane), cough, chills, malaise, URI symptoms and myalgias

How does a posterior shoulder dislocation present clinically

adducted, internally rotated, prominent humeral head

How does biceps tendonitis present clinically

anterior shoulder pain

How do you confirm diagnose of Toxic epidermal necrolysis

biopsy

Red, swollen and painful cluster of boils under the skin

carbuncle

How does chronic mesenteric ischemia present clinically

chronic dull abdominal pain worse after meals (intestinal angina) and weight loss due to anorexia (manage the same way as acute mesenteric ischemia)

What test is indicated to dx & tx lower GI bleed, biopsy lesions, and evaluate IBD (UC & Chron's)

colonoscopy

Patient presenting with confusion, amnesia, vomiting, headache, visual disturbances most likely has a

concussion

How does vibrio cholerae diarrhea present clinically

copious watery diarrhea (rice water stools - grey)