STEP 2 missed questions

12 week old infant, normal at birth, 3 week hx of weakness, choking spells, poor appetite, excessive sleeping, constipation, apathy, hypotonia, large tongue, abdominal bloating-- dx?

congenital hypothyroidism

contraindication to RI treatment of Grave's disease?

exophthalmos

development of small L sided pleural effusion in pt 1 day s/p CAGB- management?

expectant management, observation and tx of symptoms

24 yo man in ED after GSW to L 6th intercostal space, L 7th posterior intercostal space , received 2L NS. BL 86/40 HR 130 FAST shows no pericardial effusion, questionable intraperitoneal fluid next step in management?

exploratory laparotomy

lab finding in patients w/o spleens

extreme thrombocytosis

20 yo M w elevated Ca levels on prescreening labs. asx, no polyuria, polydipsia, constipation. pmhx unremarkable. Temp nl BP nl HR nl PE nl Na 140 K 4 Cl 103 HCO3 24 BUN 18 Cr 0.8 Ca 11.2 Glu 98 Alb 4.2 PTH 65 (high-normal) Urine Ca/Cr clearance ratio <0.01 dx?

familial hypocalciuric hypercalcemia (high-normal PTH, elevated serum calcium, low urine Ca)

petichial rash following femur fracture and fixation

fat embolism syndrome

nerve responsible for knee extension/hip flexion?

femoral

differentiation between aspiration pneumonitis and fat embolism syndrome

fever and leukocytosis in aspiration pneumonitis

test of choice to diagnose CLL

flow cytometry

65 yo M hospitalized for acute MI complicated by acute renal failure and lower GI bleed no PMH thyroid disease thyroid normal on palpation T4 nl T3 decreased TSH nl dx?

euthyroid sick syndrome

50 yo M w hx of alcohol use disorder and liver cirrhosis dx 5 years ago. most recent RUQ U/S was 18 mo ago, showed surface nodularity & increased livery echogenicity but no ascites. p/w 2 mo progressive generalized weakness, anorexia, and abdominal distention w associated BL LE edema. Temp 99.1 BP 95/76 pulse 82 rr 14 evidence of ascites and chronic liver disease present on PE CBC- mild anemia Kidney fx nl LFT Albumin- nl TB- 2.1 Alk phos- 330 AST- 89 ALT- 95 viral hep panel negative dx? next step in mgmt/diagnosis?

evaluate for HCC with abdominal U/S

first line empiric treatment for acute cervicitis

azithromycin plus ceftriaxone

common causes of basophilic stippling

lead poisoning alcoholism thalassemias

complications infants who are SGA are at risk for (7)

- hypoxia - perinatal asphyxia - meconium aspiration - hypothermia - hypocalcemia - polycythemia

area of spine most commonly affected in RA

cervical spine (not SI joints- think ankylosing spondylitis with involvement of SI joints)

most common nephrotic syndrome in which renal vein thromboses are seen

membranous glomerulonephropathy

Hep B- associated with which cause of nephropathy?

membranous nephropathy

where are the receptors that are responsible for the clinical manifestations of organophosphate ingestion located?

peripherally (muscarinic receptors)

coag studies in antiphospholipid syndrome

prolonged PTT d/t prevention of coagulation by APLAbs

most common pathogen associated with bacterial conjunctivitis in adults

staph aureus

vomiting predominant food borne illness

staph aureus

organism most commonly associated with prosthetic implants (joint replacement etc.)

staph epidermidis

CHARGE syndrome

*C*oloboma *H*eart defects *A*tresia of the choanae *R*enal anomalies *G*rowth impairment *E*ar abnormalities/deafness

pt holds their arm slightly abducted and externally rotated

*anterior* shoulder dislocation

pt holding their arm adducted and internally rotated after tonic-clonic seizure

*posterior* dislocation of the shoulder

cavitary lesion in RUL on CXR in chronic smoker- concern for?

*squamous cell* carcinoma

28 yo F pmh SLE currently on systemic glucocorticoids for a flare p/w skin rash on back and arms x2 weeks. dx?

steroid induced acne

65 yo F w afib undergoes TTE prior to cardioversion, that evening develops severe chest pain, intrascapular back pain, fever, hypotension, tachycardia dx?

esophageal perforation

contraindicated medication in female pt with hx of migraine with aura?

estrogen-containing contraception (d/t risk of stroke)

Envelope shaped crystals in urine- classic for ingestion of what substance?

ethylene glycol (antifreeze)

dx for anion gap met acidosis- osmol gap?

ethylene glycol, methanol, propylene glycol

differentiation between CAH and placental aromatase deficiency?

****** virilization of the mother is more often seen in placental aromatase deficiency

management of preterm labor at <32 weeks?

- Betamethasone - Tocolytics - Magnesium sulfate - Penicillin if GBS+ or unknown

cervical cancer screening guidelines

- Pap test at age 21 - HPV cotesting NOT recommended for ages 21-29 - HPV vaccination recommended

Budd-Chiari syndrome

- Posthepatic venous thrombosis - Abdominal pain - Ascites - Hepatomegaly can be seen in polycythemia vera

risk factors for developing c. diff (3)

- abx - hospitalization - PPI use

indications for urgent urologic consultation for pt with kidney stone?

- associated urosepsis - anuria - AKI - refractory pain - stone >10mm

management of preterm labor at 32-34 weeks?

- betamethasone - tocolytics - penicillin if GBS unknown or +

drugs commonly associated with interstitial nephritis (8)

- cephalosporins - penicillins - sulfonamides - sulfa diuretics - NSAID - rifampin - phenytoin - allopurinol

hyposthenuria

- common in sickle cell trait - inability to concentrate urine from sickling in the vasa recta impairing countercurrent exchange and free water reabsorbtion

ocular complications associated with Sjogren's syndrome

- decreased visual acuity - superficial infection - corneal ulceration - corneal perforation

clinical presentation of Duchenne's muscular dystrophy

- enlarged calves - proximal muscle weakness - dilated cardiomyopathy - scoliosis

adverse effects of SERM therapy (tamoxifen/raloxifene)

- esophagitis - hot flashes - VTE - endometrial hyperplasia & carcinoma (tamoxifen)

risk factors for shoulder dystocia (4)

- fetal macrosomia - maternal obesity - GDM - post-term pregnancy

clinical findings of hyperparathyroidism (4)

- hypercalcemia - kidney stones - neuropsych presentations - HTN

3 physiologic renal and urinary changes in normal pregnancy and their associated lab findings?

- increased renal blood flow ---- decreased BUN - increased GFR ----- decreased Cr - increased renal basement permeability --- increased renal protein excretion

pulmonary nodule characteristics that increase chance of malignancy

- large size - advanced patient age - female sex - smoking hx - upper lobe - spiculated radiographic appearance

Causes of PTH independent hypercalcemia (8)

- malignancy - Vit D toxicity - granulomatous diseases - drug induced - milk-alkali syndrome - thyrotoxicosis - Vit A toxicity - immobilization

complications of short interpregnancy intervals (<6-18 mo from delivery to next pregnancy)- (4)

- maternal anemia - PPROM - preterm delivery - low birth weight

what 5 things are included on routine newborn screening?

- metabolic/genetics panel - hyperbilirubinemia - hearing - pre & post-ductal pulse ox - hypoglycemia (select populations)

most commonly implicated bacteria in acute bacterial rhinosinusitis in children? (3)

- nontypeable H. flu - strep pneumo - moraxella catarrhalis

MEN 1

- pituitary adenoma - primary hyperparathyroidism - pancreatic/GI neuroendocrine tumors --- gastrinoma --- insulinoma --- VIPoma --- glucagonoma

risk factors for PPROM? (4)

- polyhydramnios - antepartum bleeding - genital tract infection - asymptomatic bacteriuria

risk factors for respiratory distress syndrome (2)

- prematurity - maternal DM

indications for SERM therapy (tamoxifen/raloxifene)

- prevention of breast CA in high-risk patients - tamoxifen- adjuvant treatment of breast cancer - raloxifene- postmenopausal osteoporosis

conditions where pulsus paradoxus is seen?

- primarily cardiac tamponade - also seen in COPD and asthma

when should you choose IV ceftriaxone over oral doxycycline in tx of Lyme disease?

- progressed dz - children <8 - pregnancy

indications for endoscopic removal of swallowed foreign body

- sharp object - symptoms of esophageal obstruction - symptoms of respiratory compromise - button battery - magnets UNLESS object is distal to the proximal duodenum in an asymptomatic patient.

cardiovascular effects of thyrotoxicosis? (7)

- tachycardia - afib - hypertension - increased contractility - decreased SVR - increased myocardial o2 demand - coronary vasospasm

preventative migraine therapy options (4)

- topiramate - divalproex - tricyclic antidepressants - beta blockers

abortive migraine therapy options (5)

- triptans - NSAIDs - acetaminophen - antiemetics - ergotamines

Bacillary angiomatosis

-Benign friable capillary skin papules found in AIDS patients. Caused by Bartonella henselae infections. -Frequently mistaken for Kaposi sarcoma, but has neutrophilic infiltrate.

Symptoms of theophylline toxicity?

-CNS stimulation (headaches, insomnia, seizures) -GI disturbances (nausea, vomiting) -Cardiac toxicity (arrhythmia) note: ciprofloxacin is a known drug that can raise serum theophylline concentration and cause toxicity

contraindications to breastfeeding (7)

-HIV positive mother -Active TB -chemotherapy or radiation -Drug abuse by mother -Infant galactosemia -Herpes lesion on mother's breast -active varicella infection

when are the only times enteral feeding is contraindicated?

-discontinuous bowel - prolonged ileus in general, enteral nutrition>>>>TPN

manifestations of malignant hyperthermia

-masseter muscle/generalized rigidity - sinus tachycardia - hypercarbia - rhabdomyolysis - hyperkalemia - hyperthermia (late)

how long do you wait before performing an orchiopexy for an undescended testicle?

1 year

indications for exploratory laparotomy with penetrating abdominal trauma

1) Hemodynamic instability 2) peritonitis 3) evisceration

3 non-Pharm things that help prevent gout attacks

1) Weight Loss 2) D/C alcohol 3) D/C diuretics

w/u of infant who has not passed meconium within the first 48 hrs of life?

1) abdominal xray 2) contrast enema

two common presentations of disseminated gonococcal infection

1) purulent monoarthritis 2) triad of tenosynovitis, dematitis, migratory polyarthralgia typically with *negative* blood cultures

incubation period of VZV

1-3 wks

next step in management of pt suspected of having ventilator associated pneumonia

1. cxr to confirm 2. bronchoscopy and sample for GS and cx 3. empiric abx

NNT equation

1/ARR

at what CD4 count is TMP-SMX prophylaxis indicated?

200

when is MG typically diagnosed?

20s-30s in women 60s-80s in men

most common cause of CAH?

21-hydroxylase deficiency

below what age is a renal ultrasound indicated after first febrile UTI

2yo

definition of recurrent AOM

3+ episodes in 6 months or 4+ episodes in 12 months (consider typanocentesis and culture with tympanostomy tube placement)

after which age is menarche considered to be late

15 yo

at which week in gestation is it safe to attempt an external cephalic version?

37

tx of suspected UTI in children?

3rd generation cephalosporin (cefexime)

cutoff measurement of TB test for treatment of healthy individuals?

15mm

age at which autism screening is performed

18 months and 2 years

test used to compare two means

2-sample t-test

what percent of SCFE cases are bilateral?

40%

at what age does endometrial cells on Pap become abnormal

45

when are pregnant women typically screened for GBS colonization?

35-37 weeks

when to begin prenatal antiviral suppression for prior HSV infx

36 weeks

indications for endometrial biopsy

45+ yo - abnormal uterine bleeding - postmenopausal screening <45 - abnormal uterine bleeding PLUS -- unopposed estrogen -- failed medical management -- Lynch syndrome >35 - atypical glandular cells on Pap

at what diameter does the risk of rupture dramatically increase in an AAA?

5.5cm

when should an average patient begin screening colonoscopies?

50 40 if high risk (family hx, etc)

time frame of developing vitamin K deficiency in an acutely ill patient

7-10 days

cutoff for carotid endartectomy

70%

fetal bradycardia

<110 bpm

what is classified as an inadequate contraction?

<200 MVU averaged over 10 minutes

treatment of herpes zoster pain

<30 days from rash onset -- NSAIDs and analgesics >30 days from onset but resolves within 4 months --- NSAIDs and analgesics >4 mo from onset --- TCA, gabapentin, pregabalin

Management of pancreatic pseudocyst

<6cm or less than 6 wk: observation symptomatic or over 6 wk: drainage

timeframe for developing ventilator-associated pneumonia

> or = 48 hours after intubation

26 yo F p/w marked confusion x2 hrs and flu-like illness x3 days. increased fatigue, weakness, nausea. recently started thyroid hormone replacement therapy for autoimmune thyroiditis 1 week ago TSH- 3 Temp 100 BP 80/40 HR 140 confused and lethargic mottled skin generalized hyperpigmentation, especially involving palmar creases lungs CTAB TTP throughout abdomen hgb 10 leuk 9000 neut nl eos elevated lymph nl Na 124 Cl 92 K 6.4 HCO3 16 CXR nl UA nl ECG - peaked T-waves and tachycardia test to confirm primary cause of patient's condition? dx?

ACTH stim test dx- autoimmune adrenal insufficiency

correlation between AFP and HCC?

AFP is elevated in 50% of HCC cases

contraindications to yellow fever vaccine?

AIDS recent stem cell transplant immunosuppressive therapy

normocytic anemia splenomegaly reticulocytosis jaundice w elevated indirect bili increased serum LDH decreased serum haptoglobin recent penicillin/lymphoproliferative disorder/viral infection/autoimmune condition

AIHA

Microscopic colitis

AKA lymphocytic colitis/collanegous colitis Females, 60-70yo Chronic watery diarrhea w/ bleeding Classically nighttime diarrhea Little to no abdominal pain Afebrile and no weight loss Normal appearing colonic mucosa, but: - Increased inflammatory cells in epithelium and lamina propria - Colonic crypts are NOT distorted Associated with autoimmunity (including celiac) or NSAIDs Spontaenous remission over time Treat with antidiarrheal agents

5 yo african american M increasing fatigue bone pain fever pallor cervical, axillary, inguinal LAD thrombocytopenia

ALL - evaluate with bone marrow biopsy (>25% lymphoblasts)

22 yo F p/w 3 wk hx of rash on upper back and face which first appeared in Florida over spring break. Assoc with a flu-like illness, fatigue and aching pain in joints. temp 100.4 bp 142/80 pulse 92 erythematous, maculopapular rash on face and upper back nontender, generalized lymphadenopathy abd nontender faint diastolic murmur pulm ctab hgb 10.4 MCV 92 Plt 110,000 leuk 3200 most appropriate step in establishing likely diagnosis?

ANA assay to evaluate for likely SLE

differentiation between aspiration pneumonia and TB

AP - look for air-fluid levels on xray - putrid sputum - poor dentition/alcohol abuse TB - similar social risk factors - cavitary lesions - associated with hemoptysis

indications for urgent dialysis

Acidosis (<7.1, refractory to medical therapy) Electrolyte abnormalities (severe or symptomatic) Ingestion Overload (refractory to diuretics) Uremia (symptomatic, encephalopathy, pericaridits, bleeding)

Prophylaxis criteria for Lyme Disease (5)

All 5 MUST BE MET: 1. tick is ixodes scapularis 2. tick attached >36 hours or engorged 3. prophylaxis started within 72 hours of tick removal 4. Local borrelia burgdorferi rate >20% (new England area) 5. No contraindications to doxy (not <8, not pregnant)

8 yo boy w gross hematuria after recent upper respiratory infection. BL sensorineural hearing loss that has been worsening.

Alport Syndrome - x-linked - mutation of type 4 collagen - nephropathy - BL sensorineural hearing loss - anterior lenticonus renal bx finding: longitudinal splitting of GBM

Tx of UTI in pregnancy

Amoxicillin

16 yo M p/after FOOSH injury during soccer. workup shows bruising around base of neck and L shoulder. intact sensation in L upper extremity. L radial pulse slightly decreased compared to R. XR shows displaced frx of clavicle with nl cardiac silhouette. next step in mgmt?

CT angiogram

Type III hypersensitivity reaction

Antibody-antigen complex deposition serum sickness poststrep glomerulonephritis lupus nephritis

soft and single S2

Aortic stenosis

management of pt with complicated diverticulitis and associated abscess formation

CT guided percutaneous drainage

treatment of focal nodular hyperplasia

Asymptomatic: no treatment, because there is no risk of malignant degeneration or rupture with hemorrhage Symptomatic: surgical resection

acute management of afib with RVR

B-blocker or ndCCB

initial treatment in pts with Grave's disease p/w severe thyrotoxicosis

B-blockers and anti-thyroid drug (i.e. methimazole)

next step in management of pediatric patient with signs of elevated ICP who has a VP shunt

CT or fast MRI to evaluate for malfunction of the shunt

next step in management of pregnant woman p/w shortness of breath, normal CXR, and low-probablility V/Q scan for PE?

CTA

MRI finding with hypoxic brain injury

BL enhancement of the globus pallidus

BMI cutoff for anorexia nervosa

BMI < 18.5 kg/m^2

lab test with the greatest sensitivity for CHF

BNP

70 M p/w urinary hesitancy and frequency x9mo. temp 99.5 PE circumcised penis w/o urethral discharge nl testicular exam enlarged, rubbery, nontender prostate UA many leuks no erythrocytes gram stain- gram neg rods dx?

BPH causing outflow obstruction of the bladder

differential diagnosis for vaginitis

BV - pH>4.5 - clue cells - whiff test - no inflammation Trichomoniasis - pH>4.5 - inflammation Candida - normal pH (~4) - inflammation

localized papule with ipsilateral regional lymphadenopathy fever of unknown origin cat exposure

Bartonella henselae

35 yo F p/w oral ulcers x3days. similar lesions 3 mo ago that healed without issue. recent eval by ophthalmologist for anterior uveitis. hx of recurrent genital lesions. PE oral ulcers scattered hyperpigmented skin lesions and tender, indurated areas on legs most likely dx?

Behcet syndrome - multisystem inflammatory condition characterized by recurrent oral and genital ulcers - skin and ocular involvement is common - common in Turkish, Middle Eastern, and Asian descent

PCP intoxication

Belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. Treatment: benzodiazepines, rapid-acting antipsychotic

luteoma

Bilateral (or unilateral) androgen producing ovarian cysts during pregnancy, will regress spontaneously after delivery High risk of fetal/maternal virilization

what is haptoglobin?

Binds free hemoglobin and takes it to the spleen in order to conserve iron and prevent damage. Often decreased during intravascular hemolysis.

treatment for Paget's disease of the bone

Bisphosphonates

Management of shoulder dystocia?

Breathe, don't push Elevate legs and flex hips, thighs against abdomen (McRobert's) Call for help Apply suprapubic pressure enLarge vaginal opening with episiotomy Maneuvers

starry sky histology

Burkitt's lymphoma

diplopia ptosis ophthalmoplegia (typically down and out)

CN III palsy

differentiation between primary CNS lymphoma and metastatic disease to the brain

CNS lymphoma is much more common in immunocompromised patients. Imaging of CNS lesions reveal lesions that are periventricular Imaging of metastatic disease reveals lesions that are at the gray and white junction

35 yo F w persistent clear rhinorrhea that increases with increased ICP (bowel movements, bending over). external nose is straight turbinates are pink small amount of clear fluid in R nostril dx? likely cause of dx?

CSF rhinorrhea occurs most commonly after accidental head trauma can also occur after surgical trauma or ^ICP managed by inpatient monitoring for s/s of meningitis

Erb-Duchenne palsy

C5-C6 brachial plexus Waiter's tip

2 day old infant, uncomplicated pregnancy and delivery, complete prenatal care. pts length 10%ile at birth, weight and head circumference 25%ile. ambiguous genitalia- severe curvature of underdeveloped phallus, urethral meatus at base of structure, flanked by labioscrotal folds, gonads are not palpable. breastfeeding with appropriate UOP and stools alert newborn with normal tone labs remarkable only for Testosterone extremely elevated Karyotype 46XX dx?

CAH electrolytes are typically normal at birth and progressively become hyponatremic, hyperkalemic, dehydrated, and are at risk of shock at age 1-2 weeks

DiGeorge syndrome pneumonic

CATCH CATCH Conotruncal Cardiac defects Abnormal facies/Arrhythmias Thymic hypoplasia/aplasia (T-cell deficiency) Craniofacial deformaties (Cleft palate) Hypocalcemia/Hypoparathyroidism

in what condition is there the absence of BL vas deferens?

CF

nasal polyps in a child should prompt evaluation for?

CF

mgmt of LE edema from CHF compared to CVI

CHF - control HTN - furosemide - dietary sodium restriction CVI - leg elevation - compression stockings - exercise

smudge cells

CLL

55 yo F 3 mo of night sweats, 11 lb unintentional weight loss. recent return from trip to Vietnam temp --- 99.3 bp --- 144/78 pulse --- 96 pale mucosa, no scleral icterus, no cervical lymphadenopathy spleen tip palpable hgb --- 8.7 plt --- 610,000 leuk --- 66,000 - neut --- 32% - bands --- 12% - eos --- 3% - basos --- 5% - monos --- 4% - metamyelos --- 12% - myelos --- 23% - lymph --- 9% Ddx? additional lab test to help confirm dx?

CML vs. leukemoid rxn - leuk alk phos would be decreased in CML, elevated in leukemoid reaction - metamyelocytes < myelocytes in CML (myelocytes has fewer letters- CML has fewer letters)

45 yo HIV+ M p/w intermittent bloody diarrhea, abdominal pain, 9lb weight loss. no dizziness or chest pain. Temp 100.4 BP 114/68 HR 96 mucous membranes are moist moderate cervical lymphadenopathy mild LLQ tenderness CD4 count 28 K 3.2 responsible pathogen?

CMV

is malabsorption more common in Celiac or Crohn's

Celiac (villous atrophy on histology)

fever jaundice RUQ pain

Charcot's triad- acute cholangitis (can also include confusion and hypotension- Reynold's pentad)

differentiation b/w chlamydial conjunctivitis of the newborn and gonococcal conjunctivitis of the newborn

Chlamydial - typically 5-14 days after birth - milder chemosis and eyelid swelling - watery discharge - NOT prevented by erythromycin administration at birth Gonococcal - 2-5 days after birth - more severe chemosis and eyelid swelling - copious purulent discharge - prevented by erythromycin administration at birth

short 6 yo boy, bleeding gums, increasing fatigue, patches of hypopigmentation, hypoplastic thumbs pancytopenia on labs

Fanconi anemia - d/t DNA repair defect - tx is HSCT

tx for HIT (heparin induced thrombocytopenia)?

stop heparin immediately and begin anticoagulation with alternate anticoagulant (fondaparinux, argatroban)

2 bacteria strongly associated with colon cancer

strep bovis clostridium septicum

subtype of strep viridans that typically affects heart valves following dental procedures

strep mutans

most common causes of meningitis in children

strep pneumo n. meningitidis h. flu (does not present with a rash)

REM sleep behavior disorder has a strong association with development of what future disorder

Parkinson's

noncaseating granulomas

Crohn's disease

associated bacteria in septic shock in sickle cell patients

strep pneumo salmonella

4 mo old boy w progressive lethargy, poor feeding, fatigue, increasing pallor UTD vaccines diet predominately breast milk PE webbed neck cleft palate mild hypertelorism flat nasal bridge pale mucous membranes triphalangeal thumbs CBC hgb 4 MCV . 108 reticulocytes . 0.4% plt 300,000 leuk 7500 blood type A- maternal blood type O+ dx?

Diamond-Blackfan anemia pure red blood cell aplasia, normal leukocytes and platelets typically

ddx for anion gap met acidosis- hyperglycemia?

DKA

67 yo F with 1-2 years of periodic confusion, memory loss, poor sleep, visual hallucinations walking more slowly, increase in falls, BL hand tremors, lower limb rigidity dx?

Dementia with Lewy Bodies

DRESS syndrome

Drug Reaction w/ Eosinophilia and Systemic Symptoms (DRESS) syndrome is a drug-induced condition characterized by: •Extensive rash •Fever >38°C •Lymphadenopathy •Hematologic abnormalities •Hepatitis •Involvement of at least one internal organ Onset = *2-6 wks* after drug initiation w/ a mortality rate of 10-20%, w/ most fatalities 2/2 *liver failure* Tx = supportive, steroids, antihistamines

T/F: sickle cell trait provides immunity against malaria

F- provides protection against severe infection/complications of malaria

hereditary protein C resistance

Factor V Leiden

RA, neutropenia, splenomegaly

Felty syndrome

renal cell carcinoma triad

Flank pain, hematuria, palpable abdominal mass

AR, neurodegenerative disease that presents in adolescence with progressive ataxia and loss of position and vibratory senses. Genetic testing = excessive GAA repeat sequences

Freidrich's ataxia

14 yo girl w progressive weakness in lower limbs for 3 weeks. hx of fever, cough, congestion 1 mo ago. hx of high plantar arches, scoliosis. MRI shows cervical spine atrophy dx? confirmatory testing?

Friedrich's ataxia, genetic testing

DM2 therapy associated with weight loss

GLP-1 agonists

3 mo old M p/for wcc. has poor head control, generalized hypotonia, PMI at L anterior axillary line. Liver edge palpated 4cm below R costal margin. spleen is not palpable. dx?

GSD type II, Pompe's disease

55 yo pt, r ear otalgia, hearing loss, renal insufficiency, recent development of non-healing ulcer of the leg after nodule formation

Granulomatosis with polyangitis (Wegener's)

how to differentiate between Grave's disease and painless thyroiditis

Grave's - has diffuse increase of RI uptake - often has extra-thyroidal manifestations Painless Thyroiditis - decreased RI uptake in thyroid gland - release of preformed thyroid hormone

12 yo M p/w "inability to walk" with pins and needles sensation and weakness in both feet for the past few days. 2 weeks ago he had a febrile diarrheal illness that self-resolved no headache, nausea, vomiting, recurrent diarrhea recent exposure to petting zoo, he is a vegetarian temp nl BP 150/90 flaccid paralysis of lower extremities absent ankle and patellar reflexes upper extremities weak and hyporeflexic sensation is intact dx? structure that is primarily impaired?

Guillain-Barre syndrome peripheral nerve fibers

risk factor strongly associated with MALT lymphoma

H. pylori infection

28 yo F at 35 weeks gestation preeclampsia nausea/vomiting RUQ pain MAHA elevated LFTs low platelet count

HELLP hemolysis elevated liver enzymes low platelet count

3 yo M 1 wk generalized edema gradually worsening no recent illness unremarkable PMH periorbital edema Na, K, Cr, AST, ALT, Tbili, Dbili normal Tprotein low Albumin low UA 4+ proteinuria, no RBCs dx? when would a biopsy be indicated?

MCD prednisone Bx if age >10 w nephrotic syndrome, or in child w nephritic syndrome or MCD that is unresponsive to steroids

difference in presentation b/w hereditary spherocytosis and minor thalassemia

HS- jaundice and splenomegaly MT- pale conjunctiva and mucous membranes (lab results can look very similar)

3 week old M p/w seizure, fever, lethargy. full ant fontanelle. brain imaging shows patchy areas of increased attenuation in cerebral cortex, and edema and hemorrhage in L temporal lobe and brainstem. no intracranial calcifications. responsible organism?

HSV - Skin-eye-mouth -- mucucutaneous vesicles -- keratoconjunctivitis - CNS -- seizures, fever, lethargy -- temporal lobe hemorrhage/edema -Disseminated -- sepsis, hepatitis, pneumonia

36 yo F 2 days agitation and confusion did not sleep at all last night twitching of R arm this morning temp 100 nl bp, rr, hr EEG prominent high-amplitude slow waves over L temporal and frontal lobes

HSV encephalitis - typically presents with abnormalities on the frontotemporal region of the brain - CSF- lymphocytic pleocytosis, elevated protein, elevated RBC, normal glucose

electrolyte abnormalities in tumor lysis syndrome

High uric acid, phosphate and Potassium Low Calcium (bound to released intracellular phosphate)

blood smear finding in sickle cell anemia?

Howell-Jolly bodies

contraindications to rotavirus vaccine?

Hx of intussception Hx of uncorrected congenital GI malformations (ie Meckels) SCID

28 yo w difficulty conceiving, hx of irregular menses, no medical conditions or surgeries, nl breast exam, nl genitalia, uterus, ovaries FSH . low LH . low Prolactin . nl TSH . nl DHEA . nl Estradiol low b-hCG . negative dx? what if FSH was elevated?

Hypogonadotropic hypogonadism, if FSH was elevated dx= primary ovarian insufficiency

24 yo G1P0 F at 18 wks p/for routine prenatal visit. Has had increased BM x9 weeks, stool occasionally covered in mucous and blood. OTC anti-diarrheals have not been effective. otherwise uncomplicated pregnancy erythematous, tender nodules over anterior LEs, some with violaceous hue uterus c/w 18 week gestation no hemorrhoids or fissures FHT heard by doppler dx?

IBD erythema nodosum is a characteristic extra-intestinal manifestation of IBD

34 yo woman with daily abdominal cramping, occasionally preceded by eating, accompanied by small, loose stools and mucus and significant improvement in symptoms-- diagnosis and colonoscopy findings?

IBS, normal colonic mucosa

pathophysiology of respiratory symptoms in systemic sclerosis

ILD

next step in suspected mastoiditis

IV abx (generally do not need CT scan to diagnose)

75 yo M hx of prostate cancer p/w severe back pain x3 wks. significant worsening over past 12 hours w inability to urinate and difficulty walking. point tenderness over T10-11, positive babinski, LE reflexes 3+ next step in mgmt?

IV glucocorticoids

2 yo boy p/w fever and cough x2days. hx of strep pneumo meningitis at 1yr old, s pneumo bacteremia at 18 mo, pneumomia at 22 mo. famhx of 2 uncles dying from "infection" before age 2 temp 103 HR 150 resp 60 with subcostal retractions hgb 10 leuk 36,000 seg neut 70% bands 20% lymph 8% mono 2% plt 240,000 IgA <5 IgG 30 IgM <5 CXR shows infiltrate in LUL most appropriate next step in mgmt?

IVIG infusion

What is the rare disease assumption?

If the prevalence of a disease is low (<5%), odds ratios approximate relative risk

asymptomatic 32 yo M presents for routine health examination. 10 yr hx frequent sinus and pulm infections. hx of anaphylactic rxn to blood transfusion. mild erythema in posterior pharynx lungs CTAB CBC and SPEP are within normal limits most likely cause of frequent infections?

IgA deficiency

Type II hypersensitivity reaction

IgG and IgM autoantibody mediated AIHA Goodpasture's syndrome

Type I hypersensitivity reaction

Ige mediated anaphylaxis urticaria

CML treatment

Imatinib- inhibits BCR-ABL tyrosine kinase production

treatment of papulopustular rosacea

topical metronidazole (treat other subtypes with avoidance of triggers and gentle cleansing)

medications likely to cause "pill esophagitis"? (4)

KCl tetracyclines bisphosphonates NSAIDs

58 yo man with pruritic rash on BL feet, associated with significant skin peeling/flakes -- how to confirm diagnosis?

KOH prep showing branched, segmented hyphae- dx is tinea pedis

25 yo girl p/w primary amenorrhea and inability to identify various odors. no pmh or psh. no breast tissue development, no axillary or pubic hair. U/S confirms presence of uterus and ovaries FSH low LH low dx? karyotype?

Kallman syndrome - d/o of migration of fetal olfactory and GnRH producing neurons - hypogonadotropic hypogonadism karyotype XX

26 yo M p/w difficulty conceiving with his wife. decreased libido. vitals nl height 6'1" BMI 20 intact sense of smell BL gynecomastia sparse facial and body hair normal penis, small, firm BL testes most likely dx and cause of infertility?

Klinefelter's syndrome (XXY) - dysgenesis of seminiferous tubules

treatment for pregnant woman with potential APS dx?

LMWH (corticosteroids have limited efficacy in APS)

anticoagulation agents contraindicated in patients with severe renal insufficiency

LMWH (enoxaparin) fondaparinux rivaroxiban

8 mo boy p/w fever, vomiting x3days. UTD w vaccines. Temp 104 BP nl HR nl resp 30 cries on neck flexion anterior fontanelle is bulging Perrla extraocular movements nl no neuro deficits CBC and cx pending next step?

LP infants with open anterior fontanelles do not need imaging prior to LP because they are not at risk for herniation

regression of language skills due to severe epileptic attacks 3-6yo

Landau-Kleffner

lytic bone lesions eczematous rash diabetes insipidus

Langerhans histiocytosis

57 yo M p/w fever, nonproductive cough, SOB x2 days and HA, abd pain, diarrhea x1 day after returning from a cruise to the Bahamas. pmhx of T2DM, 20 py hx. temp 102.6 bp 110/65 pulse 80 resp 18 pulse ox 97% pulm- BL crackles abd- soft, nontender pt confused at times during exam glu nl Na 128 CXR bl infiltrates dx? abx?

Legionella pneumonia - recent hospitalization or travel - hyponatremia - patchy unilobar or interstitial infiltrates on CXR - PMNs w/o organisms on sputum gram stain - dx with urine legionella antigen - tx: respiratory fluorquinolone or newer macrolide

previously healthy 23 yo pt recent hx tonsilitis p/w severe sore throat, SOB, pain with swallowing IJ vein thrombosis peripheral cavitary lung lesions

Leimerre syndrome Fusobacterium necrophorum

pt <7 with wide array of seizure types associated with intellectual and developmental disabilities

Lennox- Gastaut

pt with meningitis >50 yo- additional bug at risk?

Listeria monocytogenes

54 yo M p/w 2 days of fever, dysphagia, chills, drooling w/ inability to eat d/t pain in mouth and neck. Hx of etoh abuse, no drug use Temp 101.8 BP 110/70 HR 108 RR 22 pt appears toxic, is drooling, has muffled voice BL submandibular area is tender, indurated, nonfluctuant w/ palpable crepitus dx? most likely source of infx?

Ludwig angina - progressive cellulitis of submandibular space - typically arise from dental infections - polymicrobial - develop rapid systemic sx with risk of airway compromise - tx w IV abx

29 yo M p/w 1 week progressive BL LE weakness. no hx trauma or back pain. TG neuralgia 3 mo ago, URI 2 weeks ago. VS normal increased resistance to passive flexion and extension of LE. DTR 3+, babinski upgoing decreased vibratory and positional sensation in LUE dx?

MS

lens dislocation in Marfan's vs. homocystinuria

Marfan's- up homocystinuria- down

precocious puberty irregular cafe-au-lait spots recurrent fractures

McCune Albright

Guillan-Barre with ophthalmoplegia

Miller Fisher syndrome

22 yo F p/w 6 mo hx of progressive pain and swelling of the hands w bluish discoloration when exposed to the cold. frequent episodes of food getting stuck in her chest when swallowing. erythematous rash over malar area and nasal bridge skin of hands is shiny and thick w small ulcers at fingertips hand and wrist joints are swollen and tender hgb 10 leuk 3800 plt 110,000 cr 0.8 ESR 50 ANA + Anti U1 ribonucleoprotein Ab + dx? pt will most likely exhibit clinical manifestations of _______ in the future.

Mixed Connective Tissue Disorder - AI d/o .w variable features of SLE, SSc, polymyositis - Raynauds* - hand/finger swelling* - arthritis/synovitis* - inflammatory myopathy* - pulm HTN - malar rash - mild CNS/renal dz - labs - *Anti-U1 ribonucleoprotein* - ANA - Rheumatoid factor, anti-cyclic citrullinated peptide - elevated CK - anemia/cytopenias (* diagnostic criteria)

ideal tx for basal cell carcinoma of the face?

Moh's surgery (to promote healing and theoretically cause the least damage possible)

Waldenstrom's macroglobulinemia

Monoclonal IgM M spike, no lytic bone lesions or hypercalcemia, proliferation of plasma cells acute management with PLEX

optic gliomas

NF1

acoustic neuromas

NF2

64 yo M p/w intermittent burning midline chest pain over the last two hours. EKG- sinus rhythm with ST elevations in II, III, aVF 3 mins after admin of sublingual nitroglycerin pt is lightheaded and extremely weak. bp 75/50 pulse 85 diaphoretic with cold extremities JVD 3 cm above sternal angle clear lungs no murmurs best next step?

NS bolus dx is RV STEMI -hypersensitive to intravascular volume depletion -sx worsened by administration of nitroglycerin

common comorbidities of tourrettes?

OCD, ADHD

17 yo girl w PCOS comes for evaluation of irregular menses. Tx?

OCP for menstrual regulation weight loss is 1st line overall treatment of PCOS

Lisch nodules

Neurofibromatosis

Cafe-au-lait spots optic pathway gliomas lisch nodules axillary and inguinal freckling mutated gene 17, neurofibromin protein

Neurofibromatosis type 1

bilateral acoustic neuromas chromosome 22 mutation, protein merlin

Neurofibromatosis type 2

differentiating normal changes in renal funct from renal disease in pregnancy

Normal Pregnancy ---- Pathologic trace proteinuria ---- significant proteinuria decreased Cr ----- increased Cr decreased BP ----- increased BP

Pink stains or "brick dust" in newborn diaper

Normal uric acid crystals due to especially high uric acid excretion at birth, decreases until adolescence.

typical features of cerebellar degeneration

P.I.N.T. P.D. - progressive gait dysfunction - intention tremor - nystagmus - truncal ataxia - pendulum reflex (different than myoclonus) - dysdiachokinesia

most appropriate analgesic pharmacotherapy for 64 yo woman s/p TAH w BLSO x1day?

PCA IV morphine

32 yo F p/w infertility x2 years. she and her husband have sexual intercourse q2 days. Menarche at age 14 w/ irregular cycles. Sperm count nl BMI 31 PE acne vulgaris over face, upper shoulders, and back rest of exam nl TSH nl free testosterone nl DHEAS nl LH nl FSH nl dx?

PCOS

28 yo F with difficulty conceiving, husband has normal semen analysis, hx of irregular menses since age 13 no nipple discharge no STI normal TSH normal prolactin elevated free testosterone levels cause of infertility? dx?

PCOS= dx hyperandrogenism occurs due to ovarian steroid overproduction persistently elevated estrone levels d/t conversion of testosterone in adipose tissues which leads to high frequency, short GnRH pulses. causes imbalance of LH/FSH and prevents follicle maturation and oocyte release.

prophylactic therapy in HIV+ patients w CD4 count of 45

PCP --- TMP-SMX Toxoplasma --- TMP-SMX Histoplasma --- itraconazole VZV --- vaccination Hep A, Hep B --- vaccination if no indication of immunity

common cause of hyponatremia in pts with HIV

PCP infection

3 days after hospitalization for tx of hip fracture, 62 yo woman becomes acutely short of breath and coughs up small amount of blood tinged sputum BP 110/70 HR 110 RR 24 ABG on 40% O2 pH 7.4 PCO2 38 PO2 70 V/P scan shows multiple segmental areas of mismatch on R side dx? next step in mgmt?

PE heparin therapy

vent settings that primarily influence PaO2

PEEP and FiO2

differentiation bw asthma and COPD

PFTs before and after Bagonist administration

5 mo M projectile vomiting diarrhea generalized tonic-clonic seizure did not receive newborn screening pregnancy and delivery uncomplicated urine has a musty odor

PKU - failure to convert phenylalanine into tyrosine

*non*-enhancing multifocal brain lesions in white matter

PML

differentiation between anovulation and premature ovarian failure?

POF- decreased estrogen with associated symptoms (hot flashes, vaginal dryness)

recurrent BV during pregnancy is a risk factor for which complication?

PPROM

recommended sequence of pneumococcal vaccines

PPSV23 1 time followed by sequential PCV13 and PPSV23 at age 65

periorbital cellulitis= ____septal cellulitis

PRE (relatively mild)

antiphospholipid syndrome- associated with prolonged _______

PTT (will not correct upon mixing with normal plasma whereas pts with factor deficiencies will correct)

isolated elevation in alk phos

Paget's disease of the bone

classic presentation of pineal gland mass?

Parinaud syndrome - limitation of upward gaze - BL lid retraction - light-near dissociation can also present with HA and vomiting 2/2 obstructive hydrocephalus

which central nervous system disorders are associated with seborrheic dermatitis?

Parkinson disease, HIV

67 yo M p 1 hr after onset of vertigo, nausea, and imbalance. 20-year hx of poorly controlled HTN. HR 70 RR 20 BP 210/115 small R pupil mild R ptosis nystagmus weakness of R palate decreased sensation to pinprick over R face and L extremities poor coordination on R which artery is most likely occluded?

R vertebral

non-reducing scrotal varicocele is concerning for what?

RCC

risk factors for placental abruption? (4) common complications of placental abruption? (2)

RF - maternal HTN - abdominal trauma - prior placental abrupt - cocaine and tobacco use comorbidities - hypovolemic shock - DIC

vent settings that most influence PaCO2

RR and TV

74 yo F p/w painful, erythematous vesicular rash on auditory canal and ipsilateral facial paralysis

Ramsay Hunt syndrome -reactivation of *varicella zoster* virus from geniculate ganglion disrupting CN VII and VIII

18mo regression in language gait abnormalities frequent rubbing hands together seizures

Rett syndrome (typically only affects girls)

differentiate SBO and ileus

SBO - nausea, vomiting - obstipation - acute abdomen - hyperactive or absent bowel sounds - air-fluid levels on xray - dilated proximal bowel, collapsed distal bowel - little/no air in colon/rectum - tx w/ NG tube Ileus - nausea +/- vomiting - no flatus - abdominal distension - decreased or absent bowel sounds - no transition point on xray - dilated loops of bowel - air in colon/rectum - expectant management for treatment w/ avoidance of opioids if possible

Marjolin ulcer

SCC arising within a burn wound

most common malignancy presenting in upper cervical node?

SCC of head and neck

12 yo af. american female w dull thigh pain, worse with activity, BMI in 97th%, decreased ROM in hip on internal rotation, foot points laterally while walking dx?

SCFE (slipped capital femoral epiphysis)

5 mo boy p/w fussiness and fever x2 days. hx sig for recurrent otitis media, oral candidiasis, gastroenteritis d/t rotavirus. in 3rd% for weight temp --- 102 pulse --- 120 rr --- 28 bp --- 80/60 erythematous, bulging r tympanic membrane no palpable lymphadenopathy, no tonsil visualization plt --- 240,000 leuk --- 7500 IgG --- low IgA --- low IgM --- low CD4 --- low CD8 --- low dx?

SCID - only tx is stem cell transplant

SJS vs TEN

SJS <10% TEN >30%

27 yo F L sided chest pain nonproductive cough dyspnea on exertion 3 mo BL knee pain fatigue temp 100 elevated bp anemia thrombocytopenia elevated BUN and Cr L sided pleural effusion, enlarged cardiac silhouette

SLE - pericardial effusion/pleural effusion -- serositis - symmetric arthritis - elevated Cr with HTN suggesting kidney injury

64 yo F p/w bitemporal HA, dizziness, blurry vision, numbness of feet x1 week. no fever, no jaw pain, no sinus or temporal tenderness. moist mucous membranes PERRLA fundoscopic exam- dilated, segmented, tortuous retinal veins normal facial sensation/strength normal BL U/LE strength decreased pinprick & reflexes BL LE CBC Hgb --- 11.2 Plt --- 180,000 Leuk --- 8000 Chem Cr --- 0.8 Ca --- 9.6 total protein --- 10.5 (elevated) albumin --- 3.7 ESR --- 80 (elevated) next step in dx? dx?

SPEP to assess for Waldenstrom macroglobulinemia

first line treatment for panic disorder

SSRI/SNRI

headache that worsens with leaning forward

SVC syndrome - typically caused by malignancy

secretory vs osmotic diarrhea

Secretory: Low stool osmolar gap - larger daily stool volumes - NOT altered with fasting + night-time symptoms Osmotic (think lactose intolerance): HIGH osmolar gap - decreased with fasting

differentiation between seminona and nonseminomatous tumor

Seminoma - BhCG Non-seminomatous - BhCG and AFP

laboratory workup of HTN

Serum electrolytes, Cr UA Alb/Cr ratio TSH Fasting glu or Hgb A1c Lipid profile ECG CBC Uric acid

Takotsubo cardiomyopathy

Stress induced cardiomyopathy A bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted.

2 yo F p/after 1st time seizure. pmh of receptive and expressive language delays. normal vitals sleepy but arousable toddler erythematous, macular lesion present on forehead/eyelid R homonymous hemianopia neuro exam otherwise nl dx?

Sturge-Weber syndrome - port wine stain - leptomeningeal capillary venous malformatin - seizures - intellectual disability - visual field defects - glaucoma

areas where Yellow fever vaccine is recommended

Sub-Saharan Africa South America

xanthochromia of CSF - diagnosis?

Subarachnoid hemorrhage

indications to begin immediate anticoagulation therapy in suspected PAD

Suspicion for acute arterial occlusion leading to an immediately-threatened limb Pain Pallor Paresthesia Poikilothermia Pulselessness Paralysis

Ovarian hyperstimulation syndrome

Syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of multiple, enlarged follicular ovarian cysts. Can cause massive extravascular fluid shifts and VEGF leakage into intraperitoneal cavity leading to ascites and abdominal distention

JIA subtypes and associated findings

Systemic -- rash, HSM, LAD Polyarticular -- uveitis Monoarticular -- uveitis

Type IV hypersensitivity reaction

T-cell and macrophage mediated contact dermatitis tuberculin skin test

acute tx of PCP

TMP-SMX w associated corticosteroid admin (shown to decrease mortality)

in which Tanner stage of development does menarche typically occur?

Tanner stage 4

2 mo old boy p/w cyanosis, fussiness, sweating while eating. poor weight gain since birth, ill-appearing, agitated, cyanotic, tachypneic Grade II/VI crescendo-decrescendo systolic ejection murmur at L upper sternal border knee-chest position improves pt's condition dx? pathophysiology?

Tetraology of Fallot 1) right vent outflow tract obstruction 2) right ventricular hypertrophy 3) overriding aorta 4) VSD RVOT obstruction severity determines clinical presentation- knee to chest position improves cyanosis by forcing deoxygenated blood through RVOT into lungs to be oxygenated instead of through VSD and into aorta RVOT obstruction=crescendo- decrescendo murmur

Multiple ring-enhancing lesions on brain CT or MRI (especially within basal ganglia) in HIV+ patient

Toxoplasma gondii

infant who feeds poorly and becomes cyanotic crying paroxysms associated with cyanosis

ToF

6 yo M difficulty moving R arm and leg found unresponsive on the floor of his room regained consciousness after 3 minutes and was confused exam otherwise unremarkable regains strength in R U/LE over the next 4 hours

Todd's paralysis

Tx of parkinson's disease in younger patients who have tremor as primary symptom?

Trihexyphenidyl (anticholinergic)

hypopigmented macules angiofibromas of malar region CNS lesions (hamatomas) Epilepsy Intellectual disability Autism/behavioral disorders rhabdomyoma angiomyolipomas

Tuberous sclerosis

_____ inability to resorb bicarb _____ inability to excrete H+

Type 2 renal tubular acidosis Type 1 renal tubular acidosis

AD inherited defect of type I collagen u/s findings in utero - multiple fractures - short femur - fetal growth restriction - intrauterine demise - hypoplastic thoracic cavity

Type II osteogenesis imperfecta

Pronator drift indicates

UMN lesion - corticospinal/pyramidal

Schilling test

Used to detect the etiology of B12 (cobalamin) deficiency (malabsorption vs. pernicious anemia)

heart defect seen in Edward's syndrome

VSD

palpable thrill associated with harsh holosystolic murmur in 4th L intercostal rib space

VSD

VEAL CHOP

Variable ----- Cord Early ----- Head Acceleration ----- Okay Late ----- Placental insufficiency

36 yo F G3P2 35 wks w hx 2 term c-sections p/w leakage of fluid and painless vaginal bleeding. no prenatal care this pregnancy. Normal fetal movement earlier in the day, doppler cannot pick up FHT now. Has HTN, has not been taking her medication while pregnant. temp nl bp mild elevation hr nl spec exam- confirmed ROM cervical os 1cm dilated with minimal vaginal bleeding most likely cause of presentation?

Vasa previa - fetal vessels overlying the cervix - presents with painless vaginal bleeding with ROM or contractions - FHR abnormalities - rapid fetal exsanguination and demise management is inpatient during last trimester and early C-section at 34-35 weeks

malnourished patient with angular chelitis, stomatitis, glossitis, normocytic-normochromic anemia, seborrheic dermatitis

Vitamin B2 (riboflavin) deficiency

39 yo previously healthy man, nausea, malaise, fever, loss of appetite, recent travel with no vax and drinking local water. LFTs significantly elevated, tender hepatomegaly and scleral icterus-- expected prognosis?

complete recovery (HAV)

ddx of hypocalcemia (6)

Vitamin D def and osteomalacia Malabsorption Hypoparathyroidism Chronic Renal failure Meds (Loop diuretics, phenytoin, foscarnet) Hypomagnesemia

26 yo man p/w f/u for painless, progressive visual loss in R eye. macular edema and capillary hemangioma on recent exam father died from cerebral hemorrhage at age 52 MRI of brain with gadolinium shows 2 small, cystic, enhancing nodules in the cerebellum, renal US shows multiple cysts in both kidneys dx?

Von Hippel-Lindau

34 yo F 2 weeks postpartum p/w sudden onset, heavy vaginal bleeding no associated fever, chills, abdominal pain, nausea large vaginal laceration during delivery with well-approximated well-healing repair, small, firm, mobile, nontender uterus Temp nl BP 100/52 HR 98 CBC Hct 30% Plt 260 Leuk 11 Coag PT nl aPTT nl Bleeding time elevated dx?

Von Willebrand Disease tx with desmopressin

Wilms tumor, aniridia, genital abnormalities, Intellectual disability (previously mental and motor retardation)?

WAGR syndrome/11p deletion syndrome

vertigo, diplopia, nystagmus, ipsilateral limb ataxia dysarthria, dysphoria, hoarseness ipsilateral Horner's syndrome intractable hiccups

Wallenberg syndrome - lateral medulla infarct

sudden vasomotor collapse and skin rash in child w/ meningococcemia

Waterhouse-Friderichsen (d/t adrenal hemorrhage)

AR disorder that involves degeneration of anterior horn cells and cranial nerve motor nuclei- cause of floppy baby syndrome other cause of floppy baby syndrome?

Werdnig-Hoffman syndrome, infant botulism

pt p/w chronic malabsorptive diarrhea, protein losing enteropathy, weight loss, migratory arthritis, lymphadenopathy, low-grade fever. occasional damage to eyes, CNS, myocardium small intestine bx shows +PAS macrophages in lamina propria dx?

Whipple dz

22 yo M resting tremor, rigidity, clumsy gate recent onset of slurred speech and drooling no PMH no meds hepatomegaly CBC nl LFT- increased Tbili, AST, ALT immunologic studies and hepatitis panel normal Bx shows portal fibrosis and hepatocyte necrosis, macrovesicular steatosis, vacuolated hepatocellular nuclei, mallory bodies Dx

Wilson's disease

Kayser-Fleischer rings

Wilson's disease

18 mo boy w blood in stool, eating and drinking nl. hx recurrent otitis media, frequent herpes labialis, 2 episodes of pneumonia PE well developed, well nourished eczema on cheeks, trunk, extremities, scattered petechiae Labs plt --- 24,000 leuk --- 9,000 dx? process affected by gene mutation?

Wiskott-Aldrich syndrome - thrombocytopenia - ezcema - recurrent infections impaired cytoskeleton changes in leukocytes, platelets tx w stem cell transplant

inheritance pattern of duchenne/becker muscular dystrophy?

X-linked recessive

Thalamic Pain Syndrome (Dejerine-Roussy Syndrome)

a condition caused by damage to the thalamus resulting in burning or tingling sensations and possibly hypersensitivity to things that would not normally be painful such as light touch or temperature change

most common cause of bacterial pneumonia in pts w/ CF?

ages <20 --- staph aureus ages >20 --- pseudomonas

next step in management of suspected anastomotic bowel leak following RenY surgery

abdominal CT with oral contrast

pathophysiology of vasovagal syncope

abrupt parasympathetic activation leads to cardioinhibitory response that manifests as bradycardia with sinus arrest *OR* decreased sympathetic drive leads to vasodepressor response, resulting in peripheral vasodilation and abrupt hypotension

Management of epididymitis

abx

asymptomatic 57 yo M p/ for routine health exam. 37 PY history, BP 180/112 HR 82 bruit in RUQ of abdominal exam no masses Hct 42% BUN 23 Cr 1.4 cause of the bruit?

accumulation of lipids in the arterial wall

difference bw condylomata acuminata and lata

acuminata - genital warts - HPV 6 & 11 - lesions range from smooth, flattened papules to exophytic/cauliflower growths lata - secondary syphilis - raised gray-white lesions that develop on mucosal surgaces - typically have a broader base and smooth surface

severe 1-sided headache, seeing halos around lights, non-reactive pupil, excessive lacrimation and erythema generally affects women ages >40 more common in Asian/Inuit typically occurs in response to medications that dilate pupils

acute closed angle glaucoma

large volume diarrhea after eating spoiled food treatment with increased oral fluid intake and antidiarrheals improvement of diarrhea followed by abrupt cessation of bowel movements, decreased bowel sounds, colonic dilation on imaging without apparent anatomic obstruction

acute colonic pseudoobstruction (likely due to electrolyte derangements) - tx w NPO, NG tube decompression - neostigmine if sx do not improve in 48 hrs

37 yo F 34 wk gestation nausea, vomiting, severe epigastric pain bp 130/86 temp 99 hr 106 fetal HR 170 with minimal variability tenderness to palpation over epigastrum uterus is nontender hgb 10 plt 80,000 leuk 18,000 glucose 40 tbili 4 ast 103 alt 96 amylase elevated lipase normal

acute fatty liver disease of pregnancy - profound hypoglycemia d/t inability to convert glucagon into glucose - hyperbilirubinemia - thrombocytopenia - +/- DIC

5 yo F p/w leg pain. Persistent leg pain since falling off a stepstool 1 week ago, appears to be worse at night. pt refuses to walk. no medical conditions, has had a chronic cough x1mo. Temp 100.9, other VS normal nontender abdomen liver palpable 5cm below costal margin pain on palpation of BL anterior tibias scattered bruises across chest and back CBC hgb- 8 Plt - 30,000 leuk- 3,000 dx?

acute lymphoblastic leukemia

major complication of retropharyngeal abscess d/t contiguous spread of infection?

acute necrotizing mediastinitis

5 yo F p/w migratory joint pain and nonpruritic, nonpainful rash x1 week. pmhx sig only for sore throat a couple of weeks ago that resolved on its own. temp 101 pulse 85 resp 20 cardiopulm nl multiple well-demarcated, erythematous, nonpruritic patches with slightly raised outlines are present on the trunk and proximal limbs. leuk 6500 - neut 56% - lymph 33% hgb 12.5 plt 380,000 CRP elevated ESR elevated dx?

acute rheumatic fever (JONES)

Treatment of myasthenic crisis

acute stabilization (intubation) IVIG or plasmapheresis corticosteroids

mouth-breathing chronic nasal congestion in childhood tonsillar hypertrophy

adenoid hypertrophy

42 yo F G2P2 p/w pelvic pain, painful menses x2 years, heavy bleeding. pain worsening over past months, now unresponsive to ibuprofen. regular menstrual cycles. no dysuria, urinary frequency, constipation. has not had cervical cancer screening x5 years is not sexually active boggy uterus that is tender to palpation dx?

adenomyosis

generalized abdominal tenderness hyperpigmentation weight loss serum electrolyte abnormalities dx?

adrenal insufficiency

why don't you vaccinate adults with Hib vaccine? what is the one scenario that you do vaccinate adults with Hib vaccine?

adults are typically affected by non-typable H flu so vaccination would not be effective (except in the case of splenectomy)

treatment of female pattern hair loss

topical minoxidil (my-noggin)

immediate tx for placental abruption and hypotension following blunt trauma to abdomen

aggressive fluid resuscitation with crystalloids pt in L lateral decubitus position emergency transfusion indicated for unresponsive hypotension and/or persistent bleeding

condition associated with methimazole

agranulocytosis

route of transmission for measles?

airborne

major gluconeogenic amino acid in liver? converted to?

alanine --> pyruvate

Mallory Bodies are seen in which diseases?

alcohol liver injury Wilson's disease

definition of anaphylaxis

allergic symptoms affecting 2+ organ systems

bx of liver shows mononuclear infiltrate with significant number of eosinophils in hepatic triads- dx?

allograft rejection

mechanism by which B-blockers promote weight gain and insulin resistance

allow alpha2 action of insulin resistance to go unmediated by B2 increase in insulin sensitivity

2 yr old boy w/ sudden onset of coughing and difficulty breathing, wheezing, diminished breath sounds on R side. Ddx?

always consider foreign body aspiration in toddlers w/ sudden, unexplainable onset of symptoms

digoxin interacts with which commonly co-prescribed medication to dramatically increase digoxin levels

amiodarone

initial treatment option for stable ventricular tachycardia

amiodarone

treatment for pregnant pts with early localized Lyme disease

amoxicillin

sympathetic ophthalmia

an inflammatory condition created in the fellow eye by the affected eye "uncovering hidden antigens"

common late complications of RenY bypass surgery (4)

anastamotic stricture marginal ulcer cholecystitis dumping syndrome

common early complications of RenY bypass surgery (2)

anastomotic leak bowel ischemia

dx test when suspicious of PAD

ankle-brachial index

pathophysiology of mitral valve regurgitation in decompensated heart failure?

annulus stretches and causes lateral displacement of papillary muscles

first step in management in 35 yo pt w/ presentation concerning for hemorrhoids?

anoscopy if inconclusive, can consider sigmoidoscopy or colonoscopy

32 yo F G2P2 p/w amenorrhea x4 mo. well-estrogenized vagina, no evidence of virilization UPT negative administration of medroxyprogesterone causes bleeding 3 days later dx?

anovulation

antibodies associated with Hashimotos thyroiditis?

anti-TPO Ab anti-thyroglobilin Ab

empiric treatment for chemo induced febrile neutropenia

anti-pseudomonal beta-lactam - cefepime - meropenem - pip-tazo

therapy in pts with arterial thromboembolism?

anticoagulation- apixaban or warfarin antiplatelet agents (clopidogrel, aspirin) are much less effective in reducing thromboembolic risk

pharmacotherapy for acute delirium and agitation in elderly patients?

antipsychotics NOT BENZOS

most common complication in giant cell arteritis aside from vision loss?

aortic aneurysm

what are the optic radiation?

axons that travel from the lateral geniculate nucleus to the primary visual cortex

18 yo F w no breast development, normal axillary and pubic hair. ambiguous genitalia at birth with nl uterus, ovaries, and fallopian tubes. She has never had a menstrual cycle. electrolytes normal FSH --- elevated LH --- elevated testosterone --- elevated androstenedione --- elevated estradiol --- undetectable estrone --- undetectable dx? dx if presented w/ electrolyte abnormalities?

aromatase deficiency classic congenital adrenal hyperplasia (21-hydroxylase deficiency)

common extraintestinal symptoms of IBD

arthritis (spondyloarthritis) uveitis skin involvement hepatobilliary disease

indication for TIPS

ascites refractory to medical management esophageal varices that continue to bleed despite appropriate management via endoscope

medication likely to induce asthma exacerbation in pt with undiagnosed asthma, chronic rhinitis, and nasal polyps

aspirin

normal NST

at least 2 HR accelerations within 20 mins

blood glucose level where hyperglycemic nonketotic state typically occurs

at least >600 generally >1000

differentiation between large hemothorax/pleural effusion and large volume atelectasis

atelectasis- mediastinal structures pulled towards opacification pleural effusion- mediastinal structures bow out away from opacification

most common arrhythmia seen with digitalis toxicity?

atrial tachycardia with AV block

pts with Fragile X most commonly exhibit features of _______

autism

18 mo boy, nl growth, able to walk, starting to run, can scribble, can use a spoon to feed himself does not make eye contact, does not respond to his name, does not follow doctor's gaze when toys are pointed out to him, 1-word vocabulary, prefers to play alone normal hearing testing dx?

autism spectrum disorder

Lambert-Eaton myasthenic syndrome

autoantibodies against v-gated calcium channels in pre-synaptic nerve terminal

inheritance patten of myotonic muscular dystrophy?

autosomal dominant

most common nerve injured in an anterior dislocation of the shoulder

axillary affects abduction of the shoulder

when is RhoGam typically administered?

b/w 28-32 weeks and within 72 hours after delivery if baby is Rh+

soft, mobile, nontender, cystic mass present at the base (4 o'clock) position of the labia majora

bartholin duct cyst

most common site of hypertensive intraparenchymal brain hemorrhage ?

basal ganglia (putamen) -internal capsule that lies adjacent to the putamen is commonly involved and leads to contralateral hemiparesis, sensory loss, and ipsilateral conjugate gaze deviation

management of chest pain associated with cocaine use

benzodiazepines aspirin nitroglycerin and calcium

most common cause of isolated aortic regurg in young adults in developed countries?

bicuspid aortic valve

2 wk M p/w persistent jaundice of the skin and eyes. exclusively breastfeeding, voiding frequently, light yellow stools 3-4x daily. tbili 10 direct bili 7 dx?

biliary atresia

common neuromuscular impairment associated with Colles fracture

compression or median nerve- acute carpal tunnel - impaired thumb abduction

36 yo F p/w intermittent abdominal pain, dull, RUQ and epigastrum, radiates to her back, occurs only after eating, is not relieved by antacids, no melena, weight loss, hematemesis BMI 32 normal LFTs dx? next step in mgmt?

biliary colic eval with abdominal US

therapy of choice to stabilize bony metastatic lesions an prevent hypercalcemia of malignancy

bisphosphonate

56 yo M w abdominal pain and distention after waking up from a heavy night of drinking where he sustained trauma to the abdomen no fever, no vomiting, unable to void BP 158/90 HR 90 abdomen is distended, mildly ttp throughout, dull to percussion with + fluid wave nl CBC BUN 50 Cr 3.5 nl LFTs dx?

bladder rupture afebrile because urine is typically sterile within the bladder and therefore will not cause peritonitis immediately

first line treatment for urge incontinence?

bladder training- try to resist the urge to void for longer periods of time to increase bladder capacity if bladder training and exercises fail, pharmacotherapy is oxybutinin

24 yo M p/after bicycle crash in which he sustained blunt trauma to the chest. presents with persistent tachycardia throughout the day despite remaining afebrile and normotensive. ECG- sinus tachy with frequent PVCs dx? next step?

blunt cardiac injury, TTE and ultimately continuous cardiac monitoring for 24-48 hours

2 mo M p/for well child check. smiles spontaneously, vocalizes without crying, does not laugh or squeal. will not work for a toy out of his reach. language development? psychosocial development?

both normal

peripheral pulse finding in hyperdynamic (early) septic shock

bounding pulses d/t widened pulse pressure (untreated shock will progress to cool extremities)

anterior displacement of supracondylar humerus fracture puts what structure at risk

brachial artery median nerve

Klumpke palsy

brachial plexus C8 and T1 "claw hand"

cyanotic congenital heart disease is a risk factor for ________ d/t bypassing lungs and allowing hematogenous spread of bacteria

brain abscesses

next step in mgmt of a patient w/ massive hemoptysis who continues to bleed following ET tube placement?

bronchoscopy to evaluate and treat cause

common fracture sustained in children who fall on outstreched hand

buckle fracture

differentiation between bullous pemphigoid and pemphigus vulgaris?

bullous pemphigoid - subepidermal blisters - "B" for intact "blisters" pemphigus vulgaris - intraepidermal blisters

20 yo F presents with concern for depression. labs show hypochloremic hypokalemic metabolic acidosis. contraindicated antidepressant?

bupropion (lowers seizure threshold)

tx for impetigo

topical mupirocin

scabies treatment

topical permethrin

heel pain in athletic young adolescent?

calcaneal apophysitis

vitamin D mediates absorption of __________

calcium and phosphorus

Tx of lead poisoning

calcium disodium EDTA

timing of onset of dry cough associated with ACE inhibitor use

can be within 24 hours or delayed by several months

37 yo M severe weakness and dizziness 2 episodes of syncope over the past 8 weeks vague mid-chest discomfort x1 week sore throat and dry cough 2 weeks ago lungs clear to auscultation BL thready pulses disappear with deep inspiration

cardiac tamponade after viral pericarditis

in which type of shock is the pulm cap wedge pressure elevated?

cardiogenic

most common mononeuropathy in patients on hemodialysis

carpal tunnel syndrome - commonly due to dialysis-related amyloidosis

lights "look like halos" in the dark

cataracts

pathogenesis of struvite stone development

caused by urease+ organisms. hydrolysis of urea leads to increased levels of ammonia--> alkalinizes the urine and facilitates the precipitation of mag ammonium phosphate (struvite) stones

intrapartum GBS abx ppx for woman with rash when she takes PCN? for anaphylactic rxn?

cefazolin erythromycin/clindamycin sensitivities, if sensitive to both tx with clindamycin- if resistant to erythromycin or clindamycin tx with vancomycin and prolonged observation

abx ppx for total joint replacement

cefazolin (vanc or clinda good 2nd line options)

tx of 21 yo M w positive testing for n gonorrhoeae and negative testing for c trachomatis?

ceftriaxone and azithromycin (due to increasing abx resistance rates as well as to treat potential associated pharyngeal infection)

14 yo boy w skin rash for 3 weeks, red spots on skin that turn into fluid filled blisters that crust over. located on extensor surfaces of elbows and knees other findings: microcytic anemia fatigue conjunctival pallor negative fecal occult blood dx?

celiac disease- dermatitis herpetiformis dx with TTg IgA

how to differentiate between erysipelas and cellulitis?

cellulitis- flat borders, infiltrates deeper into subcutaneous tissue erysipelas- limited to epidermis and dermis and has a raised, sharp border with intense erythema

acute, painless monocular vision loss "like a shade dropping over my eye" retinal whitening cherry-red macula

central retinal artery occlusion

what is the optimal position for a fetal presentation?

cephalic, occiput anterior

10 mo M premature delayed motor milestones abnormal tone, hyperreflexia seizures

cerebral palsy (risk factors include prematurity and low birth weight)

57 yo M p/w several months of difficulty walking. recent stiffness and weakness in BL LE with associated numbness and tingling in his arms and legs. 30 py hx, hx of IVDU, several sexual partners. vitals nl normal mental status and cranial nerves. mild weakness and atrophy of upper arm muscles, decreased triceps reflex BL LE strength 4/5 vibratory and pain sensation decreased in both hands and legs upward babinski dx?

cervical myelopathy - age >55 - presents as gait dysfunction first, then extremity weakness and numbness - LMN signs in arms - UMN signs in legs - decreased proprioception/vibration/pain sensation

62 yo woman w progressive gait unsteadiness, stiffness, tingling and numbness in hands, electric shock sensation down spine no bowel or bladder incontinence upper extremity weakness, wasting of intrinsic hand muscles increased lower extremity tone and reflexes dx?

cervical spondylosis (spinal cord compression)

chronic, granulomatous inflammation of meibomian gland hard, painless lid nodule

chalazion

first-line tx for small cell carcinoma

chemo

cherry vs strawberry hemangioma, tx for disfiguring strawberry hemangioma

cherry - adults - small bright red - widespread and increase in number with time strawberry - also called superficial infantile hemangioma - appears during first few weeks of life - blanches - gets bigger before it shrinks - can use propranolol if hemangioma is disfiguring or disabling

6 yo boy w new onset chest pain, 1 wk hx of viral illness w paroxysmal coughing episodes temp 99.1 BP 106/76 HR 130 pulse ox 98 mild swelling of neck with crepitus over anterior chest next step in mgmt? dx?

chest xray to evaluate for pneumomediastinum

high fever severe polyarthralgias headache myalgias conjunctivitis rash lympho/thrombocytopenia transaminitis recent travel to caribbean islands

chikungunya fever

most common cause of acute cervicitis?

chlamydia

"culture negative urethritis" in men

chlamydia (you can typically see gonorrhea on a gram stain)

13 day old boy p/w mild eyelid swelling, conjunctival injection, scant amount of watery, slightly mucopurulent discharge that began 2 days ago dx? tx?

chlamydial conjunctivitis tx with ORAL macrolide (topical has high failure rate)

hx of PSC subacute RUQ pain weight loss biliary obstruction sx hx of UC

cholangiocarcinoma

premature rupture of membranes leakage of clear fluid maternal fever maternal tachycardia fetal tachycardia uterine fundal tenderness maternal leukocytosis

chorioamnionitis - not an automatic indication for c-section as long as FHT remain reassuring

impaired glucose control in diabetes - mineral deficiency?

chromium

pregnancy=physiologic state with increased tidal volumes, increased minute ventilation, increased PaO2, and _________

chronic compensated respiratory alkalosis

recurrent skin abscesses failure to thrive brother died of serratia infx mother and sister are healthy

chronic granulomatous disease - x-linked - decreased production of superoxide anions - susceptible to fungal organisms and catalase+ bacteria

52 yo M w decreased libido, inability to achieve and maintain erections. fatigue, anorexia, 11-lb weight loss does use alcohol does not use drugs, does not smoke BL gynecomastia firm, small testes nl TSH, decreased T3 and T4 dx?

chronic liver disease with cirrhosis

Trachoma

chronic, contagious form of conjunctivitis that typically leads to blindness 2/2 chlamydia trachomatis, dx with giemsa stain

when should vaccines be given in premature infants?

chronologic age (NOT adjusted for gestational age)

1st line tx for aspiration pneumonia

clindamycin

abx selection for postpartum endometritis

clindamycin/gentamicin

32 yo woman w difficulty conceiving, irregular menses, thick, dark, velvety patches under axillae, BL enlarged ovaries-- therapy for infertility?

clomiphene citrate (selective estrogen modulator that primarily blocks estrogen receptors at the level of the hypothalamus to inhibit negative feedback mechanism)

indication for post-exposure prophylaxis in Pertussis outbreak

close contacts high risk (pregnant, immunodeficient, infant)

chest pain cough fever fatigue NL CXR bx spherules with endospores

coccidioides

pathophysiology of polycythemia vera

constitutively active JAK2 enzyme

1st line tx for patients with acute uncomplicated lower back pain

continue moderate activity and treat symptoms with non-opioid analgesics PT recommended for persistent pain beyond 6 weeks

35 yo M w hx IV drug use p/w right sided weakness d/t embolus from bacterial endocarditis of aortic valve. next step in mgmt after blood cultures and IV abx are initiated?

continue with current care and observe

skin depigmentation anemia osteoporosis neurologic dysfunction -- mineral deficiency?

copper

best option for contraception in current breast cancer patient about to begin chemotherapy?

copper IUD avoid all hormones of any kind in patients with current breast cancer

18 yo F needs emergency contraception after unprotected intercourse the previous night. no Hx STIs, no sig pmh, no meds, no alcohol, smoking, drugs. most effective emergency contraceptive method?

copper containing IUD --- 0-120 hrs after intercourse, >99% Ulipristal --- 0-120 hrs after intercourse, 98-99% Levonorgestrel --- 0-72 hrs after intercourse, 59-94% combined OCP --- 0-72 hrs after intercourse, 47-89%

5 yo boy clumsiness polyuria/polydipsia NL glucose bitemporal hemianopsia calcified suprasellar lesion on imaging

craniopharyngioma - compresses pituitary stalk causing endocrinopathies (diabetes insipidus) - pituitary adenoma would not have calcifications

2 y/o M rhinorrhea congestion cough development of high-pitched sound during inspiration 100 temp 140 pulse 44 resp

croup (parainfluenza virus)

pts with HIV who have subacute-onset of low-grade fever, headache, signs of increased intracranial pressure

cryptococcal meningitis

risk factor associated with high rate of AAA expansion and rupture

current smoking (more than uncontrolled HTN, DM, daily EtOH consumption)

what should be empirically treated in victims of house fires?

cyanide poisoning (w hydroxocobalamin or sodium thiosulfate)

pathophysiology of HTN in ADPKD

cyst expansion leads to localized renal ischemia which results in increased renin release

17 yo M w/ intense L flank pain that radiates to groin. describes it as "stone passage." hx of recurrent kidney stones. UA shows hexagonal crystals Urinary cyanide nitroprusside test positive dx?

cystinuria characterized by impaired transport of cystine and dibasic amino acids- inability to reabsorb cystine which is poorly soluble in water (unlike other dibasic amino acids which are easily excreted in urine)

first line treatment of condyloma acuminata in pregnancy

topical trichloroacetic acid

fetal intracranial calcifications

toxoplasma gondii

infx of lacrimal sac sudden onset of pain and redness in medial canthal region with purulent discharge

dacryocystitis

9 mo boy recently adopted from Nigeria p/w swelling of hands and feet for 1 day and associated fussiness and poor feeding. no sick contacts, no recent illness, vaccines UTD temp 101 HR 150 dorsal surfaces of hands and feet are swollen and tender to palpation, other joints are normal appearing no rash present x-rays show soft tissue swelling dx?

dactylitis sickle cell anemia- vaso-occlusive crisis

pathophys of statin induced myositis

decrease coenzyme Q10 synthesis (involved in muscle cell energy production)

when to defibrillate vs. direct current cardiovert

defibrillation - v fib - pulseless v tach cardioversion - all patients with a pulse w persistent tachyarrhythmia causing hemodynamic instability

64 yo pt p/w groin pain that increases with activity, relieved with rest, sometimes radiates to upper thigh pain w passive internal rotation of hip no focal tenderness of palpation of groin/hip dx?

degenerative joint disease - osteoarthritis of the hip often is felt in groin, trochanteric region, and/or buttock.

best predictor of prognosis in pt with astrocytoma

degree of anaplasia

Prader Willi- genetics

deletion in 15q12 paternal origin or maternal disomy PRADER willi without PADRE

dendritic ulcers v dendridiform ulcers

dendritic ulcers- HSV keratitis dendridiform ulcers- herpes zoster ophthalmicus

potential life threatening complication of succynlcholine use for rapid sequence intubation

depolarizing neuromuscular blocker- triggers influx of Na and efflux of K, can lead to severe hyperkalemia and cardiac arrhythmia in patients at high risk (i.e. crush injury)

violaceous rash surrounding eyes violaceous raised papules overlying joints

dermatomyocytis (heliotrope sign, Gottron's papules)

Charcot joint

destruction and potential collapse of weight bearing joint 2/2 impaired proprioception and sensation. most commonly seen in DM

pathophysiology of anticholinergic urinary retention?

detrusor hypocontractility

leading cause of end stage renal disease in the US? pathognomonic finding on histopathology?

diabetes mellitus Kimmelstiel-Wilson nodules (nodular glomerulosclerosis)

64 yo F w hx of poorly controlled DM p/w sudden onset double vision x3 hrs. ptosis of R eye with eye in "down and out" position w extremely limited ROM L ocular movements normal in all directions BL pupils PERRLA normal neuro exam dx?

diabetic ophthalmoplegia - ischemic neuropathy of cranial nerve 3

1st line treatment for gestational diabetes? 2nd line?

dietary modification is 1st line insulin (does not cross placenta) /metformin is 2nd line

pulsus parvus et tartus

diminished and delayed carotid pulses (seen in AS)

32 yo M p/w increasing tremulousness, increasing anxiety, progressive fatigue x2days. has been taking lorazepam in divided doses daily for acute anxiety since being robbed at gunpoint 4 weeks ago. stopped lorazepam 3 days ago. hx of mitral valve prolapse, seasonal allergies, dysthymic disorder. other meds- loratadine and paroxetine explanation for new sx?

discontinuing lorazepam

Colles fracture

distal radius is broken by falling onto an outstretched hand

etiology of RUQ pain in HELLP syndrome

distention of the liver capsule

most common cause of lower GI bleed in adults

diverticulosis

management of septal hematoma following trauma to the face

drainage of hematoma - complications of undrained septal hematoma are severe

pregnant woman w/ UTI presents w SOB, fevers, dry cough, bilateral mid and lower lung opacities. dx?

drug (nitrofurantoin) induced pulmonary injury - short term hypersensitivity pneumonitis - long term ILD

59 yo man s/p partial distal gastrectomy, 10 days of intermittent abdominal cramps and diarrhea as well as nausea, weakness, palpitations, diaphoresis, that begin 25-30 mins after eating-- dx?

dumping syndrome

most common gastrointestinal anomaly associated with Down syndrome?

duodenal atresia

45 yo man w 2 mo hx of painless, nonpruritic, nonblanchable, purple lesions on legs. associated fatigue, weakness, fleeting joint pain. BP 147/91 no fever, weight loss, diarrhea, abdominal pain Cr 1.9 AST . 78 ALT . 99 C3 complement low-nl C4 complement very low +rheumatoid factor -ANA Ab -HIV1 Ab UA 3+ blood 3+ protein dysmorphic red blood cells dx? associated testing?

dx- mixed cryoglobulinemia commonly associated with viral hepatitis

most common cause of congenital hypothyroidism?

dysgenesis of the thyroid - all inherited in an AR pattern

recommendation for patients who recover from acute pancreatitis, are medially stable, and are surgical candidates

early cholecystectomy

murmur associated with aortic dissection

early diastolic murmur (aortic regurgitation)

how to confirm benign, transient proteinuria

early morning protein/Cr ratio

Farmer from rural Guatemala p/w hepatic cyst with daughter cysts inside. dx?

echinococcus - dog tapeworm (sheep are intermediate hosts) - tx with albendazole

43 yo M 2 days of fevers and a lesion on his R foot erythema->bulla surrounded by erythema bulla ruptured leaving a painless ulcer with a black center hx non-hodgkin lymphoma and recent chemo

ecthyma gangrenosum pseudomonas aeruginosa

rash on forearms and legs in pt w hx of allergies to pollen and dust. patches of erythema and mild lichenification over antecubital and popliteal fossa, clusters of painful umbilicated vesicles at sites of inflammation dx?

eczema herpeticum

nNRT that causes dizziness, insomnia, vivid dreams, depression, anxiety?

efavirenz

most common area of ulnar nerve entrapment?

elbow EXTREMELY HIGH YIELD per UWorld

Management of androgen insensitivity syndrome

elective gonadectomy for malignancy prevention

********** 27 yo F p/w 2 day hx of weakness in arms and legs and numbness of hands and feet. 4 hour hx of mild SOB while supine. weakness began in feet and has progressed to involve hands. "electrical shocks" from buttocks to feet. tripped and fell several times, difficulty holding utensils and buttoning clothes. 3 weeks ago she had mild upper GI illness that self-resolved w/in 5 days resp 20 and shallow mild facial weakness proximal muscle strength >> distal areflexia absent babinskis decreased vibration sensation x4 extremities dx test?

electromyography and nerve conduction studies

is FSH elevated or decreased during menopause?

elevated

CSF analysis of Guillain Barre

elevated protein normal everything else

how to differentiate between embolic stroke and thrombotic stroke

embolic stroke symptoms come on more suddenly relatively slower onset of thrombotic stroke symptoms

initial step in suspected Fournier gangrene

emergent surgery

malignancy associated with PCOS?

endometrial

38 yo nulligravid F p/w 8 mo of abnormal uterine bleeding (spotting between periods, heavier periods) that has not been controlled with 4 mo of COCPs. Labs and exam are normal. next step?

endometrial biopsy for endometrial hyperplasia or endometrial cancer

Adnexal mass unilocular homogenous, low level echoes

endometrioma (chocolate cyst)

tx of jaundice and pruritis in pt diagnosed with advanced pancreatic adenocarcinoma

endoscopic stent placement

77 yo M hx of recurrent pyelonephritis, rheumatic heart disease and recent cystoscopy for eval of persistent dysuria. Temp 100 BP 150/86 Pulse 98 Resp 16 pt is diaphoretic, new II/VI holosystolic murmur at apex, Osler nodes present likely bacteria responsible for current condition?

enterococci hx of recurrent pyelonephritis suggests enterococci colonization of urinary tract

25 yo M p/w difficulty swallowing, has had a piece of steak stuck substernally x12 hours. hx frequent heartburn refractory to PPI therapy, bronchial asthma. CV nl pulm nl abdominal nl skin nl most likely explanation of presentation?

eosinophilic esophagitis

"lipoma" with central punctum

epidermal inclusion cyst

21 yo M with blunt trauma to head after a fall. Did not lose consciousness, developed headache and emesis x2, drowsy but well-oriented. dx?

epidural hematoma (only 20-50% of patients preset with "classic" LOC followed by lucid interval)

inflammation or infx of episcleral tissue between the conjunctiva and sclera mild-moderate discomfort, photophobia, watery discharge

episcleritis

ovarian mass with solid components, thick septations, moderate amount of peritoneal fluid dx?

epithelial ovarian carcinoma - teratomas do not have thick septations

64 yo F pmh ESRD 2/2 CKD from DM on hemodialysis p/w headache and nausea x2 days. receiving tx with EPO and iron d/t hypoproliferative anemia bp 210/121 pulse 76 muscle strength normal sensory exam normal no heart murmurs BL retinal hemorrhages present on ophthalmoscopic exam glu 186 most likely cause of pts current condition?

erythropoetin-related HTN

most important initial step of HHS

fluid replacement

previously healthy 52 yo M p/w hiccups x1 week. 60 py hx, does not drink alcohol, alert and oriented temp 98.6 BP 150/90 pulse 70 resp 12 Na 120 CXR hilar mass most appropriate next step?

fluid restriction

first steps in pt with excessive burns including genitals

fluid resuscitation catheterization prior to edema of genitals

12 mo old p/w severe dehydration and inability to tolerate anything by mouth tx?

fluid resuscitation with 20ml/kg normal saline add dextrose to maintenance fluid but NOT resuscitation fluid

what is a syringomyelia?

fluid-filled cavity in central spinal cord

injury to eye without obvious foreign body- next step in mgmt?

fluorescein stain- saline wash should not be performed until open globe laceration is ruled out

antibiotic class that exacerbates myasthenia gravis?

fluoroquinolones

well-circumscribed liver lesion with a central scar in 40 yo F

focal nodular hyperplasia treatment is not required is not related to OCP use

common complication of hemolytic anemia (seen in sickle cell patients)?

folate deficiency

long-standing painless/mediastinal lymphadenopathy with absence of B symptoms- concerning for?

follicular (non-Hodgkin) lymphoma

treatment for ethylene glycol ingestion?

fomepizole (competitive alcohol dehydrogenase) or ethanol

what is Asherman syndrome?

formation of intrauterine adhesions following surgery such as D&C. 2ndary amenorrhea d/t obliteration of endometrium

pagets disease affecting the cranial bones

frontal bossing headaches cranial nerve dysfunction hearing loss

drug of choice in flash pulmonary edema

furosemide

most prominent clinical sign of NPH?

gait impairment

65 yo M p/w 4 mo abd pain, nausea, occasional emesis. pain is deep, mid-epigastric, persistent, non-radiating. no relationship with food intake. emigrated from China to USA 20 yrs ago upper abdomen is mildly tender to palpation but nondistended hepatomegaly hgb low mcv low plt nl leuk nl tbili nl alb low alk phos elevated ast elevated alt elevated lipase nl dx?

gastric cancer

16 yo F p/w fatigue x6 mo, bone pain x2 years. no systemic symptoms. temp nl bp nl pulse nl resp nl height and weight 5th percentile for age no jaundice no nasal congestion normal TM and pharynx cardiopulm nl abd soft, nontender, profound hepatosplenomegaly pubic hair and breast development Tanner Stage 1 CBC hgb 8.6 Hct 28% plt 78,000 leuk 8200 dx?

gaucher's disease - AR dz of glucocerebrosidase deficiency - severe hepatosplenomegaly - anemia, thrombocytopenia - bony pain - FTT, delayed puberty mgmt is enzyme replacement therapy

indication for buspirone

generalized anxiety disorder

common cause of urinary incontinence in postmenopausal women

genitourinary syndrome of menopause - estrogen deficiency leads to bladder/urethral atrophy and urge incontinence

18 yo M p/ for sports physical. has had a dull ache in the scrotum x2 weeks after being hit with a basketball. exam non-tender, hard, 2-cm, mass in R testicle that does not change in size with position and does not transilluminate most likely cause?

germinal cell tumor (rather than trauma or vascular injury)

65 yo F p/w 2 mo fatigue and weight gain. Hx of RA, PUD, HTN. Does not smoke, drink, drugs. BP 120/70 HR 80 RR 14 generalized edema liver palpable 5 cm below costal margin 4+ proteinuria on UA BL renal enlargement on U/S biopsy finding?

glomerular deposits seen after special (congo red) staining dx is amyloidosis. RF for amyloidosis include RA, other findings include enlarged kidneys, hepatomegaly

66 yo M p/w LLQ abdominal pain, fever, vomiting c/w diverticulitis. He is hospitalized and improves w treatment. 3 days after hospitalization he reports acute pain in the R ankle that becomes unbearable within a couple hours. similar episode 1 yr ago that resolved with OTC medication pmh T2DM, hyperlipidemia, hypertension temp nl bp 140/90 pulse 98 bmi 36 swollen, erythematous R ankle w moderate restriction of movement d/t pain. dx?

gout

pathogens commonly responsible for ventilator associated pneumonia

gram neg bacilli (p. aeruginosa, e coli, klebsiella) and gram pos cocci (MRSA, strep)

who is at risk for preeclampsia? how do you prevent it in these patients?

high risk - prior preeclampsia - CKD - chronic HTN - DM - multiple gestation - autoimmune disease moderate risk - obesity - advanced maternal age - nulliparity tx with aspirin at 12 weeks gestation

62 yo M evaluated in burn unit d/t progressive confusion, lethargy, and reduced UOP. 5 days ago, pt was hospitalized for 20% of body surface area burn and inhalation injury d/t a house fire. Receiving analgesics, enteral feedings, IV fluids. Temp 96 BP 100/60 HR 90 RR 26 some areas of partial thickness injury appear to have progressed to full-thickness necrosis Plt 80,000 Leuk 16,000 gluc 230 most likely cause of current condition?

gram negative sepsis *immediately after burns gram+ organisms dominate. after 5 days, gram- organisms or fungi take over. earliest sign of wound/burn infection is partial thickness injury turning into full thickness injury

70 yo F p/w increasing abdominal pain x2 dayS. Hx of renal failure w peritoneal dialysis for 18 mo. last tx was 2 hrs ago. appears toxic T 102.2 BP 140/90 abdomen distended an diffusely tender to palpation, rebound tenderness leuk 18,000 most appropriate next step?

gram stain of abdominal fluid

common bacteria responsible for septic joints

gram+

abx coverage of vancomycin

gram+ organisms does NOT cover gram- organisms

59 yo F R adnexal mass with solid components and septations breast tenderness abnormal uterine bleeding call-exner bodies dx?

granulosa cell tumor - increased estradiol - increased inhibin

Uhthoff phenomenon

heat sensitivity in MS that worsens symptoms

cause of "bronze diabetes"

hemochromatosis

33 yo woman w dull, aching pain in RUQ for several weeks meds- OCP for 12 yr does not drink, smoke, drugs vitals- nl no jaundice or ascites no cardio abnormalities albumin 4.1 tbili 0.9 alk phos 215 ast 45 alt . 40 u/s shows solitary hyperechoic 7-cm lesion in R lobe of liver dx?

hepatic adenoma

27 yo M p/w unremitting nose bleeding. hx of similar episode 1 year ago. drinks alcohol socially, does not smoke/use illicit substances several ruby-colored papules on his lips that blanch partially w/ pressure digital clubbing abdomen soft, nontender nl liver and spleen Hct 60% Plt 180,000 Leuk 8,000 dx?

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) AD disorder characterized by diffuse telangiectasias, recurrent epistaxis, widespread AVMs

positive acidified glycerol lysis test-- indicative of?

hereditary spherocytosis

positive eosin-5-malemide binding test- indicative of

hereditary spherocytosis

2 yo pt w oropharynx with several small vesicles on uvula, soft palate, and tonsillar pillars- dx?

herpangina caused by coxsackie virus infx

18 mo boy w fever and facial rash x2 days. hx of atopic dermatitis. flare of itchy, dry, thickened skin on face 4 days ago then developed many overlying, painful bumps. vaccinations UTD. PE numerous painful, clear vesicles over erythematous skin on both cheeks with some overlying dark-red crusting. dx?

herpes simplex infection (eczema herpeticum- HSV infection commonly associated with atopic dermatitis)

vesicles and dendritic ulcers on the cornea

herpes simplex keratitis (K and X looks like branching dendritic ulcer)

levels of FFN are _____ in 1st trimester of pregnancy, _____ in med 2nd-3rd trimester, and ______ at term, before labor

high low high

tx of bullous pemphigoid

high dose topical steroid

********** 4 wk old F p/w increased difficulty feeding, poor weight gain, excessive perspiration since birth. normal pregnancy and delivery T 98.6 HR 160 RR 80 and labored II/VI holosystolic murmur over LL sternal border lungs CTAB CXR- cardiomegaly w increased pulmonary vascular markings EKG- RVH most likely explanation for absence of murmur on initial exam?

high pulmonary vascular resistance

prenatal screening for high risk v. low risk mothers

high risk (>35yo) - cell free fetal DNA testing at > or = 10 weeks to detect aneuploidy low risk - combined test (pregnancy associated plasma protein A, BhCG, nuchal translucency) in first trimester - quadruple screen in 2nd trimester

what is spironolactone used for in PCOS?

hirsutism (does not regulate menstrual cycles)

32 yo F p/w 1 yr increasingly severe low back and buttock pain. morning stiffness that lasts 1-2 hours. no hx trauma/heavy lifting BP 110/70 HR 68 RR 16 tenderness to palpation over BL SI joints, decreased flexion and extension of lumbar spine xray of lumbar spine shows sclerosis of SI joints lab finding?

histocompatibility HLA B27, ankylosing spondylitis

subacute fever chills malaise headache myalgias dry cough CXR hilar LAD focal, reticulonodular infiltrates bx granulomas with narrow-based budding yeasts

histoplasma capsulatum associated with spelunking

33 yo M p/w 6 wks nonproductive cough and fatigue, unintentional weight loss, subjective fevers enlarged mediastinum on CXR hilar and mediastinal adenopathy on CT PET uptake in brain, kidneys, bladder, supraclavicular, and mediastinal lymph nodes dx?

hodgkin lymphoma

abscess located over upper or lower eyelid localized red tender swelling over eyelid

hordeolum

stye

hordeolum

18 yo nulliparous F p/w lower abdominal pain, nausea, vomiting x1 day. Unable to keep anything down. Sexually active, uses OCPs for contraception. LMP 15 days ago. Temp 102.2 BP 100/70 Pulse 110 dry mucous membranes diffuse abdominal tenderness speculum exam shows purulent discharge from cervical os, CMT, tender, small uterus UPT negative leukocytosis with neutrophilic predominance next step in mgmt?

hospitalization with cefotetan and doxycycline indications for hospitalization for PID - pregnancy - failed OP treatment - inability to tolerate oral meds - severe presentation - complications

management of hypertensive emergency in pregnancy vs. chronic htn

htn emergency- hydralazine (bradycardia) or labetalol (tachycardia) chronic htn- methyldopa or labetalol

management of exposure to VZV

hx of immunity-- observation no hx of immunity & immunocompetent-- vaccine no hx of immunity & immunodeficient-- VZIG

next step in pt with persistent, confluent tinea corporis over large areas of the body?

hx of immunodeficiency (DM, HIV, systemic steroid therapy)

5 yo M p/after fainting after standing from a sitting position. sx began 3 days ago w diarrhea and vomiting. has had no UOP x18 hrs T 99.5 BP 75/45 HR 120 RR 28 dry lips tenting of skin hyperactive bowel sounds cap refill 5sx UA finding?

hyaline casts

risk factors for hyperemesis gravidarum? (3)

hydatidiform mole multifetal gestation hx of HG

nephrotic syndrome is frequently associated with _______coaguability

hyper

other risk factor for Wernicke's encephalopathy besides alcoholism

hyperemesis gravidarum

34 yo F p/w fatigue and decreased exercise intolerance, proximal muscle weakness and atrophy. reports increased anxiety, irritability and unintentional weight loss. no fever, no loss of appetite. muscles are non-tender. DTR normal. HR 115. dx?

hyperthyroidism

electrolyte side effect of B2agonists?

hypokalemia

side effect of oxytocin that can lead to post-partum seizures?

hyponatremia (due to similar structure to ADH)

calcium deposits in basal ganglia

hypoparathyroidism

39 yo F p/w abnormal uterine bleeding x1 year. also describes difficulty concentrating at work and increased irritability w depressed mood. denies hot flashes. nl VS. skin is cool and dry, normal vaginal mucosa. dx? FSH ___ TSH ___ prolactin ___

hypothyroidism decreased increased increased

2 phases of the first stage of labor

latent- 0-6cm cervical dilation - no expected rate of change active- 7-10cm cervical dilation - at least 1cm change q2 hr if active stage of labor is progressing more slowly than expected, administer oxytocin

15 yo F p/w irregular menstrual cycles. no chronic medical issues, surgeries, meds. Famhx PCOS in sister and mother. has never been sexually active. Prolactin nl TSH nl Tanner stage V abd exam nl no active bleeding from os administration of micronized progesterone leads to withdrawal bleeding w/in 3 days pelvic u/s shows normal ovaries and uterus most likely explanation for irregular menstruation?

immature developing hypothalamic-pituitary-gonadal axis - produces inadequate quantities and proportions of GnRH (and therefore FSH and LH) to induce ovulation - w/o progesterone surge during ovulation, endometrium builds up and does not have cue to slough off

34 yo F G2P1 at 26 wks gestation p/w intermittent leakage of fluid, no vaginal bleeding or contractions. pobhx of pprom at 29 wks. temp 103 bp 100/70 pulse 114 fetal HR 170 uterus is ttp speculum exam shows purulent amniotic fluid from os transabdominal us shows vertex fetus c/w gest age next step in mgmt in addition to admin of abx?

immediate induction of labor dx- chorioamnionitis - tx is abx and immediate delivery regardless of gest age d/t risk of maternal morbidity and mortality

ITP

immune thrombocytopenia - generally occurs after a viral illness - characterized by isolated thrombocytopenia - p/w petechiae and occasionally mucosal bleeding - tx is observation if only cutaneous sx - glucocorticoids, IVIG, or anti-D if bleeding (or plt count <30 in adults)

presentation of CMV?

immunosuppressed patient viremia most commonly affects GI tract - colitis - enteritis - malaise, vomiting, bloddy diarrhea, abdominal pain cytopenias atypical lymphocytes

Why is Primaquine used along with Chloroquine in the treatment of malaria?

in order to treat dormant hepatic infection that can reactivate weeks to months after initial resolution of symptoms

maneuvers that decrease the intensity of HCM murmur

increase afterload - sustained hand grip - squatting increase preload - passive leg raise - squatting

Maternal serum alpha-fetoprotein (MSAFP)

increased - open neural tube defects - ventral wall defects - multiple gestation (when associated with increased uterus size compared to gestation dates) decreased - aneuploides (trisomy 18 & 21)

acetaminophen effects on warfarin?

increased efficacy (increased bleeding risk)

etiology of spider angioma in liver cirrhosis

increased levels of estrogen

intra-abdominal air CT

indication for emergent surgical exploration

3 mo boy refusing to feed, normal urination, constipation, head seems floppy, BL ptosis, sluggish pupillary reflex to light, copious drool, weak suck reflex, flaccid and extended extremities exclusively breastfed with vitamin D supplementation living in newly built neighborhood in CA dx? other dx on differential and why it isn't that?

infant botulism caused by ingestion of clostridium botulinum spores from environmental dust similar presentation to Werdnig-Hoffman, but WH does not affect the pupils, weakness is greater in the lower extremities than the upper

Eikenella corrodens is associated with______ and is found in _______

infective endocarditis the mouth- poor dentition

risk factors for hydatidiform mole?

infertility extremes of maternal age

intervention to rapidly lower potassium in severe hyperkalemia?

insulin and glucose

pathophysiology of DKA in children

insulin deficiency--> increased lypolysis of peripheral fat stores--> fatty acids are broken down into ketones in liver--> acidosis/DKA

mechanism of amitriptyline associated orthostatic hypotension

interaction with alpha adrenergic receptors

indication for cilostazol use?

intermittent claudication

pathophysiology of SBP?

intestinal bacterial translocation - dx made when ascitic fluid neutrophil count is >250

******************* 57 yo M p/after being found on the floor of his apt w left hip pain and SOB. hx of renal failure caused by ingestion of ethylene glycol, has missed his last 2 dialysis txs. meds amlodipine doxazosin temp 99.5 BP 150/100 pulse 95 RR 24 crackles in lung bases soft abdomen, BS normal LLE externally rotated Na 135 Cl 102 K 7.1 HCO3 12 pH 7.22 PCO2 31 PO2 61 ECG - peaked T waves 45mins until dialysis can be started most appropriate next step in management?

intravenous calcium gluconate (rapid decrease of K level)

abdominal pain hematemesis diarrhea hx of depression and anemia hepatic necrosis AG metabolic acidosis

iron toxicity

Buerger's disease (thromboangiitis obliterans)

is an uncommon occlusive disease of the arteries and veins in the distal portion of the upper and lower extremities. The disease often extends into the tissues around the vessels, resulting in fibrosis and scarring that bind the artery, vein, and nerve firmly together. tx w complete smoking cessation

management of HIV+ pt with positive PPD and normal CXR

isoniazid + pyridoxine

4 yo boy w/ persistent fevers. developed rhinorrhea, cough, body aches after returning from Costa Rica. Fevers spike in the evening and are accompanied by pink, nonpruritic rash that resolves by morning several pink macules at the waist and BL axillae hepatosplenomegaly, lymphadenopathy, leukocytosis, thrombocytosis, anemia dx?

juvenile idiopathic arthritis

teenage pt w hx of absence seizures p/w frequent episodes of early morning limb jerking

juvenile myoclonic epilepsy - will eventually progress to generalized tonic-clonic seizures

"chicken skin" dx

keratosis pilaris

The preferred fluid for resuscitation of the patient with significant burns is:

lactated ringer's

ddx for anion gap metabolic acidosis- hypoperfusion?

lactic acidosis

most common sequelae of untreated giardiasis

lactose intolerance d/t brush border disruption

best pharmacotherapy for pts with bipolar dz during pregnancy?

lamotrigine

39 yo F G4P0 at 35 wks p/w severe, constant lower abdominal pain. prenatal course has been uncomplicated so far. previous 3 spontaneous abortions were d/t leiomyoma. 2 yrs ago she had a myomectomy in which her uterine cavity was entered. Temp 98 BP 130/80 pulse 100 FHT baseline rate in 140s with moderate variability and persistent variable decelerations to the 90s contractions q2-3 mins that last 45 sec cervix is 4cm dilated and 100% effaced next step in management?

laparotomy and cesarean delivery TOLAC contraindicated in this pt with surgery that entered the uterus- risk of uterine rupture is too high

type of neuron affected in DM that cause impaired propioception

large fiber neurons

home-distilled whiskey

lead poisoning

45 yo M admitted for anterior wall MI 5 days ago develops sudden onset L sided chest pain. cardiac cath on admissions showed complete LAD occlusion, revascularization was not done d/t time to cath lab. agitated and restless, 2 min later unresponsive pulse is not palpable EKG shows HR 130 dx?

left ventricular wall rupture

6 yo boy insidious onset of knee pain normal x rays

legg-calve-perthes

high fevers GI symptoms preceding respiratory symptoms

legionella tx with fluoroquinolone

what is plan B?

levonorgestrel (emergency contraception)

55 yo F vulvar pain dyspareunia erosive vulvar lesions with white borders vaginal stenosis oral ulcers lacelike, reticular appearance of gingiva multiple white plaques on the tongue and palate

lichen planus - erosive variant - papulosquamous variant is associated with small pruritic papules with purple hue - first line treatment is high-potency steroids

rash in 4 year old girl that developed 2 weeks after administration of VZV vaccine

likely due to replication and infection by attenuated vaccine strain VZV

Common extrapulmonary sites for TB (5)

liver spleen kidney bone adrenal gland (can lead to chronic primary adrenal gland insufficiency)

therapy demonstrated to prolong survival in COPD pts

long-term supplemental oxygen therapy

what are the initial steps in management of IBS?

loperamide and low FODMAP diet Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols

associated physical exam finding in pts with cataracts

loss of red reflex

intervention to prevent preeclampsia

low-dose aspirin at 12 weeks gestation in high risk patients

3 most common causes of secondary digital clubbing

lung malignancies, cystic fibrosis, R to L cardiac shunts *COPD does not cause digital clubbing!!!*

46 yo F LLE swelling x2 years recurrent LLE cellulitis pmhx T2DM BMI 34 firm edema of LLE on exam w/o tenderness or warmth

lymphedema

cause of swelling in hands and feet of infants born with Turner syndrome

lymphedema d/t lymphatic network dysgenesis

lab finding in pt with pertussis

lymphocytosis

Distortion of straight lines to appear wavy

macular degeneration

what is the most important direct role of hCG in pregnancy?

maintenance of the corpus luteum in order to maintain secretion of progesterone until the placenta is able to secrete progesterone on its own

most likely cause of significantly elevated calcium?

malignancy

cause of neonatal thyrotoxicosis?

maternal TSH receptor antibodies crossing placental barrier (neonatal Grave's disease)

next step in management of pt in whom you suspect compartment syndrome

measure compartments - will help minimize unnecessary fasciotomies

how to calculate osmol gap

measured serum osmolality-calculated serum osmolality (calculated s.o.= [2*Na]+[glu/18]+[BUN/2.8]

67 yo F p/for routine exam PE normal Hgb 12.8 Ca 11.9 - ionized 5.8 (elevated) Cr 0.8 Phos 2.8 total prot 6.5 albumin 4.2 next step in mgmt?

measurement of serum PtH concentration

widened mediastinum on CXR s/p CABG, associated fever, tachycardia, and leukocytosis

mediastinitis- tx with surgical debridement and abx

thyroid FNA with parafollicular cells

medullary thyroid cancer

preferred malaria prophylaxis for travelers?

mefloquine for 2 weeks prior to and 4 weeks after travel

15 mo M p/w cyanosis and lethargy after administration of oral topical lidocaine dx? lab findings?

methemoglobinemia (exposure to oxidizing agent) pulse ox ~85% saturation gap (>5% difference between O2sat on pulse ox and ABG) normal PaO2

histology of Reye syndrome

microvesicular steatosis

"corkscrew shaped" bowel on upper GI series in infant with bilious vomiting

midgut volvulus

pt w/ AKI associated with hypercalcemia and metabolic acidosis (elevated HCO3) recent esophagitis following initiation of bisphosphonate therapy dx? pathophys?

milk-alkali syndrome - d/t excessive intake of calcium and absorbable alkali (generally Ca carbonate) - hypercalcemia in milk-alkali syndrome causes renal vasoconstriction and decreased RBF - renal loss of sodium and water, reabsorption of bicarb p/w nausea, vomiting, constipation polyuria, polydipsia, neuropsych symptoms suppressed PTH

why is misoprostol not used for emergency contraception?

misoprostol is an abortifacent. it does not prevent pregnancy

most common cause of mitral valve regurg in developed countries?

mitral valve prolapse

66 yo M pmh COPD p/w COPD exacerbation. vitals nl except for tachycardia. Pulse ox 86% RA. ECG shows irregular narrow complex tachycardia w 3 different P wave morphologies and a variable PR interval. electrolytes nl best next step in management of arrhythmia?

monitor while treating COPD exacerbation dx is multifocal atrial tachycardia caused by COPD exacerbation. Tx is to treat underlying cause

is bipolar disorder classified as a mood or psychotic disorder

mood

acute presentation of varicocele

more likely renal vein thrombosis than RCC

language development of a 2 year old

more than 50 word vocabulary 2-word phrases

constitutional symptoms normocytic anemia renal insufficiency hypercalcemia

multiple myeloma

parkinsonism, autonomic dysfunction, widespread neurological signs

multiple system atrophy (Shy-Drager)

maneuvers that increase intensity of HCM murmur

murmurs that decrease the preload - valsalva - abrupt standing - nitroglycerin admin

ovalomacrocytosis

myelodysplastic syndrome

ddx of macrocytic anemia other than folate and B12 deficiency?

myelodysplastic syndrome - dx with bone marrow bx

40 yo M p 1hr following MVC w severe pain over sternum sys BP 80 HR 80 resp 10 ECG multifocal premature ventricular contractions, no ST-changes PO2 100 PO2 after 1L NS- 60 pulmonary cap wedge pressure- increased from 14--> 24 most likely reason for poor response to fluid resuscitation?

myocardial contusion

58 yo woman w 6mo hx L knee pain that is worse with activity, intermittent morning stiffness lasting from 10-15 minutes, no associated weight loss, fever Baker cyst present Joint fluid aspirate: WBC . 1100 gram stain . no organisms crystals . none x-ray finding?

narrowing of joint space with osteophytes (osteoarthritis)

7 day old F in NICU w truncus arteriosus, poor feeding and abdominal distension. is awaiting adequate weight gain before surgical correction of heart disease. Temp 95 BP 60/30 HR 180 Resp 65 pulse ox 82% on RA lethargic, cyanotic moderate abdominal distension and absent bowel sounds bright red blood in stool bilious fluid recovered via NG tube dx?

necrotizing enterocolitis

Fournier's gangrene

necrotizing fascitis of the perineum dx warrants immediate surgical debriedment

lithium causes what type of diabetes insipidus?

nephrogenic

34 yo man w severe abdominal pain, sharp, unbearable, located in LLQ and radiates to the groin. vomiting x2, no dysuria, no fever, nl heart and lungs, normal genitalia dx?

nephrolithiasis dx with abdominal u/s

indication for surgical decompression in pts with cerebellar hemorrhage

nerologic decline hemorrhage >3cm brainstem compression

13 mo F persistent bruising around eyes weight down 1lb from a month ago rapid jerking movements in both eyes infraorbital ecchymoses bilaterally abdomen mildly distended 6cm palpable, firm mass anterior to the left flank dx?

neuroblastoma - periorbital ecchymoses from metastases - weight loss - abdominal mass - opsoclonus myoclonus syndrome - dx by elevated catecholamine metabolites, small round blue cells on histology, N-myc gene amplification

metal in jewelry that commonly causes contact dermatitis?

nickel

common first line tocolytic from 32-34 wks

nifedipine

most appropriate pharmacotherapy in pt with cocaine induced STEMI

nitroglycerin and aspirin

does lichen sclerosis affect the vagina?

no

management of delivery in mom w outbreak of condyloma acuminata

no best option, C-section and vaginal delivery have the same risk of vertical transmission

definition of menopause

no menses for 12 months

Methaqualone (Quaalude)

non barbiturate depressant, powerful sedative and muscle relaxant, high potential for abuse.

hemineglect syndrome

non-dominant parietal lobe lesion

how to use pupillary involvement to determine etiology of CN III palsies

non-pupil-sparing CNIII palsy - intracranial aneurysm pupil-sparing CNIII palsy - microvascular ischemia

treatment of acute COPD exacerbation after SABA, steroids, and abx have been administered without resolution of sx

noninvasive positive-pressure ventilation

testicular germ cell malignancy with positive BhCG and AFP

nonseminoma

38 yo G2P1 at 38 weeks gestation has not felt fetal movement x36hrs normal pregnancy thus far FHT heard by doppler next step?

nonstress test

CRP finding in IBS?

normal

histology finding in IBS?

normal

xray finding in acute pericardial tamponade

normal heart contours

45 yo F p/w fatigue and exertional dyspnea, difficulty walking for more than 2 blocks, uses 2 pillows to sleep, pmhx of hyperlipidemia, hypertension, T2DM. 15y pack history quit 10 y ago, does not use alcohol or illicit drugs. BP 150/90 Pulse 80 rr 16 BMI 55 JVD-- cannot be visualized given body habitus lungs CTAB heart sounds are distant abdomen obese and nontender trace BL LE edema neuro nl Labs CBC nl ABG pH 7.3 PaO2 70 PaCO2 59 dx? pathophysiology?

obesity hypoventilation syndrome - daytime hypercapnia in an obese patient w/o another explanation for hypercapnia d/t alveolar hypoventilation

6 mo F p/for routine health exam. hx of lumbosacral myelomeningocele at birth that was successfully repaired at 2 days of age. anterior fontanelle 6x8cm and bulging posterior fontanelle 3x4cm and bulging severe motor and sensory deficits involving upper and lower extremities head circumference has steadily increased from 34.2cm at 1 mo to 47cm currently most likely cause of increased ICP?

obstruction of cerebrospinal fluid flow

nerve responsible for hip adduction and medial thigh sensation?

obturator

immediate intervention in central retinal artery obstruction

ocular massage high flow O2

which nerve is most at risk of damage following uncal herniation?

oculomotor

When is a DEXA scan recommended?

one time screening for: all women > or = 65 yo or women <65 yo with elevated risk of osteoporotic fracture

best tx to prevent chronic pain in pt w/ shingles?

oral acyclovir

mainstay of therapy for Bell palsy?

oral glucocorticoids

23 yo pt requests emergency contraception after the condom broke during sexual intercourse one day ago. Best pharmacotherapy recommendation?

oral levonorgestrel now and again in 12 hours

next step in management of pt with unstable cervical spine and impending respiratory failure?

orotracheal intubation with manual stabilization of cervical spine to minimize movement

enlarged cardiac silhouette in an infant following corrective heart surgery- indicative of?

pericardial effusion, likely inflammation of pericardial cells inducing fluid production 2/2 surgery

3 yo M pmh frequent fx, conductive hearing loss, short stature, joint hypermobility dx?

osteogenesis imperfecta - AD defect in type I collagen gene

single punched out lesion on bone associated with pain at night, unrelated to activity

osteoid osteoma

45 yo F hx of celiac sprue and w/ noncompliance to diet p/w fatigue, weakness, diffuse bone pain Hgb --- 12 Ca --- 9 Phos --- decreased PTH --- significantly elevated Alk phos --- 234 dx? mechanism of dx?

osteomalacia d/t vitamin D deficiency from celiac sprue osteomalacia- defective mineralization of organic bone matrix

common complication of Turner's syndrome

osteoporotic fracture - estrogen deficiency leads to uninhibited osteoclast-mediated bone resorption

concentric layers of reactive bone

osteosarcoma

most common primary bone tumor affecting children and young adults, "sunburst appearance"

osteosarcoma

most common cardiac manifestation of SLE

pericarditis

vertigo triggered by Valsalva maneuver

perilymphatic fistula

60 yo woman p/w SOB, decreased appetite, nausea, unable to fit into pants, famhx of sister with BRCA+ breast cancer PE shows distended abdomen w/decreased bowel sounds, clear lungs, nodular, non-mobile adnexal mass pelvic US confirms exam findings dx? next step in mgmt?

ovarian cancer exploratory laparotomy

23 yo F 1 day postpartum after uncomplicated vaginal delivery has the onset of loss of small amounts of urine. received epidural anesthesia during labor and delivery. voiding 50-75 mL at a time. PVR 300mL cause of urinary incontinence?

overflow incontinence

31 yo F p/w 15 lb weight gain, weakness, irregular menstrual periods, increased anxiety and insomnia BP 160/100 pulse 88 proximal muscle weakness dark terminal hair on lower abdomen normal labs except mildly elevated glucose next step in evaluation?

overnight low-dose dexamethasone suppression test (eval for Cushing's syndrome) 24 hr urine collection and cortisol measurement late night salivary cortisol assay

clinical findings in complex regional pain syndrome?

pain, severe, regional (not dermatomal), burning edema, abnormal sweating vasomotor changes skin, hair, nail changes patchy demineralization on xray

histology of liver damage caused by isoniazid

panlobular mononuclear infiltration and hepatic cell necrosis (similar histologic appearance to viral hepatitis)

65 yo F p/w 24 hr hx chest pain. Substernal chest pain that began yesterday, persisted all night long, started to clear in the morning. hx HTN and DM, poorly compliant with treatment. ECG shows sinus rhythm with ST elevation in leads II, III, aVF. cath shows total occlusion of proximal R artery 3rd day of hospitalization develops severe SOB and hypotension diaphotetic and tachypneic bibasilar crackles short, soft systolic murmur is heard at the apex most likely cause of sx?

papillary muscle rupture

retrocardiac air-fluid level on xray

paraesophageal hiatal hernia

who can give consent for treatment of a child of divorced parents?

parents with custody, if parents share joint custody, only one parent must give consent to treatment in order to proceed

43 yo F abdominal pain dark urine RUQ tenderness HGB 8.9 tbili 6 LDH 740 haptoglobin low hepatic vein thrombosis

paroxysmal nocturnal hemoglobinuria - hemolysis - cytopenias - hypercoagulable state - dx by assessing presence of CD 55 and CD 59 proteins on the surface of the RBCs

patchy vs. diffuse hair loss

patchy- AA diffuse- TE

anterior knee pain worsened with running, stairs, prolonged sitting. associated weakness of quadriceps. pain reproduced with tonic contraction of quad with flexed knee. dx?

patellofemoral pain syndrome

loud S2, bounding peripheral pulses, widened pulse pressure dx?

patent ductus arteriosus

46 yo nulliparous F p/for routine exam. hx of regular mestrual periods. sexually active w husband, vasectomy for BC. Bimanual exam shows 5-cm irregularly shaped R adnexal mass. UPT- next step in mgmt?

pelvic U/S

55 yo M p/w skin sores, painful ulcerations in mouth, large, painful blisters on trunk and extremities light rubbing of skin causes easy separation of the epidermis immunofluorescence shows intercellular deposits of IgG dx?

pemphigus vulgaris (v=pinching skin together)

single tap of patellar tendon elicits persistent, slow, back and forth swinging of leg

pendular reflex, caused by muscle hypotonia. seen in cerebellar degeneration

22 yo M intubated w chest tube placement after severe trauma to chest w/ resultant tension pneumothorax. Chest tube continues to have large air leak despite adequate seal at chest wall and connection points. next step in mgmt?

perform bronchoscopy

53 yo M p/w worsening weakness and exertional dyspnea x2 days. URI 3 mo ago w/o complete resolution of sx. jugular venous pulsation is 11 cm H2O. heart sounds are muffled dx?

pericardial effusion leading to cardiac tamponade

infant with repeated episodes of coughing, gagging, gasping for air followed by episodes of apnea

pertussis

18 yo M p/w irritating, dry cough following clear rhinorrhea x1 week. coughing episodes recently worsened, occur without warning, and cause post-tussive emesis. last immunizations at age 11. dx?

pertussis lifelong immunity to pertussis is not conferred from vaccination. acquired immunity wanes 5-10 years following vaccination.

newborn found to have growth restriction, microcephaly, wide anterior fontanelle, cleft palate, distal phalange hypoplasia likely d/t maternal use of _________ while pregnant

phenytoin

15 mo M p/w bowed legs, appears to have gotten worse since he began to walk 1 mo ago. pt is not in pain. eats a varied diet and consumes 16 oz whole milk daily. nl pregnancy and delivery. full ROM of BL hips, knees, ankles tibiofemoral outward bend when pt stands with his feet together dx? next step in management?

physiologic genu varum- often resolves by age 2. tx is reassurance and observation

2 day old Asian F p/w jaundice. born at 40 weeks, uncomplicated delivery and pregnancy. exclusive breastfeeding with good latch, voiding appropriately, passing meconium. famhx of siblings needing phototherapy during first few days of life. jaundice of face and neck present on exam T bili 9 Conj bili 0.4 Hct 52% peripheral smear normal pathophysiology of condition?

physiologic jaundice of the newborn - fetal RBCs increased at birth, high turnover rate - hepatic bilirubin clearance decreased b/c UGT activity does not reach adult levels until 2 weeks of age - enterohepatic recycling is increased b/c low bacterial load in newborn gut results in slower conversion of bilirubin to urobilinogen for fecal excretion

most common brain tumor in children

pilocytic astrocytoma

Multiple oval macules and patches in a "Christmas tree" pattern on the back associated herald patch

pityriasis rosea

painless vaginal bleeding after 20 weeks gestation?

placenta previa

35 yo F p/w hematuria. has been working in the garden for the past 2 days, has BL flank pain denies fever, chills, vomiting, dysuria, urinary frequency sexually active, uses condoms father died of kidney dz at age 40 Temp nl BP 180/120 BMI 40 BUN 24 Cr 1.6 UA significant only for blood dx?

polycystic kidney disease flank pain occurs generally with activities that involve bending and straightening which can cause cyst rupture

"crescent sign" on medial malleolus

pooling of blood suggestive of ruptured popliteal cyst

33 yo F p/w non-painful, itchy blistering on back of hands after spending time outdoors gardening. hx of skin fragility and easy scarring. pmhx Hep C that is untreated. takes daily OCP dx?

porphyria cutanea tarda -- deficiency of uroporphyrinogen decarboxylase. triggered by ingestion of estrogen/ethanol. frequently associated with hep C.

finding suggestive of cardiac etiology of edema?

positive hepatojugular reflux

2 day old boy with abdominal distention, respiratory distress, weight gain, has had 1 stool and 1 wet diaper since birth and normal cardiac exam-- dx?

posterior urethral valves

60 yo F decreasing vision and dull ache over L eye cataract extraction 5 days ago fever elevated bp swollen eyelid edematous conjunctiva exudates in anterior chamber

postoperative exophthalmitis - bacterial or fungal infection within the eye (within the vitreous)

what is the primary risk factor for intraventricular hemorrhage?

prematurity

intervention to improve post-cardiac surgery rates of atelectasis and pneumonia

preop physical therapy

patient demographic affected by lichen sclerosus

prepubertal girls and peri/postmenopausal women

complications of PPROM? (4)

preterm labor intraamniotic infection placental abruption umbilical cord prolapse

75 yo Af. Amer. M w/ hx diabetes and HTN p/w cupping of optic disc and constricted peripheral vision dx?

primary open angle glaucoma

Management of PPROM

prior to 34 weeks- inpatient expectant management with prophylactic latency antibiotics (latency- period between rupture and delivery) and corticosteroids 34+ weeks- delivery

pharmacotherapy indicated in pts with cancer-related anorexia/cachexia syndrome?

progesterone analogues (longer life expectancy) corticosteroids (shorter life expectancy)

pt with short cervix by TVUS at 16 weeks-- management?

progesterone to maintain uterine quiescence

family history of eczema, allergies, asthma young infant painless bloody stools spitting up after meals

protein-induced allergic proctocolitis

best option to reverse warfarin-associated intracerebral hemorrhage?

prothrombin complex concentrate (or fresh frozen plasma) IV vitamin K

"5 P's" of Lichen planus

pruritic purple/pink polygonal papules plaques typically forms on flexural surfaces of wrists and ankles treat with topical high-potency corticosteroids

nonpsychotic woman presenting w s/s of pregnancy and belief that she is pregnant. evaluation excludes pregnancy with negative pregnancy test and u/s showing empty uterus

pseudocyesis

52 yo M w 24 hr hx of pain and swelling in his R knee. no fevers, chills, recent trauma to knee. also has constipation, excessive urination, fatigue x several months. pmhx of kidney stone 1 yr ago. does not take meds, drink alcohol, smoke, drugs. temp nl bp nl tenderness, erythema, swelling of knee hgb 13 plt 240,000 leuk 13,000 na 138 k 4.2 bun 18 cr 1 ca 11 glu 90 dx? expected finding on arthrocentesis?

pseudogout - caused by calcium pyrophosphate dihydrate crystals in joint space - common complication of hyperparathyroidism - also associated with hypothyroidism - hemochromatosis inflammatory effusion with rhomboid-shaped, positively birefringent crystals

pathogen responsible for "hot tub folliculitis"

pseudomonas aeruginosa

organism(s) most commonly associated with contact-lens associated keratitis?

pseudomonas and serratia

4 yo M p/after MVC where he was an unrestrained passenger BP 110/70 HR 100 RR 32 w grunting and retractions multiple bruises over chest ABG pH 7.38 PCO2 34 PO2 66 CXR 4 hrs later diffuse infiltrates on R side dx?

pulmonary contusion

Widened splitting of S2, increases with inspiration, crescendo-decrescendo systolic murmur

pulmonic valve stenosis

how do you confirm a diagnosis of suspected vulvar lichen sclerosis?

punch biopsy dx can often be made clinically, but a punch biopsy should be done to r/o vulvar cancer

abdominal succession splash suggests

pyloric stricture

tx for elevated homocysteine levels

pyridoxine, folate, and B12

treatment of moderate/severe croup

racemic epinephrine and corticosteroids

nerve most likely damaged in mid-shaft humeral fracture

radial nerve

patients with untreated hyperthyroidism are at high risk for developing _____

rapid bone loss and osteoporosis

hallmark of ischemic liver injury

rapid, significant increase in transaminases with modest accompanying elevations in total bili/alk phos

management of incidentally found endometriosis

reassurance and observation

75 yo M w heart murmur, no chest pain, SOB, palpitations, fatigue, dizziness, syncope hx of HTN TTE shows thickened left ventricular wall with no regional wall abnormalities, EF 45%, valve area of 0.9cm2, transvalvular gradient consistent with severe aortic stenosis next step in mgmt?

recommend aortic valve intervention EF <50% Symptomatic already undergoing cardiac surgery

UA findings in rhabdomyolysis

red urine + blood w/o RBC on microscopy pigmented casts

common risk factor for hypermagnesemia treatment of magnesium toxicity

renal insufficiency calcium gluconate

5 mo old girl with regular intake, poor weight gain, no diarrhea, no vomiting, thin appearance, nl physical exam, nl newborn screen Serum Chem Na . nl K . 3 Cl . 121 ABG pH . 7.21 PaCO2 . 31 Bicarb . 14 UA pH . 7.9 K . nl Na . nl cause of FTT?

renal tubular acidosis

first step in evaluation of a patient with hypertension and hypokalemia

renin/aldosterone levels

f/u after aspiration of simple breast cyst in 29 yo woman?

repeat exam in 2-4 months to ensure resolution of cyst, then return to annual screening

how to determine compensation for respiratory/metabolic acid/base disturbances

respiratory compensation occurs quickly metabolic compensation begins slowly, after several hours and takes several days to complete

50 yo patient flashes of light "curtain coming down over my eye" gray elevated retina

retinal detachment

next step in mgmt of M pt brought in with significant pelvic fractures/injuries and large scrotal hematoma

retrograde urethrography

34 yo M p/w penile fracture sustained during sexual intercourse. following adequate analgesia, what is the next best step in mgmt?

retrograde urethrography to eval for urethral damage

4 yo boy p/w fever and neck pain, 1 wk hx fever, sore throat, nasal congestion, rhinorrhea. 2 day hx of worsening neck pain, is now refusing to eat or drink. no pmh, UTD w vax. Temp --- 103 pulse --- 120 rr --- 24 bilateral anterior lymphadenopathy passive extension is painful muffled voice limited mouth opening by pain erythematous, symmetrically enlarged tonsils with gray exudate midline uvula lungs CTAB, no stridor or rhonchi lat neck XR- widened prevertebral space but no other abnormalities dx?

retropharyngeal abscess

CLL treatment

rituximab- mab against CD20 antigen on B lymphocytes

persistent facial erythema/telangiectasias onset with sun exposure and alcohol ingestion

rosacea

ddx for anion gap metabolic acidosis- drug ingestion?

salicilates, isoniazid, iron

Extremely itchy rash, presenting on hands and feet and spreading proximally

scabies

sandpaper rash

scarlet fever

acute renal failure malignant HTN systemic sclerosis

scleroderma renal crisis - associated with schistocytes

51 yo F p/w 2 mo pain and numbness of r index and middle fingers. Fingers turn white when subjected to cold. PMHx chronic cough, lower back pain, acid reflux. 28 p/y smoking hx. 2 small ulcers present on the tip of her index finger dx? next step in mgmt?

secondary Raynaud's ANA Ab to assess for systemic disorder

elevated phosphate low calcium CKD

secondary hyperparathyroidism

what kind of bias does loss of follow up create the potential for?

selection bias

thyroid dysfunction cardiomyopathy immune dysfunction -- mineral deficiency?

selenium

testicular germ cell malignancy with negative BhCG and AFP

seminoma

most common middle ear pathology in AIDS pts?

serous otitis media (non-infectious effusion)

22 yo F p/w worsening acne on face and body over the past 6 mo, has been losing weight to try to get rid of it with no success, no pmh, psh BP 138/86 HR 72 BMI 42 coarse hair on upper lip and chin, enlarged clitoris elevated total testosterone, normal DHEA dx?

sertoli-leydig cell tumor rapid onset hyperandrogenism, elevated testosterone, normal DHEA if DHEA^ and testosterone nl, suspect adrenal gland tumor

45 yo F p/w progressive fatigue, myalgias, muscle weakness x 1mo. slight difficulty getting up from a chair, weakness and cramping in legs after walking a short distance. pmh htn tx w lisinopril. no drugs, smoking, alcohol. bp 140/80 hr 64 resp 14 decreased ankle jerk reflexes normal ESR elevated CK other labs normal most appropriate next step?

serum TSH and free T4

45 yo M p/w epigastric abdominal pain and diarrhea. pmh PUD. 20 py smoking hx. abdominal tenderness 3 duodenal ulcers upper jejunal ulceration most appropriate next step in mgmt?

serum gastrin concentration - multiple ulcers and jejunal ulceration are suggestive of a gastrinoma more than H. Pylori

child w/ fever, urticaria & polyathralgia 1-2 wk after b-lactam/TMP-SMX exposure

serum sickness-like syndrome

sinusoidal NST?

severe fetal anemia- often associated with vasa previa

pathophysiology of HUS?

shiga toxin causes endothelial damage in renal glomeruli--> platelet activation--> microthrombi formation--> microangiopathic hemolytic anemia NO Ab INVOLVEMENT

seizures in the setting of an acute bacterial gastroenteritis most likely organism?

shigella- typically causes mucoid diarrhea +/- blood

differentiation between iron deficiency and sideroblastic anemia?

sideroblastic - dimorphic RBC population - increased serum iron concentratoin - decreased TIBC iron deficiency - decreased serum iron concentration - increased TIBC

clinical finding that is strongly suspicious for chronic osteomyelitis?

sinus tract with a persistently draining wound

management of anal fissures?

sitz bath analgesics stool softeners high fiber diet

classic presentation of heparin-induced thrombocytopenia

skin necrosis at abdominal injection site

MS treatment

slow progression with beta-interferon IV steroids for acute flares catheterization, muscarinic antagonists for neurogenic bladder baclofen, GABAb receptor agonists for spasticity opiods for pain

29 yo M p/w persistent vomiting and crampy, diffuse, worsening abd pain x24 hours. normal BM 3 days ago, no diarrhea. emesis is green w/o blood or coffee grounds. temp nl pulse nl bp decreases with standing abd distended with hyperactive bowel sounds diffusely tender to palpation hct 45% leuk 9600 na 147 k 3.1 cr 1.0 ast 20 alt 12 bili 0.8 dx?

small bowel obstruction

38 yo woman w hx of Roux-en-Y 2 yrs ago p/w 2 mo diarrhea and abdominal bloating Hgb . 11 MCV . 108 dx?

small intestine bacterial overgrowth- RNY surgery creates blind pouch of small intestine that allows for bacterial overgrowth

which lab value typically mirrors the severity of CHF?

sodium levels - extent of hyponatremia mirrors severity of CHF

pathophysiology of carpal tunnel assoc with hypothyroidism

soft tissue enlargement by mucopolysaccharides

75 yo M with low back pain that improves with leaning forward

spinal stenosis (AS typically presents before age 45)

fever, leukocytosis, LUQ pain L pleuritic chest pain L pleural effusion

splenic abscess

complication of CLL associated with anticoagulation, hypotension, diffuse abdominal pain, and acute anemia

splenic rupture

12 yo M w progressive back pain pain occasionally radiates to buttocks and legs unresponsive to ibu/acet palpable step-off in lumbosacral area pain with lumbar extension lumbar flexion is painless SLR normal dx?

spondylolisthesis - palpable step-off is characteristic of this dx

most common cause of oligohydramnios in patient at term

spontaneous ROM

38 yo M with mildly pruritic and uncomfortable skin lesions that began with a papule on R index finger that ulcerated and drained purulent discharge. works as a landscaper has recent exposure to cats no lymphadenopathy Temp nl BP 120/80 HR 74 dx?

sporothrix schenckii (sporotrichosis)

cutaneous malignancy associated with chronically wounded/scarred/inflamed skin?

squamous cell carcinoma

laryngeal malignancies are typically __________

squamous cell carcinoma

most common malignancy of the lip?

squamous cell carcinoma - pathologic findings include invasive cords of squamous cells with keratin pearls

Bowen's disease

squamous cell carcinoma in situ

treatment of torsades de pointes

stable pt: magnesium sulfate unstable pt: immediate defibrillation

3 yo M w pmh sickle cell anemia p/w fever and chills. no bone pain, cough, difficulty breathing. functional asplenia. T 103 bp 78/40 hr 140 rr 22 hct 24% plt 325,000 leuk 18,800 - neut 80% most likely responsible organism? most likely responsible organism if pt presented with bone pain?

strep pneumo- sepsis salmonella enteriditis- osteomyelitis

urethral hypermobility

stress incontinence

testicular malignancies that can produce excess estrogen

stromal - leydig- either testosterone or estrogen - sertoli- estrogen

childhood-onset fluency disorder; aka

stuttering

differentiation between subacute and suppurative thyroiditis

subacute- hyperthyroid symptoms suppurative- euthyroid

54 yo woman underwent laparoscopic surgery 5 days ago. presents today with RUQ pain, hiccups, anorexia, nausea, SOB. temp 102 bp nl resp 24 BMI 30 right pleural effusion on CXR leuk 24,000 dx?

subphrenic abscess

tx of hydatidaform mole?

suction curettage followed by serial b-hCG levels

tx of vulvar lichen sclerosis?

superpotent topical corticosteroids (topical estrogen is for vulvovaginal atrophy caused by menopause)

mgmt of newborn in respiratory distress 2/2 meconium aspiration

supplemental O2

airway management pathway of epiglottitis

supplemental O2--> bag mask with 100% O2--> video assisted endotracheal intubation--> surgical cricothyrotomy

treatment of E. coli O157:H7?

supportive only

treatment options for patients with pelvic organ prolapse

surgical v non-surgical (equally as efficacious) - pessary, pelvic floor exercises, weight loss

fetal tachycardia

sustained HR >160

prominent rhinorrhea is characteristic of which congenital infection?

syphilis

Anti-topoisomerase I ab

systemic sclerosis

sensory ataxia w broad based gait lancinating pains reduced/absent DTR pupils constrict to accomodation but not to light involuntary dribbling of urine

tabes dorsalis (tertiary neurosyphillis)

HR trend in hypothermia

tachycardia until body temp drops below 90

medication used to relax ureters to promote stone passage

tamulosin

23 yo F p/w diffuse hair loss. NSVD 4 mo ago w/ subsequent psychiatric hospitalization for depression. normal scalp and hair strands. >20% of hair fibers are pulled out with firm tugging. dx?

telogen effluvium

most common neuroimaging finding in Alzheimer disease?

temporal lobe atrophy

episodes of unresponsiveness fumbling hand movements lip smacking post-ictal confusion

temporal lobe epilepsy

17 yo F p/w colicky LLQ pain that worsens with intercourse and exercise but resolves upon resting. no diarrhea, constipation, urinary symptoms. UPT and STI negative. 8cm L ovarian cyst with calcifications and hyperechoic nodules on U/S dx?

teratoma

"focal sclerotic bone lesions"

think metastases

67 yo M p/w 6 mo hx of double vision, slurred speech, difficulty swallowing liquids. sx originally intermittent, now are daily and worse at the end of the day. SOB with exertion. hx of pernicious anemia, autoimmune thyroid disease bilateral ptosis, disconjugate gaze BL facial weakness, hypernasal speech weak tongue, decreased gag reflex muscle strength 4/5 x4 extremities DTR 2+, Babinski nl intrathoracic lesion of CXR most likely __________?

thymoma

what is the most important factor for survival in patients w cardiac arrest?

time to rhythm analysis and defibrillation if indicated

only tinea infection not caused by dermatophyte infection

tinea versicolor (malassezia sp.)

biggest differentiation between syncope and epileptic seizure

tongue biting

first-line therapy for labial adhesions

topical estrogen

initial treatment for limited plaque psoriasis?

topical high-potency glucocorticoids

1 day old M p/w macrocephaly and jaundice. uncomplicated pregnancy and delivery with complete prenatal care. While pregnant, mother traveled to Zambia where she developed fever, swollen glands, and muscle aches that resolved spontaneously after 2 weeks. weight and length are 25%ile, head circumference is 95%ile. VS nl diffuse jaundice on exam hepatomegaly cardiopulm nl hydrocephalus and diffuse intracranial calcifications on head CT Tbili 7.2 dbili 5.5 maternal exposure?

toxoplasmosis in undercooked meat congenital toxoplasmosis tx with pyrimethamine x1 yr

pt at 32 wks gestation p/w painless bleeding, no prenatal care next step?

transabdominal u/s (TVU/S risk is too high given likelihood of placenta previa dx)

what is a post-traumatic neuroma?

transection of nerve fibers which leads to inflammatory rxn and formation of a tangled mass of unmyelinated nerve endings which over-respond to non-painful stimuli can occur in amputees

6 yo F p/w R knee pain after gymnastics class 4 days ago. temp 100.2, limits weight bearing on r side when walking. limited internal rotation full ROM of R knee leuk elevated CRP nl u/s shows small, bilateral effusions of hips dx?

transient synovitis

first step in evaluating risk of preterm labor

transvaginal ultrasound to assess cervical length

immune-mediated disorder characterized by infiltration of inflammatory cells in to a segment of the spinal cord leads to : motor weakness autonomic dysfunction sensory deficits at a distinct level

transverse myelitis

What is Leriche syndrome?

triad of - bilateral hip, thigh, buttock claudication - impotence - absent or diminished femoral pulses

trichinella/trichomaniasis

trichinella- undercooked pork trichomaniasis- vagina

differentiation between trichotillomania and OCD

trichotillomania - recurrent hair pulling - NO presence of intrusive obsessive thoughts - one compulsion OCD - presence of intrusive obsessive thoughts - generally have many compulsions

murmur associated with carcinoid syndrome

tricuspid regurg

common murmur that develops after implantation of pacemaker/cardioverter

tricuspid regurg (d/t lead traveling from RA to RV through TV)

differentiation between jejunal and duodenal atresia on xray

triple bubble vs double bubble sign

differentiation of trisomy 18 and 21 on maternal quadruple test lab results?

trisomy 21 - decreased MSAFP - increased inhibin A - increased b-hCG trisomy 18 - decreased MSAFP - normal inhibin A - decreased b-hCG

40 yo F fever, abdominal pain R multiloculated adnexal mass with thick walls and internal debris elevated CRP and CA-125 Leuk 22,000

tubo-ovarian abscess

medical emergency associated with APML treatment

tumor induced consumptive coagulopathy all trans retinoic acid

alk phos level in multiple myeloma

typically normal as MM is only associated with osteoclastic lesions, not osteoblastic

23 yo man in MVA p/w lower extremity fractures, abdominal bruising, scalp lacs, pain, SOB. initial bp 95/60 hr 120 given 1L IV fluid becomes progressively lethargic and develops one sided weakness bp 160/90 hr 50 dx?

uncal herniation expedited by admin of IVF

Mammary Paget's Disease is almost always associated with ______

underlying breast adenocarcinoma

pregnant pt with T1DM p/w significant proteinuria prior to 20 weeks gestation

underlying diabetic nephropathy exacerbated by pregnancy

risk factors that increase likelihood of endometrial cancer?

unopposed estrogen exposure - obesity - nulliparity - anovulation - etc.

development of arm swelling, pain, mild erythema in the setting of a pt hospitalized for chemotherapy through a PICC should raise suspicion for what?

upper extremity DVT evaluate with duplex u/s

dx for anion gap met acidosis- renal failure?

uremia

54 yo F w leakage of urine, 1 wk of dysuria, no frequency or urgency. does not leak with valsalva, vagina is dry and atrophic 2-cm tender anterior vaginal mass is palpable and causes expression of bloody discharge from the urethra PVR 50ml dx?

urethral diverticulum

first step in evaluation of hyperemesis gravidarum?

urinalysis for ketones

common cause of recurrent UTI in children with chronic constipation

urinary stasis

treatment of choice in primary biliary cholangitis

ursodeoxycyclic acid

management of intrahepatic cholestasis in pregnancy

ursodeoxycyclic acid delivery at 37 weeks gestation

most likely cause of late decelerations on FHT monitoring in a 41 wk gestation?

uteroplacental insufficiency d/t age-related changes in late-term pregnancy can eventually lead to chronic fetal hypoxemia

most common extraarticular manifestation of ankylosing spondylitits

uveitis

most common cause of sudden cardiac arrest in the setting of acute MI

v fib (reentrant ventriular arrhythmias)

blood tinged ROM with fetal bradycardia should raise concern for

vasa previa

differentiation of vasa previa from placenta previa

vasa previa- generally associated with rapid fetal decline placenta previa- generally reactive fetal heart rate tracing

only current indication for HRT

vasomotor symptoms in women <60 who have undergone menopause within the past 10 years

65 yo M w/ sudden-onset respiratory distress following removal of central vein catheter. dx?

venous air embolism can lead to obstructive shock pts w/ suspected VAE should immediately be placed in L lat decubitus position to trap air on lateral wall of RV administration of 100% high-flow O2 encourages nitrogen gas resorption and shrinking of the air embolus

52 yo M p/w unilateral sensorineural hearing loss, episodes of imbalance, mild unilateral facial numbing no vertigo, no pain TM normal BL strength, reflexes, sensation NL throughout U/LE dx?

vestibular schwannoma (meniere disease is characterized by episodes of spinning/vertigo; vertebrobasilar insufficiency rarely is associated with hearing loss)

48 yo M w wound sustained on dock at a marine harbor. likely infectious organism?

vibrio vulnificus

2 yo M p/w resp distress. 1 week ago had episode of rhinorrhea and nasal congestion that spontaneously resolved. UTD w vax low grade fever tachycardia S3 gallop III/VI holosystolic murmur scattered wheezes at bases of lungs unresponsive to bronchodilator treatment dx?

viral myocarditis

21 yo p/after generalized tonic-clonic seizure. recent hx of headaches, fever, nasal congestion, rhinorrhea. no pmh, etoh, smoking, drugs temp 102 BP 130/85 HR 96 CT w shows 3cm ring-enhancing lesion of left frontal lobe, air fluid levels in paranasal sinuses HIV neg tissue biopsy result? dx?

viridans streptococci sinus infection that extended to brain- brain abscess other common organism is staph aureus

appropriate screening at 4 year well-child visit

visual acuity

"tea and toast" diet with bleeding gums, ecchymoses, hemorrhages around hair follicles deficiency?

vitamin C

sudden loss of vision with onset of floaters caused by diabetic retinopathy

vitreous hemorrhage

48 yo F presents b/c she is "urinating all the time." initially only stress incontinence, has progressed to urge incontinence. denies hematuria, dysuria. next step in mgmt?

voiding diary - helps to determine the primary etiology of incontinence and optimize treatment

management of post-ictal anion gap metabolic acidosis

watchful waiting and repeat labs in ~2hrs typically 2/2 lactic acidosis and will self-resolve

eval for intussusception?

water-soluble contrast enema

evaluation of suspected esophageal perforation?

water-soluble contrast esophagogram

first line therapy for woman with PCOS trying to conceive

weight loss

mechanism by which acyclovir causes AKI?

when acyclovir is given IV, it is rapidly excreted in urine and precipitated into crystals, causing an intratubular obstruction and direct renal tubular toxicity less commonly causes AKI via AIN or ATN

when do you only need to treat chlamydia or gonorrhea individually?

when confirmed by NAAT

what is the timeframe for acute rejection in transplant patients? classic bx finding? tx?

within the first 6 months lymphocytic infiltrate high dose IV corticosteroids w/ increased maintenance immunosuppression regimen

Recurrent sinopulmonary/GI infx after 6 mo small tonsils

x-linked agammaglobulinemia (defect in B cell lymphocyte maturation)

alopecia pustular skin rash (perioral) hypogonadism impaired wound healing impaired taste immune dysfunction -- mineral deficiency?

zinc

decreased taste

zinc