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ITP (Idiopathic thrombocytopenic purpura) - tx of choice?
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TTP (thrombotic thrombocytopenic purpura) - cause?
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COMLEX Level 2
| Question | Answer |
|---|---|
| ITP (Idiopathic thrombocytopenic purpura) - tx of choice? | Corticosteroids & IV IG |
| TTP (thrombotic thrombocytopenic purpura) - cause? | Inhibition of enzyme ADAMTS13, a protease that cleaves vWF |
| Fall on dorsiflexed hand w/ pain over dorsum of wrist at level of 3rd digit & worsened by hand gripping - dx? | Lunate fx |
| Hypocalcemia & hyperphosphatemia with low normal PTH - dx? | Hypoparathyroidism |
| Pseudohypoparathyroidism - what is it; PTH level? | Kidney unresponsiveness to PTH; high PTH |
| Chvostek's sign - cause; what is it? | Hypocalcemia; facial nerve tapping causes contraction of facial muscles |
| Trousseau's sign - cause; what is it? | Hypocalcemia; blood pressure cuff on the arm causes carpopedal spasms |
| Ovarian tumor causing virilization? | Sertoli-Leydig cell tumor (androgen-secreting) |
| Sudden pruritic rash on palms and soles, no meds - causative organism; name of rash? | Herpes simplex virus; erythema multiforme minor |
| Erythema multiforme major - name of syndrome; usual cause; which bug causes; difference between minor? | Stevens-Johnson syndrome; medications; mycoplasma pneumonia; mucous membrane ulceration w/ target lesions |
| Non-pruritic macules on palms and soles - most likely dx? | Secondary syphilis |
| [OMM] T9 ESL - setup for Muscle Energy? | Flex, sidebend R, rotate R |
| Labyrinthitis - tx? | Corticosteroids |
| Meniere's dz - acute tx; chronic tx? | Benzodiazepine or meclizine; diuretic & low salt |
| Acute sinusitis - days after which bacterial concern > viral; supportive tx options? | 10 days; antihistamine, saline spray, NSAIDS, decongestants |
| Rhabdomyolysis - initial tx; likely metabolic disturbance and screening test; tx to reduce renal failure after initial step? | IV hydration; hyperkalemia check EKG; IV NaHCO3 to alkalinize urine |
| PCOS (polycystic ovary syndrome) - characteristic lab finding; tx? | LH:FSH ratio at least 2:1; OCPs (oral contraceptive pills) +/- spironolactone |
| Afebrile 25 y.o. female w/ h/o salpingitis has sausage-shaped cystic lesions inside fallopian tube - dx? | Hydrosalpinx |
| [OMM] Pancreatitis - chapman point? | R 7th intercostal space |
| [OMM] Splenic dysfunction - chapman point? | L 7th intercostal space |
| [OMM] 2nd intercostal space chapman point - possible structures involved (4 of them)? | Myocardium, thyroid gland, esophagus & bronchi |
| Child has a febrile seizure 2/2 AOM and presents with moderate left arm weakness - dx? | Todd's paralysis |
| Tourette syndrome - tx? | Fluphenazine or haloperidol (typical antipsychotic) |
| Tourette syndrome - comorbidities? | OCD, ADHD, learning disorder, conduct disorder |
| Leg pain on flexion, absent patellar reflex - herniated disc at what level; nerve root injured? | L3-L4; L4 |
| Barium swallow shows: - dx; tx? | Diffuse esophageal spasm; diltiazem |
| 70 y.o. pt w/ SOB and CP w/ following EKG and clean coronary cath - dx? | Pulmonary embolism (S1Q3T3 pattern, sinus tachycardia & RBBB [S wave in lead I, Q and T waves inverted in lead III) |
| A pt is placed on haloperidol and develops jitteriness and inner restlessness - side effect name; tx? | Akathisia; propranolol or benzodiazepine |
| Baby Ashkenazi Jew has cherry-red spot, hypotonia, mental retardation, and hepatosplenomegaly - dx; enzyme affected; characteristic difference between similar disorder? | Niemann-Pick disease; sphingomyelinase deficiency; Tay Sachs does NOT involved the liver (hexosaminidase deficiency) |
| Tall, long-armed pt with medullary thyroid CA, pheochromocytoma - what else should be evaluated; dx; type of genetic transmission? | Tumor of the tongue; MEN IIB (MEN IIB has marfanoid body habitus and mucosal neuromas, while MEN IIA has parathyroid tumor); autosomal dominant (all MEN II AD) |
| TTP (thrombotic thrombocytopenic purpura) - tx? | Fresh Frozen Plasma (urgent exchange) |
| 45 y.o. female w/ abd pain and distension, no passage of stool or flatus, no peritoneal signs, tympanitic abd, abd x-ray shown: - dx; tx? | Sigmoid volvulus; endoscopic decompression followed by elective sigmoid resection (50% recurrence) |
| 27 y.o. female w/ suicidal ideation and a plan was sexually abused 16 years ago has intrusive memories and nightmares plus hypervigilance - dx; tx? | Chronic PTSD (post-traumatic stress disorder); Inpatient admit due to suicidal behavior (PTSD can be tx w/ SSRI and desensitization-exposure psychotherapy) |
| Infant w/ abdominal distension, choking upon feeding, and inability to pass NG tube - dx; tx? | Tracheoesophageal fistula (NOT choanal atresia b/c abd distension; surgical repair) |
| Genetic causes of conjugated hyperbilirubinemia? | Dubin-Johnson syndrome & Rotor syndrome (DJS black liver, can't visualize gallbladder on oral cholecystography, urine coproporphyrin I 80%...reverse is true for Rotor and 80% coproporphyrin III) |
| 2nd degree burn gives off a blue/green discharge with a fruity odor 2 weeks later - test to identify organism? | Culture and sensitivity (pseudomonas aeruginosa) |
| Gastric adenocarcinoma - which 2 organisms can cause it; which blood type? | Helicobacter pylori and Epstein-Barr virus; blood type A |
| Drug X is being tested on several pts who have HTN - which clinical phase is it in? | Phase II (Phase II = few subjects for effectiveness, Phase III = large scale trials, Phase IV = general surveillance after drug is released) |
| Most common location for compartment syndrome of the leg? | Anterior compartment (contains anterior tibial artery and deep fibular nerve) |
| Endometriosis and no desire to conceive - tx? | OCPs & NSAIDS (laparoscopy may be used if desires to conceive and cannot) |
| OCD - tx? | TCA or SSRI + CBT |
| 29 y.o. female w/ severe RUQ pain, jaundice and hepatomegaly. US shows obliteration of hepatic vein, large collateral vessels, and ascites - dx, tx? | Budd-Chiari syndrome (thrombosis of hepatic vein or IVC 2/2 hypercoagulable state); tissue plasminogen activator |
| 28 y.o. male w/ unilateral headaches and "watery" eyes especially in the winter - dx; acute tx; prophylactic tx? | Cluster headache; 100% oxygen; verapamil, prednisone, topiramte, or valproic acid |
| 65 y.o. female with a mass in her neck that is painful while drinking alcohol, CXR shows mediastinal lymphadenopathy, CT shows spleen involvement, bx of lymph node shows the following image: - dx; stage; tx? | Hodgkin L, St 3 (St 1 = 1 LN, St 2 = 2 or more nodes on same side of diaphragm, St 3 = both sides of diaphragm incl one organ or area near the lymph nodes or spleen, St 4 = extralymphatic tissue [liver, bone, lungs], chemo (St 1/2 = rad, St 3/4 = chemo) |
| Obsessive-compulsive disorder vs. obsessive-compulsive personality disorder - difference? | OCD pt recognizes own rituals as irrational. OCPD pt believes what they are doing is correct |
| Congenital Adrenal Hyperplasia - serum test for dx; high or low? | 17-hydroxyprogesterone; high (21-hydroxylase is responsible for converting 17-hydroxyprogesterone to 11-deoxycortisol) |
| 45 y.o. female w/ intermittent RLQ pain, muscle weakness, and hallucinations. UA reveals high aminolevulinic acid - dx? | Acute intermittent porphyria (unlike most other porphyria does not have a rash) |
| 40 y.o. male w/ epigastric pain, eating helps the pain, but is worse 3-4 hrs after, positive urea breath test - next step? | Omeprazole, amoxicillin, clarithromycin (upper GI w/ bx if age > 50 or troubling sxs) |
| [OMM] Prostate Chapman's point? | Lateral & posterior margin of iliotibial band (anterior iliotibial band is colon) |
| Wound dehiscence - what are some causes? | Poor suture placement, wound infxn, advanced age, obesity, chronic steroid use, uncontrolled diabetes, malnutrition |
| 65 y.o. female h/o rheumatic heart disease, 3 day h/o palpitations, ECG shown: - dx? | Atrial flutter |
| 26 y.o. pt w/ difficulty hearing in R ear, immobile tympanic membrane, image shown: - tx? | Oral Amoxicillin (AOM) |
| 40 y.o. woman undergoes stereotactic bx of breast mass, which shows lobular carcinoma in situ - next step? | Observation (LCIS is not CA but a marker for breast CA development in both breasts at a rate of 1% per year...excision for ductal carcinoma in situ [DCIS] is appropriate followed by post-op radiation therapy) |
| 6 y.o. female with Tanner stage III breasts, high LH and FSH levels that increase after GnRH administration, MRI of brain and abd US are normal, skeletal age is advanced - dx; tx? | True precocious puberty (GnRH increasing LH/FSH = true, if LH/FSH are low and GnRH doesn't affect = precocious pseudopuberty); GnRH analog (leuprolide, histrelin, nafarelin, buserlin...tx helps reach desired height) |
| 65 y.o. female has outbreaks of painless blisters on the dorsum of her hand, denies abd pain, has hypertrichosis and hyperpigmentation. Serum and urine levels of porphyrin elevated - dx; risk factors; tx? | Porphyria cutanea tarda (lack of abd pain sets this aside from other porphyria); high iron, hereditary, hep c, hiv, alcohol, estrogen use; chloroquine, phlebotomy for iron overload |
| Ascending paralysis with minimal sensory change in a child who received the flu vaccine a week ago - dx; tx? | Guillain-Barre syndrome; IVIG and plasmapheresis, if diaphragm involved use intubation |
| Management of symptomatic paraesophageal hiatal hernia vs. sliding hiatal hernia? | Paraesophageal requires surgery b/c it is fixed, sliding just treat GERD sxs |
| Fetal HR monitor shown: - etiology? | Umbilical cord compression (variable decelerations) |
| A new drug for HTN has an absolute risk reduction of 0.8% in deaths - how many people must be treated to save one extra life? | 125 (100/0.8) |
| What quality is of paramount importance in clinical trials? | Reproducibility |
| 35 y.o female w/ duodenal ulcer - most common with which blood type; diagnostic test; most common risk factor? | Type O (gastric ulcer most common with A); urea breath test (EGD if > 50 or alarm sxs); H. pylori infxn (NSAID are risk factor for gastric ulcer) |
| Symptomatic hypertrophic cardiomyopathy - tx? | Propranolol or verapamil |
| 20 month old found in kitchen with unlabeled canister is drooling, has white eschars of tongue and soft palate, frequently coughs - what did the baby ingest; next step? | Corrosive akali like drain cleaner (white eschars are burns); upper endoscopy (evaluate extent of injury, i.e. esophageal perf that would require abx and surgery) |
| [OMM] What is the order in which thoracic cage dysfunctions are treated? | Thoracic spine à structural rib dysfunctionà respiratory rib dysfunction |
| [OMM] Rib 3 anterior tenderpoint - tx position? | Flexed, sidebent and rotated towards (counterstrain of ribs: anterior point = "depressed," posterior point = "elevated") |
| In order to make the dx of schizophrenia how long must the sxs be present? | 6 months |
| L testicular torsion - tx? | Surgical detorsion of L testicle AND b/l orchiopexy (fixation) |
| Endometrial CA - How thick of endometrial stripe in postmenopausal woman is abnormal; Risk factor for endo CA, True/False: Smoking, Diabetes Mellitus, Obesity, OCP, PCOS? | > 5mm; F/T/T/F/T |
| Celiac disease - associated skin lesion; associated antibody tests? | Dermatitis herpetiformis; anti-gliadin, anti-transglutaminase & anti-endomysium |
| Thyroid nodule > 1cm on physical - next step; step after that? | TSH level (thyroid US for nodules no easily observed on physical); fine needle aspiration (FNA) |
| Pt present w/ stab wound to the chest, diminished breath sounds and dullness to percussion, otherwise stable - dx; next step? | Hemothorax; CXR (to confirm dx in stable pt, tube thoracostomy for drainage) |
| Pt w/ painless bleeding, BP 100/70, P 95, R 18, colonoscopy shows diverticulosis - tx? | IV fluids |
| Appendicitis in pregnancy - which unusual area can it appear; first line dx test; second line dx test? | RUQ; US; MRI (preferred over CT in pregnancy) |
| Melancholic depression vs. atypical depression? | Melancholic has weight loss & lack of mood reactivity & atypical has weight gain & mood reactivity (improved mood when something good happens) |
| Meningitis - what age is the cutoff between mostly Group B streptococcus prevalence to Streptococcus pneumoniae? | 3 months |
| Meningitis - what age is the cutoff between mostly Streptococcus pneumonia prevalence to Neisseria meningitidis? | 9 years |
| Meningitis - what age is the cutoff between mostly Neisseria meningitidis prevalence to Streptococcus pneumonia? | 18 years |
| Paracentesis yields serum ascites albumin gradient of 1.6 g/d - what physiologic process is occurring? | Portal HTN (all ascites w/ SAAG > 1.1 g/dL...pre-hepatic [portal vein thrombosis], intra-hepatic [cirrhosis, hepatic fibrosis, hepatocellular CA] or post-hepatic [CHF, constrictive pericarditis, Budd-Chiari syndrome]) |
| Pregnant mom has HIV - at what viral load is C-section indicated? | > 1000 copies/mL |
| 60 y.o pt w/ chronic 5 week cough, R-sided hearing loss and tinnitus, no drainage, no pain when auricle is pulled - dx? | Cerumen occlusion |
| Newborn w/ polydactyly, meningomyelocele, and rocker-bottom feet - dx? | Trisomy 13 (rocker-bottom feet also in Trisomy 18) |
| Pt assaulted her husband and kids, is very agitated, has rotatory nystagmus, and elevated CK - intoxicated by what? | Phencyclidine hydrochloride (PCP) |
| Chorea of Huntington's disease - tx? | Tetrabenazine (promotes degradation of dopamine) |
| [OMM] Sacral dysfunction - (+) seated flexion on right, where is oblique axis; rules for L5 sidebend and rotation? | Left axis; L5 sidebends towards axis and rotates away from sacral rotation |
| Paraneoplastic syndromes associated with lung CA - squamous cell CA; small cell CA? | PTHrP; ACTH, SIADH (also creates Lamber-Eaton syndrome) |
| EGD shows circumferential membranous ring in distal esophagus, normal iron - dx; tx; dx if iron deficiency is present? | Schatzki's ring; esophageal dilation; Plummer-Vinson syndrome |
| 49 y.o. pt from India with weight loss, night sweats and blood-tinged sputum, orthostatic hypotension, mild hypoglycemia, and hyperkalemia, CXR shows caseating granuloma in upper R lung field - dx; how do you confirm dx; tx? | Adrenal insufficiency 2/2 Tuberculosis (TB is most common cause of adrenal insufficiency worldwide); low cortisol level w/ no response to cosyntropin (ACTH analog); corticosteroid |
| Personality trait clusters A, B & C - what is mnemonic? | Weird, wild, worried (weird = paranoid, schizoid, schizotypal...wild = borderline, histrionic, narcissistic, antisocial...worried = OCD, avoidant, dependent) |
| Polymyositis vs. dermatomyositis - 3 key differences? | Dermatomyositis has heliotrope rash, Gottron's sign (red papules on dorsum of PIP and MCP) & Shawl sign (red shoulder/back/neck) |
| Physician bills an insurance company, 80% paid by company, 20% is co-pay by pt. Physician waives co-pay - OK to do? | NO (liable for fraud...if pt refuses to pay co-pay, it may be written off and not pursued) |
| Which dietary supplement can treat mild-moderate depression and interacts with warfarin? | St. John's wort |
| Spondylolisthesis - what are grades 1-4 for anterior displacement? | Grade 1 (0-25%), grade 2 (26-50%), grade 3 (51-75%), grade 4 (76-100%) |
| Primary biliary cirrhosis - which lab study is associated with it other than antibodies and hepatic/gallbladder markers? | Hypercholesterolemia |
| Allergic rhinitis - most effective tx? | Intranasal glucocorticoid |
| Woman 40 y.o. - most common cause of death at her age? | Cancer (for men same age it's trauma...women 35-74 is cancer, 65+ is cardiovascular) |
| Neutropenia and hypochromic anemia - deficiency of which mineral can explain? | Copper |
| Amyotrophic lateral sclerosis (ALS) - unique feature; tx that slows down progression; most common cause of death? | Both upper motor neuron and lower motor neuron signs; riluzole; aspiration pneumonia |
| 40 y.o. traveled to Wisconsin, fever, chest pain, severe arthralgia and non-pruritic verrucous skin lesions on the trunk - causative organism; tx? | Blastomyces dermatitidis (broad-based budding, triad of lung, skin and bone involvement); itraconazole |
| Uterine tenderness and fever s/p C-section 2 days ago - dx? | Endometritis |
| Pt started haloperidol 3 days ago now has oculogyric crisis - what is the sx; dx? | Spasm of the eyeballs into a fixed position for minutes; acute dystonia |
| Juvenile rheumatoid arthritis - pauciarticular vs. polyarticular; age group affected; can it include uveitis? | Polyarticular involves 5 or more joints; females under 5 y.o.; yes (Reiter's syndrome affects people > 20 y.o.) |
| Epididymitis - tx > 35 y.o.; tx < 35 y.o. | Ciprofloxacin; azithromycin (or doxycycline) & ceftriaxone |
| Pt w/ new onset asthma awakens 1-2/week b/c SOB - degree of asthma; tx | Moderate persistent asthma; inhaled low-dose corticosteroid plus long and short acting β2-agonists |
| Psoriasis - what is Auspitz sign? | Pinpoint bleeding upon peeling of the scale |
| Superficial thrombophlebitis - tx? | Repeat physical in 1 week to check for progression to DVT |
| Fertility work-up - how long before intervention; first step after that? | 12 months; semen analysis |
| Gastric ulcer types - which type is most common; which type mostly with NSAIDs? | Type I (ulcer along lesser curve of stomach); type V (gastric body) |
| Acne rosacea - what is the term used to identify a large, red nose; tx? | Rhinophyma (due to soft tissue and sebaceous hyperplasia of the nose); oral tetracycline and metronidazole gel |
| Folate deficiency vs. vit. B12 deficiency - which test to differentiate; which level in common? | Methylmalonic acid (MMA high in B12 def., normal in folate def.); both have increased homocysteine |
| Pneumatura - likely cause? | Colovesical fistula |
| Acromegaly - dx test; most common cause; imaging modality; tx; describe growth hormone suppression test; which other level should you check in relation to this disease? | IGF level (GH level fluctuates); ant pit adenoma; MRI; transsphenoidal resection; measure fasting GH first, then give 75g glucose challenge GH level one hour later should be < 2 µg/L (glucose suppresses GH therefore acromegaly excluded); prolactin level |
| Diabetes insipidus, urine osmolarity is 250 mOsm/kg water - initial workup; test to differentiate central vs. nephrogenic? | Water deprivation test (urine osmolarity will stay around 250 mOsm/kg water, normally will increase with H2O deprivation); desmopression challenge (nephrogenic DI will still have unchanged urine osmolar, while central will respond by increasing urine osm) |
| Acute mania - tx aside from lithium? | Antipsychotic (olanzapine), carbamazepine, valproic acid |
| Wernicke Encephalopathy - triad of sxs; tx? | Ataxia, confusion, eye disorders; thiamine |
| Pt w/ chronic dermatitis of the hands comes to your derm office for a third opinion, has already tried moisturizers, topical antifungals, and topical steroids, has a h/o social anxiety tx'ed moderately w/ alprazolam - tx? | Paroxetine (SSRI for OCD, likely washing his hands constantly)) |
| Familial adenomatous polyposis - when should you start screening a pt; what percent get colorectal CA? | Annual colonoscopy or flexible sigmoidoscopy starting at puberty; 100% |
| Polyarteritis nodosa - which infxn is it closely associated with; which organ does it spare compared to other vasculitides; characteristic neurological finding? | Hepatitis B (can look like livedo reticularis); lungs; mononeuritis multiplex (multiple peripheral nerves affected) |
| Multifocal atrial tachycardia - describe the ECG morphology; tx; likely comorbidity? | 3 or more different P-waves in the same lead, HR > 100 and irregularly irregular; verapamil; COPD |
| Lung CA - most common type in the world; types that are peripherally located; types that are centrally located | Adenocarcinoma (not associated w/ smoking); adenocarcinoma & large cell carcinoma; squamous cell carcinoma & small cell |
| Prolactinoma failed tx with bromocriptine - next tx; tx after that if it fails? | Cabergoline (another dopamine receptor agonist); transsphenoidal pituitary surgery |
| Familial hypercholesterolemia - which type of hyperlipoproteinemia? | Hyperlipoproteinemia type IIa |
| Syncope - initial test for ALL pts; likely cause for someone shaving or wearing tight-collared shirts? | ECG; carotid sinus hypersensitivity (vagal overactivity) |
| Anal fissure - most likely location; initial tx? | Posterior midline; warm sitz baths |
| [OMM] Sacral axis - what are they and what are they for? | Superior transverse = craniosacral motion, middle transverse = postural motion, inferior transverse = innominate rotation, oblique = ambulatory (dynamic) motion |
| Adson's test - what is it for; how do you do it? | Dx thoracic outlet syndrome |
| Apley's scratch test - what is if for; how do you do it? | Glenohumeral joint ROM (Adhesive capsulitis possibly); reach hand behind the back and touch opposite inferior angle of scapula & reach over head behind it to touch opposite shoulder |
| Diabetes Insipidus - tx central first line and second line; tx nephrogenic; abx that can induce nephrogenic DI? | Desmopressin (first line), chlorpropramide (second line); reduced Na+ intake & thiazide; demeclocycline |
| Diabetes Mellitus type II, already taking metformin - at what HbA1C should sulfonylurea be started; insulin? | HbA1C 7-8.5%; > 8.5% |
| For 9 months pt has been hearing voices telling him to quit his job. He believes they are out to get him and will probably kill him if he continues working there - dx? | Schizohrenia (delusional disorder does not have hallucinations) |
| [OMM] Q-angle - normal range; what dysfunction if increased; measures angle between which two functional vertical axes? | 10-12; genu valgus; femur & tibia |
| Cleft lip vs. cleft palate - age at which surgery should be done; feeding problems? | Cleft lip surgery |
| Pregnant lady - what is normal range of fetal heart rate? | 110-160 |
| Chronic alcohol abuser w/ fatigue, abdominal pain, and conjunctival pallor. Elevated iron, ferritin and normal TIBC. Bone marrow bx shown: - dx; first line tx; second line tx? | Sideroblastic anemia (image shows ringed sideroblasts w/ Prussian blue staining [deposits of iron in cytoplasm]); pyridoxine (vit. B6); transfusion |
| Spontaneous bacterial peritonitis - paracentesis PMN count; most likely cause; second most likely cause; how do you check response to tx? | > 250 PMN/mm3; E. coli; Klebsiella pneumonia; repeat paracentesis |
| Sonambulism - tx; what stage of sleep does this occur? | TCA or benzodiazepine; stages 3-4 (tx goal is to reduce time spent in these stages) |
| Pt w/ community acquired pneumonia, getting better w/ ceftriaxone and azithromycin, day 2 develops low TSH, low T3, and normal T4 - dx; tx? | Euthyroid sick syndrome; No tx necessary (goes away w/ underlying illness) |
| Miliaria - aka; sx difference vs. folliculitis? | Heat rash; folliculitis is itchy, miliaria is stinging (involves covered areas in a humid environment) |
| Klumpke's Paralysis - injury; presentation? | C8-T1 nerves; Horner's syndrome, paralysis of intrinsic muscles of the hand & ulnar nerve distribution numbness |
| Multiple Myeloma - how do you detect Bence Jones proteins; tumor marker; peripheral blood smear; bone marrow bx? | Urine protein electrophoresis; β2 microglobulin; rouleaux formation (stacking of RBCs); > 10% plasma cells |
| Dysphagia that progresses from solids to liquids - dx; next step | Esophageal CA; upper endoscopy (achalasia has solid and liquid dysphagia from the beginning - requires barium swallow) |
| Polycythemia vera - erythropoieitin level; tx? | Low; hydroxyurea and chronic phlebotomy |
| Surgical wound - classification? | Clean (uninfected), clean-contaminated (controlled entry without unusual contamination), contaminated (accidental/surgical wound), dirty (pre-existing infxn) |
| Worst headache of my life - dx; initial test; initial test didn't see anything, pt still has same sxs next morning, next step? | Subarachnoid hemorrhage; CT scan w/o contrast; lumbar puncture (CT scan sensitivity drops after 12 hrs) |
| [OMM] Cranial rhythmic imulse - range; technique to dx craniosacral dysfunction; technique to treat CRI dysfunction? | 10-14 cycles/min (CRI can ONLY be in this range...if depressed it is low and MUST be 10); vault hold; bulb decompression (aka CV4) |
| Tremor - hertz range for essential; hertz range for parkinson's? | 6-10 Hz; 4-6 Hz |
| Adult polycystic kidney disease - associated complications? | Hepatic cyst, intracerebral aneurysm, thoracic aortic aneurysm |
| Major Depressive Disorder - dx criteria | Depressed mood or anhedonia (for 2 weeks) + 4 of SIGE CAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor agitation, suicidality) |
| Pseudotumor cerebri - demographic; what is it; dx test? | Young obese female (assoc. w/ vit A, tetracyclines and oral contraceptives); increased intracranial pressure in the absence of CSF findings; lumbar puncture |
| Pt has headache unexplained by multiple diagnostic tests, lumbar puncture reveals xanthochromia - dx? | Subarachnoid hermorrhage |
| Boerhaave's Syndrome - initial diagnostic test? | CXR (pneumomediastinum) |
| Pt w/ alopecia, dermatitis, depression, central and peripheral neuropathy and nausea/vomiting - deficiency of what mineral/vitamin? | Biotin |
| Bacterial meningitis in a 9 y.o. child - most common complication? | Sensorineural hearing loss |
| Alcoholic pt with liver failure has a creatinine of 2.7 mg/dL, 3 months ago it was 1.1 mg/dL - dx; tx? | Hepatorenal syndrome (Renal artery vasoconstriction 2/2 liver disease); liver transplant |
| 1 month old flaccid baby w/ intact extraocular movements - dx? | Werdnig-Hoffman disease (genetic disorder similar to botulinism except botulinism does not retain extraocular movements) |
| Pt w/ h/o peripheral vascular disease, peptic ulcer disease and GERD loses 20 lbs. unintentionally in 6 months, has excruciating pain after eating, esp. fatty foods & has an abdominal bruit - dx; test to confirm dx? | Chronic intestinal ischemia (usu. in pt w/ atherosclerosis, will have abdominal bruit, loses weight by not eating to avoid pain); angiogram |
| Pt w/ neck pain, diffusely enlarged and tender thyroid gland, had sinusitis 3 weeks ago, low TSH, high T4 and high ESR - dx; tx? | Subacute granulomatous thyroiditis (aka de Quervian's thyroiditis...NOT subacute lymphocytic thyroiditis which is painless); NSAIDs |
| Rheumatoid arthritis - characteristic pleural fluid finding? | Extremely low pleural fluid glucose level |
| Bloody pleural effusion - most common causes? | Malignancy & pulmonary embolism |
| Statistic - what is lead-time bias; what is Pygmalion effect? | Early detection leading to a false sense of increased survival; researcher's belief in tx affects the results |
| Mitral stenosis vs. Tricuspid stenosis - what is differentiating characteristic? | Tricuspid stenosis intensifies w/ inspiration (ms doesn't) |
| Pt w/ erectile dysunction after tx w/ fluoxetine - tx? | Taper off fluoxetine and start bupropion |
| Narcolepsy (excessive daytime sleepiness) - tx? | Modafinil (increases histamine in hypothalamus, diff. than amphetamine, which is 2nd line) |
| Multiple Myeloma - anion gap change; why? | Decreased anion gap; 2/2 positive-charged immunoglobulin or hypoalbuminemia |
| Pt is in navy and worked at shipyards for 18 yrs, has SOB - dx; what caused it? | Restrictive airway disease; asbestosis on ships |
| STD screening ages - chlamydia and gonorrhea; HIV | Sexually active females 24 and younger; 15-65 years of age |
| Pt h/o multiple episodes of acute pancreatitis - difference between chronic pancreatitis and pseudocyst; what will you find if it is hemorrhagic pancreatitis? | Chronic pancreatitis has pancreatic insufficiency (triad of diabetes, steatorrhea and pancreatic calcifications); Cullen's and Grey Turner's sign |
| [OMM] Appendix Chapman's point - anterior; posterior? | Tip of 12th rib on right; transverse process of T11 |
| Lyme disease - etiologic organism; tx for ages 8 and over; tx < 8; insect vector? | Borrelia burgdorferi; doxycycline; amoxicillin; Ixodes tick |
| 50 y.o. pt w/ leukocytosis of 54,000/mm3 - test to differentiate between CML and leukemoid reaction? | Leukocyte alkaline phosphatase (elevated in leukemoid reaction, decreased in CML) |
| Osteomyelitis - initial test? | Always x-ray |
| Cocaine and amphetamine withdrawal - sxs? | Dysphoria, excessive sleep, and hunger |
| Opioid withdrawal - sxs | Rhinorrhea, lacrimation, yawning, diarrhea, diated pupils |
| [OMM] Pheochromocytoma - level of somatic dysfunction | T10-11 (adrenals/kidneys are the same) |
| Primary hyperaldosteronism - first two lab tests à next step à next step à if last step was negative, next step? | Ald conc and plasma renin activity (PRA > 25 = hyperald) sodium (or fludrocortisone) loading test (if plasma ald is not suppressed [i.e. > 10 ng/dL] = primary hyperaldosteronism) abdominal CT (determine adenoma vs. hyperplasia) adrenal vein sampling |
| COPD, cut-offs for long-term O2 therapy - SaO2; PaO2; hematocrit? | < 88%; < 55 mmHg (55-59 if right-sided heart failure or erythrocytosis present); ≥ 55% |
| New-onset hypothyroidism tx w/ levothyroxine - when should TSH be re-evaluated? | 4-6 weeks |
| HUS - triad of sxs; what changes for TTP? | Acute renal failure, thrombocytopenia, microangiopathic anemia; add fever and neurological sxs to previous 3 sxs |
| Fibromyalgia - tx? | Duloxetine or amitriptyline (SNRI or TCA) |
| Pt w/ ESRD misses a dialysis appointment and develops chest pain and a friction rub - dx; what caused it; other sxs associated w/ the cause? | Pericarditis; uremia; dysgeusia (metallic taste), pruritis, platelet dysfunction, weight loss |
| Fractures - where are they located: Colle's, Boxer's, Monteggia's, Galeazzi's, Nightstick? | Distal radius; 5th metacarpal; proximal ulna; proximal radius; ulnar shaft |
| Infant following C-section immediately develops nasal flaring, tachypnea and intercostal retractions, resolves in 48 hrs - dx; tx? | Transient tachypnea of the newborn; IV fluids and Oxygen (meconium aspiration will usu. have green urine and nails) |
| Pt w/ 500 adenomatous polyps on colonoscopy, multiple lipomas throughout body and osteoma on the skull - dx? | Gardner's syndrome (Turcot's syndrome is FAP + CNS tumors) |
| Panic disorder - tx? | SSRI |
| Buspirone - what is it used for? | Generalized anxiety disorder |
| Mirtazapine - what is it used for? | Pts w/ depression and eating disorder (i.e. anorexia, b/c it causes weight gain) |
| 24 y.o. female w/ 5 day old child is breast feeding and develops mastitis - causative organism; tx? | S. aureaus; continue breast feeding, abx, analgesics, warm/cold compress |
| 13 y.o. pt w/ testicular pain on the superior pole of the right testicle, there is a blue dot on the superior pole of the R testicle - dx; tx? | Torsion of the appendix testis (remanant of the paramesonephric duct); supportive (pain control, bed rest, scrotal support - typically relieved in one week) |
| 42 y.o. pregnant woman 15-20 weeks gestation - what screening test should be provided? | Quadruple screen (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, inhibin A...triple test at a minimum, if age > 35 then quad screen) |
| Candida vulvovaginitis - expected vaginal pH? | 3.8 - 4.5 (normal vaginal pH, candida doesn't affect...bacterial vaginosis and trichomoniasis elevate the pH) |
| Tetralogy of Fallot - CXR finding? | Boot-shaped heart |
| Hyperthyroidism during pregnancy - tx during first trimester; subsequent trimesters? | Propylthiouracil; methimazole |
| Sudden d/c of long-term glucocorticoid tx, pt has BP 90/60, hyponatremia - which of the following will be present: hyperkalemia, hyperpigmentation, hypoglycemia, increased ACTH level? | Hypoglyc only (hyperK [mineralocorticoid deficiency] and hyperpigmentation [increased POMC] occur only in primary adrenal insufficiency, decr ACTH is expected due to negative feedback from exog corticosteroids...hypoNA in this case due to increased ADH) |
| [OMM] Primary respiratory mechanism - 5 components? | Fluctuation of CSF, Inherent mobility of brain and spinal cord, Articular mobility of cranial bones, Mobility of intracranial and intraspinal membranes & involuntary mobility of sacrum between ilia |
| Power of statistical tests - define it; what is it's relation to type I error? | 1 minus the risk of a type II error (aka the ability of a test to reject the null hypothesis); direct relationship with type I error (to increase power of a study type I error must increase - there is a tradeoff between type I and II error) |
| Secondary hypothyroidism - T4 level; TSH level | Low; low (pituitary disease is the likely culprit...high TSH and low T4 is primary hypothyroidism) |
| Dementia w/ hallucinations, tremors and rigidity - dx? | Lewy body dementia |
| [OMM] Inversion sprain - talus dysfunction? | Anterior talus (when the ankle plantar flexes, the talus glides anterior) |
| [OMM] Anterior Chpaman's point - eye? | Lateral humerus |
| Intestinal perforation is expected - initial diagnostic test? | Upright CXR (abdominal x-ray usu. doesn't show domes of diaphragm) |
| Pregnant lady w/ preeclampsia develops seizure and is tx w/ magnesium sulfate, she now has hyporeflexia and difficulty breathing - dx; tx? | Hypermagnesemia toxicity; IV calcium gluconate |
| Lactose intolerance - dx test? | Hydrogen breath test (elevated, enteric bacteria end up digesting the lactose and create hydrogen) |
| Cohort study vs. case-control study - which is prospective? | Cohort study (forward-looking observational study...case-control is retrospective and has recall bias) |
| c-ANCA is an antibody in Wegener's granulomatosis - what does it target? | Proteinase-3 (p-ANCA targets myeloperoxidase) |
| Cyanotic babies, CXR findings - truncus arteriosus; total anomalous pulmonary venous return | "Egg-on-string"; "snowman" |
| ABG pH 7.22, pCO2 15 mmHg, HCO3 25 mEq/L, K+ 5.4 mEq/L, chloride 118 mEq/L, Na+ 125 mEq/L, urine pH 4.9 - RTA type; how to confirm dx? | RTA type IV; Salt restriction (Serum Na decreases while urine Na stays the same) |
| ABG pH 7.22 pCO2 15, HCO3 21, K+ 2.7, Cl- 118, Na+ 135, urine pH 6.2 - RTA type; how to confirm dx? | RTA type I; Ammonium chloride (an acid...urine pH doesn't drop below 5.5) |
| ABG pH 7.22 pCO2 15, HCO3 16, K+ 2.7, Cl- 118, Na+ 135, urine pH 5.0 - RTA type; how to confirm dx? | RTA type II; Bicarb (urine pH continually rises) |
| Pt w/ celiac disease develops dermatitis herpetiformis - tx for dermatitis? | Dapsone |
| Newborn w/ R arm adducted, internally rotated, forearm pronated and wrist flexed - dx; nerve roots involved? | R sided Erb-Duchenne's Palsy; C5-C6 (described as "waiter's tip") |
| Neuroleptic Malignant Syndrome - tx order? | Stop medication à IV fluids à dantrolene / bromocriptine / amantadine |
| Female, DEXA screening - what age should it begin? | 65 y.o. |
| Turner's syndrome - tx | Human growth hormone (until epiphyseal fusion) & estrogen/progestin replacement |
| Pt undergoes total thyroidectomy for papillary carcinoma, now how perioral numbeness and tingling of fingers - dx; tx? | Hypoparathyroidism (can be transient from ischemia during surgery, or permanent b/c removal); calcium carbonate |
| Restless leg syndrome - first line tx; common mineral deficiency that can cause it? | Dopamine agonist (pramipexole, bromocriptine, levodopa/carbidopa); iron deficiency |
| 35 y.o. pt h/o severe "lung infection" as child that required hospitalization, has progressive cough w/ green sputum, CXR shows hyperinflation and ill-defined pulmonary nodules - dx; next step? | Bronchiectasis; high-resolution CT (will see dilated airways and ballooned cysts) |
| Delirium vs. Psychosis - how to differentiate? | Both have hallucinations, but in delirium alertness is impaired, while psychosis has intact alertness |
| Retinal artery occlusion vs. ophthalmic artery occlusion - difference on physical exam? | Retinal art occlusion has a pale retina w/ cherry-red macula (choroid artery still supplies macula), no cherry-red spot w/ oph art occlusion |
| Diabetic gastroparesis - first line tx? | Metoclopramide |
| 29 y.o. female complains of 2 cm mass in her R breast that is round and mobile - next step? | Breast ultrasound (pt is < 30, if > 30 then mammogram...if cystic then aspirate, if solid like fibroadenoma observe, if solid and suspicious bx) |
| Bacterial meningitis - when should prophylaxis tx be instituted; when do you add ampicillin to the tx regimen? | If Neisseria is the causative agent (rifampin or ciprofloxacin); immunocompromised hosts (including elderly) to cover Listeria |
| [OMM] Lumbar dysfunction can be treated w/rotated side up or down - what is the trick to remember which way to pull the arm? | Type 1: up/up, down/down & type 2: up/down, down/up |
| Benign elevated urine urobilinogen - what physiologic process is occurring? | Conjugated hyperbilirubinemia (Dubin-Johnson or Rotor syndrome, usu. asx) |
| 5 hours after birth a neonate vomits blood - next step? | Apt test (determines if blood is of fetal or maternal origin, it checks hemoglobin) |
| Newborn with insufficient surfactant - name of disease? | Hyaline membrane disease |
| 35 y.o. female on OCPs has a 2cm hepatic tumor, US shows a central scar - dx; tx? | Focal nodular hyperplasia; no tx (central scar differentiates it from hepatic adenoma and cavernous hemangioma, d/c of OCPs advised for both conditions) |
| Heat stroke vs. heat exhaustion - difference? | Heat stroke has high body temperature, cutaneous vasodilation, and altered mental status, heat exhaustion does not |
| A physician's duty to exercise reasonable care - starts when? | When the doctor dispenses medical tx (not when an appointment is scheduled) |
| Torsade de pointes (polymorphic ventricular tachycardia that may degenerate to ventricular fibrillation) - tx? | Magnesium sulfate (hypomagnesemia and hypokalemia can cause it) |
| Amyloidosis - screening test? | Abdominal fat pad bx |
| 18 y.o. female had uncomplicated birth 2 weeks ago, has trouble lactating, decreased interval between feeds to no avail - tx? | Metoclopramide (dopamine antagonist) |
| Neonatal conjunctivitis - time period for chlamydia; gonorrhea; viral; chemical? | 5-14 days; 2-7 days; 6-14 days (plus b/l lid edema w/o purulent discharge); first 24 hours |
| Incontinence tx - stress; urge? | Urethropexy or sling; oxybutynin (anticholingergic to relax muscle) |
| Neurofibromatosis type I vs. type II - differentiating characteristics? | Type I has axillary freckling and iris hamartomas (Lisch's nodules) & type II has b/l acoustic neuromas and cataracts |
| Hamstring tendon used for reconstruction of torn anterior cruciate ligament - example of what kind of graft? | Autograft (homograft is a graft from same species but different genetic makeup) |
| Third degree burn - characteristics; tx? | Painless, leathery skin that can be black, white, or cherry red in color; immediate excision and skin grafting |
| Pt w/ glucose-6-phosphate deficiency develops abdominal tenderness 5 hours ago and hematuria, UA shows 2+ blood - next step? | Urine microscopy (no RBCs under microscopy means hemolysis is the cause, if RBCs present most likely nephrolithiasis) |
| [OMM] Chapman's point - middle ear? | Clavicle |
| Uterine fibroids - medical tx; surgical tx; which type of fibroid can lead to infertility? | GnRH agonist (NOT OCP b/c they have estrogen/progestin receptors so they will grow); myomectomy or hysterectomy (depending on childbearing plans); submucosal fibroid |
| Hypochondriasis - tx? | CBT + regular visits to primary care physician |
| Scoliosis, Cobb angle - respiratory compromise, cardiovascular compromise? | > 50 degrees; > 75 degrees (surgery recommended for cobb angle > 50) |
| Muscle energy - what types of pts is it contraindicated? | Critically ill (i.e. ICU b/c it requires active participation), pts who have recently had a major cardiovascular event & surgery (wound dehiscence) |
| Temporal arteritis - concomitant finding; tx? | Polymyalgia rheumatica (proximal muscle pain); 2 year-course of glucocorticoids and low dose aspirin |
| Statistics, a new drug's effectiveness is compared with furosemide. A study shows new drug is 1.2 times effective as furosemide with a 95% confidence interval of 0.85 to 1.55 - what does this mean? | The new drug may be more effective than furosemide but the difference is not statistically significant (more than 5% chance it could be random) |
| Pregnancy - expected length of second stage of labor for nullipara; multipara; effects of epidural? | 2 hours; 1 hours; epidural adds 1 hour to each |
| Circumferential burn - tx? | Escharotomy |
| Emergency contraception - drug; dosing/timing? | Levonorgestrel (progestin-only); 2 pills, 12 hours apart within 72 hours |
| Newborn w/ hypospadias is scheduled for circumcision - next step? | Cancel circumcision as foreskin may be needed for urethral and penile reconstruction |
| Factitious hypoglycemia (i.e. exogenous insulin) - lab findings? | Decreased C-peptide, decreased proinsulin, increased insulin, anti-insulin antibodies |
| Chronic myelogenous leukemia - tx? | Imatinib (tyrosine kinase inhibitor) |
| A study has a few outliers that are attributed to athletes - which stat will be least affected by the outliers: mode, mean, standard deviation, standard error, median? | Mode (most common number) |
| 2 y.o. w/ uncomplicated umbilical hernia - next step? | Observation (until age 4, elective sx at that time) |
| Pt who recently traveled to AZ has a cough and bx of erythema nodosum reveals spherules filled w/ endospores - dx? | Coccidioidomycosis (caused by Coccidioides immitis) |
| 22 y.o. male w/ steatorrhea for several years, difficulty conceiving for 18 months, persistent cough resistant to abx, Na+ 135, K+ 4.0, ALT 20, AST 40 - dx; next test? | Cystic fibrosis; sweat chloride test |
| [OMM] Soft tissue technique - direct or indirect; what does it entail? | Direct; employs separation of origin and insertion and deep pressure |
| Constrictive pericarditis w/ edema, JVD, pericardial knock, and ascites - tx; distinguishing features of constrictive pericarditis vs. restrictive cardiomyopathy? | Surgery to remove pericardium; JVD & pericardial knock are present in constrictive pericarditis only |
| Pancreatitis - Ranson's criteria upon admission? | Age > 55, WBC > 16,000, glucose > 200, AST > 250, LDH > 350 |
| Exercise-induced asthma - dx test? | Methacholine-challenge test (aka bronchoprovocation test) |
| Mammogram - schedule according to U.S. Preventive Services Task Force? | Mammogram every 2 years starting at age 50 |
| Female pt w/ h/o hyperthyroidism s/p radioactive iodine ablation has white breast discharge - likely etiology? | Increased TRH (stimulates both TSH and prolactin release) |
| [OMM] Thoracic muscle energy - which part of the body are you using as a lever? | Head for T1-T4 & torso for T5-T12 |
| Somatostatinoma - sxs? | Diabetes mellitus, diarrhea/steatorrhea, cholelithiasis, hypochlorhydria, and weight loss |
| Croup - tx? | Dexamethasone |
| Kawasaki's disease - tx? | IVIG and high-dose aspirin |
| Henoch-Schonlein purpura has palpable purpura on the buttocks - associated problem? | Acute nephropathy |
| [OMM] Lasegue's test - what is it? | Straight leg raise test for sciatica |
| Pt comes in with chest pain to ED, insurance company will not cover charges, suddenly pt doesn't feel so bad and states he will see is own physician later today - next step? | Provide a screening exam (Emergency Medical Treatment and Active Labor Act [EMTALA] requires a medical screening exam regardless of ability to pay) |
| 55 y.o. male w/ scattered, erythematous patches across the back that has progressed to raised, scaly lesions. Has axillary lymphadenopathy, bx shows abnormal T-cell infiltrates...pic of rash shown: - dx? | Mycosis fungoides (most common type of cutaneous T-cell lymphoma...plaque psoriasis would NOT have lymph node involvement) |
| Neonate w/ hemihypertrophy - dx; likely lab finding? | Beckwith-Wiedemann syndrome; hypoglycemia soon after birth |
| Neonate born at 29 weeks has an interrupted aortic arch, large VSD, cleft palate, twitching movements of the face and hypocalcemia - dx; what is the defect? | DiGeorge syndrome; deletion of 22q11.2 |
| Pleural effusion, exudative vs. transudative - dx criteria; causes of exudative; causes of transudative? | Any ONE of the three: ratio of pleural to serum protein > 0.5, ratio of pleural to serum LDH > 0.6 or LDH > 200; lung CA, TB, pneumonia, asbestosis (anything causes dmg to lung parenchyma); CHF, cirrhosis, constrictive pericarditis, nephrotic syndrome |
| HIV infection - CD4 counts & prophylaxis: toxoplasmosis; pneumocystis jirveci pneumonia; mycobacterium avium complex? | < 100, TMP-SMX (pyrimethamine/sulfadiazine is for tx of toxoplasmosis); < 200, TMP-SMX; < 50, azithromycin or clarithromycin |
| Vit. B 12 deficiency - what is/are most sensitive test(s)? | Serum homocysteine & methylmalonic acid (vit B12 level is usually normal in deficiency...increased MMA level by itself is not as useful b/c renal insuff can cause it) |
| Pt w/ seizure disorder has T102, productive cough of foul-smelling sputum, night sweats, and significant weight loss over the past 5 weeks. CXR shows cavitation with air-fluid level in R upper lobe - dx; tx? | Lung abscess (from aspiration of anaerobic bacteria); clindamycin |
| Parkinson's - MAOI tx option? | Selegiline (MAO-B inhibitor so pts do not have to restrict tyramine from their diets) |
| Pt on a mechanical ventilator has his PEEP turned up in the morning, now he has hypotension, distended neck veins, and tracheal deviation to the right - dx; where would you hear diminished breath sounds? | L-sided tension pneumothorax; L side only (NOT both) |
| Osteomyelitis, IV abx started - labs used to monitor progress? | ESR & CRP (WBC is normal in 50% of pts w/ osteomyelitis) |
| Which ribs protect the following organs - spleen; liver; kidneys | 9-11 on L; 7-9 on R; 11-12 |
| Right bundle branch block - criteria? | Slurred S wave in leads I and V6, rSR' in V1 (and usu. V2) |
| Febrile seizure - what is the age cut-off? | 6 years or younger get them |
| 10 y.o. male has fever and sore throat last month, did not seek medical attention, sxs resolved 3 weeks ago. Now has jerking movements of hands and feet, joint pain that started in his right wrist and moved to his left elbow and knee - dx; tx? | Acute rheumatic fever (dx w/ 2 major criteria from J<NES [joints, carditis, nodes, erythema marginatum, Syndenham's chorea] plus 1 minor like throat cx or ASO titer); ALL pts get penicillin |
| Pancreatic pseudocyst - when should it be tx'ed; tx? | Over 6 cm, doesn't resolve in 8 weeks, signs of infection; endoscopic cystogastrostomy (drains in stomach) or endoscopic cystoduodenostomy (needle aspiration is never used) |
| Urine output - minimal guidelines? | 0.5 mL/kg/hr or 30 cc/hr |
| Lochia post-partum - normal time frame; what color is it? | 6 weeks; 1st week it's red (lochia rubra), 2nd week it's pink and thin (lochia serosa), rest of time it's yellow/white (lochia alba...lochia is simply shedding of decidua and blood) |
| Pheochromocytoma - proper pre-op preparation? | Start pt on phenoxybenzamine then add propranolol one week before surgery to control blood pressure |
| Zollinger-Ellison Syndrome - dx test; most common site; site with higher tendency for malignancy? | Fasting serum gastrin (increased) & secretin injection test (gastrin still elevated...normally secretin suppresses gastrin); duodenum; pancreas |
| Pregnancy - when will urine hCG first be positive; what about blood? | 2 weeks after conception; 1 week |
| 1 year old w/ jaundice, hepatosplenomegaly, cataracts, heart murmur, and hearing loss - etiologic agent? | Rubella virus (cataracts, hearing loss, cardiac defects) |
| Primary hyperparathyroidism - most likely cause? | Parathyroid adenoma (85-90%...parathyroid hyperplasia accounts for 10-15%) |
| Parkinson's vs. Alzheimer's - cholinergic tx mechanism? | Parkinson's tx involves blocking ACh (benztropine / trihexyphenidyl) while Alzheimer's increases ACh (donepezil...centrally acting acetylcholinesterase inhibitor) |
| [OMM] Lymphatic drainage - what drains through right lymphatic duct? | R arm, R head, R neck, myocardium/endocardium (but NOT the pericardium) and R lung |
| Primary spontaneous pneumothorax in a hemodynamically stable individual - what is a small pneumothorax that only requires O2 and observation? | Pneumothorax involving <15% of the hemithorax or <3cm from the apex of the lung to the top visceral pleura (repeat CXR in 24 hrs) |
| Why is chromium important? | Insulin requires chromium to function properly |
| Gastrointestinal stromal tumor (GIST), positive for c-kit mutation - tx? | Imatinib (c-kit is a tyrosine kinase mutation) |
| Left parasternal lift - what does it indicate? | Right ventricular hypertrophy |
| Premature baby 1-week old has rectal bleeding, abdominal x-ray shows pneumatosis intestinalis - dx; what is the x-ray finding? | Necrotizing enterocolitis; gas bubbles in the small bowel wall |
| Heparin induced thrombocytopenia - what causes it? | Antibody to platelet factor 4 (activates platelets) |
| Pancreatic CA - most sensitive test; most specific test? | Abdominal CT; ERCP |
| Pregnancy - what week do you start labor induction | Over 42 weeks |
| Primary vs. secondary adrenal insufficiency - tx difference? | Secondary adrenal insufficiency only requires glucocorticoid b/c pituitary has failed (primary requires prednisone + fludrocortisone b/c adrenals have failed) |
| Lichen planus - 5 P's that describe this condition? | Pruritic, polygonal, purple, papules and plaques (has white, lace-like appearance due to Wickham's striae) |
| 21 y.o. | 18 weeks gestation has elevated maternal serum alpha fetoprotein, repeat test confirms elevation and US shows normal 18 week pregnancy - next step? |
| Neonate with smooth philtrum, microcephaly, and midfacial hypoplasia - likely teratogen exposure? | Alcohol |
| Esophageal varices - medical tx for bleeding prevention; medical tx for active bleeding? | Propranolol; octreotide (also vasopressin but not as effective) |
| Carcinoid syndrome w/ unresectable tumors - tx? | Octreotide |
| CXR findings - silicosis; berylliosis; asbestosis | Nodular opacities in the upper lobe; b/l hilar adenopathy; b/l opacities w/ pleural plaques |
| First time PE is tx w/ heparin followed by Coumadin - how long; if recurrent? | 3-6 months; life |
| Coumadin - when is the therapeutic level an INR of 2.5-3.5? | Mechanical heart valves, post-MI, and antiphospholipid syndrome (INR usu. 2-3) |
| Neonate delivered via vacuum-assisted delivery, edema of the head is found - cephalhematoma vs. caput succedaneum vs. subgaleal hemorrhage? | Cephalhematoma is firm, nonpitting and does NOT cross suture lines; caput succedaneum is firm, nonpitting and crosses suture lines; subgaleal hemorrhage is boggy |
| Rabies - if you get bit by an animal that you suspect to have rabies, what do you do with it? | Isolate it for 1 week, if it's healthy then it's unlikely to have it |
| Psoriasis - first line tx; tx if severe; tx if that fails? | Topical corticosteroids; UVB light radiation; psoralen + UVA (improves w/ sun exposure, worsens in winter) |
| Adoption study vs. twin concordance study - what's the difference? | Adoption study looks at genetic and environmental factors; twin concordance study only looks at genetic factors |
| Renal cell CA - associated paraneoplastic syndromes? | Polycythemia (EPO), Cushing's syndrome (cortisol), hypertension (renin), hypercalcemia (PTH-like hormone) |
| Fetal heart rate monitor shows a sinusoidal pattern - what does that indicate? | Fetal anemia (possible Rh isoimmunization) |
| Study validity - internal vs. external? | Internal validity refers to results applicable to the population being studied, external means the results are relevant to similar populations |
| Guillain-Barre syndrome - CSF findings? | Albumincytologic dissociation (elevated CSF protein, normal WBC count) |
| Post-traumatic stress disorder - tx? | SSRI and exposure therapy |
| 21 y.o. male had a mild cough 6 weeks ago, now his coughs have been followed by vomiting, CXR is clear - dx; what could have prevented this? | Whooping cough (Bordetella pertussis); Tdap vaccination (cough is usually followed by coughing fits with sweating or vomiting) |
| A permanent tooth gets knocked out and you are unable to reinsert it - methods of transporting tooth to dentist? | Buffered salt solution (best), saline, milk, under the pt's tongue (water is the worst way to transport) |
| Infectious mononucleosis - blood findings; lab finding with high specificity? | Lymphocytosis w/ atypical lymphocytes; heterophile antibody |
| Drug-induced lupus - 4 common drugs; test to confirm? | Hydralazine, procainamide, isoniazid, quinidine; anti-histone antibodies (100% sensitive) |
| Pt had painless vaginal bleeding without contractions at 30 weeks gestation, pelvic US confirms placenta previa - most appropriate tx? | Stabilize pt and repeat US at 35-36 weeks to see if placenta has moved |
| Alzheimer's disease - some sxs; most common cause of death; mild to moderate tx; moderate to severe tx? | Acalculia, anomia, depression, confusion, apraxia; aspiration pneumonia; anticholinesterase inhibitor (donepezil, rivastigmine); memantine (NMDA glutamate receptor antagonist) |
| Chronic lymphocytic leukemia - which CD receptor will you find on the cells? | CD5 |
| Pregnancy, folic acid recommendation - time period; low-risk dose; high-risk dose? | 1 month before pregnancy through 1st trimester; 0.4 mg (400 µg) daily; 4 mg daily |
| Acute pancreatitis - dx test of choice? | CT scan |
| Sarcoidosis - what kind of lung disease; expected spirometry findings? | Interstitial lung disease causing restrictive pattern; FEV1 and FVC are reduced in proportion to each other, FEV1/FVC is either normal or elevated, TLC and VC low |
| 3 y.o. child w/ Wilms tumor - associated findings? | Aniridia, GU malformations, mental retardation |
| Leukocoria - which 2 conditions? | Cataracts or retinoblastoma |
| Gastroschisis vs. omphalocele - covering; which one is associated w/ other congenital defects; which one requires urgent surgery? | Omphalocele is covered by peritoneum and amnion, gastrochisis lacks a covering sac; omphalocele; gastrochisis (b/c prone to drying out) |
| Which type of study is good for studying rare diseases? | Case-control study |
| Pt w/ von Willebrand Disease has increased bleeding time and prolonged PTT - tx? | Desmopressin (increases circulating levels of vWF and factor VIII) |
| 40 y.o. pt newly dx'ed w/ type II diabetes - vaccine(s)? | Annual influenza & pneumococcal vaccine today (diabetics have increased morbidity w/ pneumonia) |
| 2 y.o. child didn't get a toy from the store, began crying, became cyanotic and lost consciousness - dx; next step? | Breath-holding spell (usu. 2-8 yr olds); reassure |
| Pt w/ headache that started yesterday, BP in both arms is 180/110, both legs 100/75, CXR shows a figure-3 sign - dx? | Coarctation of aorta distal to the L subclavian artery (NOT descending aorta...dilation of proximal and distal parts of aortic coactation create a "figure-3 sign" |
| You suspect child abuse - who do you contact? | Local law enforcement and Child Protective Services |
| Pre-renal due to septic shock - urinary lab findings? | BUN/Cr > 20; FE Na < 1%; Urine Na < 20 |
| Surgical site infection w/in 24 hours of operation - most likely organism; only other bug? | GpA strept; clostr spp. (infect 10'5) .strep will have erythema, pain, and wound fluild w/ WBCs...clostridium will have severe pain out of proportion to other findings, brackish fluid lacking WBCs b/c exotoxins lyse them) |
| Nocturnal enuresis - age cut-off for dx; first line tx? | After 5 years of age; conditioning w/ a bed pad and alarm (alarm or vibrating device goes off once moisture is detected) |
| Pt w/ a wrist burn 30 years ago, never healed, now is associated w/ an ulcer and intermittent oozing - dx? | Marjolin's ulcer (malignant transformation of a chronic wound, esp. burns...usu. squamous cell CA) |
| Pt w/ low calcium, low phosphate, high PTH - dx? | Vitamin D deficiency (results in decreased calcium and phosphate absorption) |
| 16 y.o. female w/ 24 hr headache, palpable, purpuric rash of the lower extremities, and positive Brudzinski and Kernig signs - next best step? | IV dexamethasone and antibiotics (If petechiae and purpura are present in suspected meningococcal disease, tx before lumbar puncture...dexamethasone should be added for meningococcal) |
| Acute viral hepatitis - which ones require anti-viral tx? | Only hepatitis C |
| Silicosis vs. asbestosis - pulmonary complications? | Silicosis à TB (damages alveolar macrophages), asbestosis à mesothelioma |
| [OMM] SBS movement - which motion decreases AP diameter? | Flexion of SBS |
| Incomplete vs. complete abortion - cervical os on physical exam? | Incomplete abortion à open cervical os, complete abortion à closed cervical os |
| Pt w/ stable angina now has more severe chest pain with increased frequency. ECG and cardiac enzymes normal, has been stable on aspirin, metoprolol, and nitrates - dx; tx? | Unstable angina; start IV heparin (unstable angina tx is same as non-ST elevation MI: β-blocker, aspirin, oxygen, nitroglycerin, morphine, heparin) |
| ST-elevation MI vs. non-ST elevation MI - tx difference? | ST-elevation MI gets thrombolytic therapy |
| Pt w/ sickle cell disease and naproxen use for headaches develops renal papillary necrosis - expected UA result? | Necrotic tissue |
| 13 y.o. male pt w/ gynecomastia, denies drugs use, thyroid, BUN/Cr normal, increased estradiol - next step? | Reasurance and follow-up in 6 months (gynecomastia is common in pubertal males and will regress - hyperthyroidism, drug use, hypogonadism and renal failure must be ruled out) |
| 21 y.o. male w/ painful, grouped vesicles on his penis, tender inguinal lymphadenopathy, T103 - next step? | Valacyclovir (start w/ tx if clinical suspicion is high...Tzanck smear is best initial diagnostic test) |
| 55 y.o. male w/ severe groin pain, "pain is unbearable," recently tx'ed for perirectal abscess, has 20 yr h/o diabetes, T101.5, erythema, swelling and severe tenderness on palpation of scrotum, no fluctuance - dx? | Fournier gangrene (necrotizing soft tissue infxn of male genitals and perineum, much more painful than orchitis) |
| [OMM] Child w/ AOM - why would V spead of the occipitomastoid suture be helpful? | The Eustachian tube traverses the temporal bone (the suture is an articulation btwn occipital bone & mastoid portion of temporal bone) |
| COPD - which tx increases survival? | Home oxygen therapy & smoking cessation |
| Obstructive sleep apnea is suspected, polysomnography is performed - how do you confirm dx? | At least five obstructive breathing events (apnea or hypopnea) per hour of sleep |
| Acetaminophen toxicity - tx (include timing)? | Within 1 hr of ingestion use activated charcoal...at 4, 6 and 8 hrs check serum acetaminophen levels (to determine need for N-acetylcysteine)...if after 8 hours give N-acetylcysteine while waiting for acetaminophen level |
| Testicular tumors: seminoma vs. yolk sac (endodermal) tumor - which hormone will be elevated; histologic appearance? | Seminoma has high β-HCG, yolk sac has high AFP; seminoma à "fried egg," yolk sac à Schiller-Duvall bodies |
| Viral drugs - HBV; HCV; EBV | Interferon α-2b, lamivudine, tenofovir; interferon, ribavirin; acyclovir |
| Retropharyngeal abscess - dx test; what does the test differentiate; tx; tx if that fails or abscess is very large | Contrast CT of the neck; retropharyngeal abscess vs. retropharyngeal cellulitis; clindamycin & ampicillin-sulbactam; surgical drainage |
| Wilson's disease - high/low: ceruloplasmin; total serum copper; free serum copper; urinary excretion of copper? | Low; low; high; high |
| Pt overdosed on a psychiatric medication presents w/ ataxia, tremulousness, and hyperreflexia - what drug? | Lithium |
| Oral thrush in an otherwise healthy 35 y.o. male - tx? | Nystatin mouthwash or clotrimazole lozenge |
| HIV - most sensitive test for dx; most specific test for dx; tx for cryptococcal meningitis | ELISA; Western blot; Intrathecal amphotericin B (it doesn't cross the blood-brain barrier) |
| Otitis externa - most common organisms; tx? | S. aureus & p. aeruginosa; topical ciprofloxacin plus hydrocortisone otic |
| CHF - drug that prolongs survival; other tx in acute exacerbation for sx relief only w/ EF 35%? | ACE inhibitor; furosemide & salt restriction |
| Pulsus paradoxus - how many mm Hg difference? | > 12 mm Hg |
| Newly prescribed lithium for a female - tests to order before beginning tx? | BUN/Cr, Thyroid function, pregnancy test (SEs include nephrogenic DI, hypothyroidism, and Ebstein's anomaly in a newborn) |
| Screening test for lead toxicity in children? | Blood lead level |
| Written consent is given for release of medical records - how long do you have to comply? | 5 working days |
| Pt w/ pyrosis and globus sensation, negative cardiac work-up - what are those sxs; likely dx? | Pyrosis = heartburn, globus sensation = lump in the throat; GERD |
| 2 pts are talking in a hospital, one states that she heard a doctor saying a pt from California has Coccidiomycosis, the other gets outraged b/c she is that pt - under what act can she sue? | She cannot sue (she can sue if a geographical subdivision smaller than a state was used) |
| Cavernous sinus - cranial nerves that pass through it; first nerve usu. affected? | CN III, IV, V1, V2 & VI; VI (b/c it floats freely while others are attached to the wall) |
| Pt w/ psoas syndrome presents w/ back pain - things that should be ruled out; tx steps? | Abscess, cauda equina, tumor, fracture; start w/ upper lumbar then go to psoas muscle itself (b/c psoas receives innervation from upper lumbar spine) |
| Intrinsic renal failure - labs? | BUN/Cr < 20:1, urine sodium > 40 mEq/L, FENa > 2%, urine osmolality < 350 mosm/kg (> 500 if pre-renal) |
| Prevalence study for a new anti-hypertensive drug - major disadvantage? | Under-representation of acute disease |
| Trisomy 13 vs. trimsomy 18 - distinguishing facial features? | Trisomy 13 has close-set eyes and cleft lip/palate, trisomy 18 has widely-spaced eyes and prominent occiput |
| Membranous glomerulonephritis vs. focal segmental glomerulosclerosis - associated complications? | Membranous glomerulonephritis à syphilis, HBV, HCV, malaria, gold salts, penicillamine, SLE, malignancy...focal segmental glomerulosclerosis àHIV, IV drug abuse, sickle cell disease |
| Suspected insulinoma, pt has low glucose, high C-peptide and high insulin levels - next dx step? | 72 hour fast (persistence of hyperinsulinism confirms dx, test is stopped if glucose reaches 45 mg/dL...pro-insulin level is not necessary b/c don't suspect factitious hypoglycemia) |
| Shy-Drager syndrome - what is it? | Parkinson-like sxs + autonomic dysfunction |
| 2 day old child w/ chorioretinitis, jaundice and calcification of the basal ganglia, mom admits to eating raw meat during pregnancy - dx? | Toxoplasmosis infection (from maternal exposure to raw meat or cat feces) |
| [OMM] Anterior fibular head - where is restricted motion of fibular head; lateral malleolus? | Restricted posterior; restricted anterior |
| Rabies - first time vaccination schedule of doses; postexposure prophylaxis for non-immunized; immunized | 4 doses total on days 0, 3, 7, 14; wound cleansing (water, soap, povidine-iodine solution), Rabies immune globulin (injected around wound), 4 doses as described previously; wound cleansing, 2 doses total of vaccine on days 0, 3 |
| Pt w/ CNS depression, respiratory/cardiac arrest and "almond-like odor in breath" - likely toxicity; tx | Cyanide; amyl nitrite |
| TCA overdose - antagonizes which receptors? | α-1 adrenergic, muscarinic ACh, histamine |
| Quinidine toxicity - causes what; tx? | Torsade de pointes & cinchonism (tinnitus, flushed skin, CNS disturbance); IV magnesium |
| Seizure vs. syncope - good question to differentiate the two? | Did the pt lose bladder control? (yes for seizure, usu. tonic-clonic) |
| 6 month old w/ CMV infection - characteristic findings? | Hearing loss & cerebral calcifications |
| 23 y.o. | 33 weeks gestation develops eclampsia, seized a few minutes ago - tx? |
| 16 y.o. female undergoes D&C for missed abortion, 2 days later vaginal bleeding and abdominal pain, BP105/70, T 100.5, P105, R18, cervix dilated 2 cm w/ uterine tenderness - tx? | Antibiotics and D&C (septic abortion, may have retained products of conception) |
| Pt's dog bit him - tx? | Irrigate w/ saline |
| ALS - dx test? | EMG (confirms lower motor neuron lesions, r/o myasthenia gravis, MS, carpal tunnel, Guillain-Barre) |
| Spinal stenosis - initial test; most accurate test; tx that provides long-term relief? | X-ray; MRI; weight loss |
| Pseudomembranous colitis - fastest test to establish dx? | Proctoscopy (C difficile toxin ELISA usu. takes 24 hrs for results) |
| Pt w/ sickle cell anemia is getting 3 units PRBC, 30 min after initiation of transfusion develops chills, mild SOB, T101 - dx; tx? | Non-hemolytic febrile reaction (most common reaction, 2/2 reaction of recipient to donor WBCs); use leukocyte washed blood products |
| Blood transfusion results in acute hemolytic reaction due to ABO incompatibility - physical findings? | Fever, flank pain, red/brown urine (Hb in urine...tx IV fluids to protect kidneys) |
| Pt is non-compliant with her medicine, has altered mental status for past 2 hours, T96.2, BP90/60, R6, sugar is normal - which med caused it: propranolol, levothyroxine, spironolactone, insulin, hydrocortisone? | Levothyroxine (myxedema coma is a complication of hypothyroidism and is often fatal...tx IV T3 and/or T4 plus IV hydrocortisone) |
| Priapism - which psychiatric drug can cause it? | Trazodone |
| Polycythemia vera - increases what type of cells? | Normal RBCs, granulocytes & platelets (activated JAK2 tyrosine kinase) |
| Lesch-Nyhan - what do you see? | Severe mental retardation w/ self-mutilation. High uric acid level leads to gout and uric acid kidney stones |
| Pain upon defecation - term? | Dyschezia |
| Breast feeding - which of the following is a benefit: high IgG, high vit. K, high iron, high vit. D, deceases vaginal bleeding? | Only decreases vaginal bleeding (increases uterine contraction by promoting oxytocin release...breast milk is high in IgA) |
| Asbestosis - DLCO finding? | Decreased DLCO (carbon monoxide diffusing capacity...decreased total lung area means less oxygen diffusion) |
| Postpartum blues vs. postpartum depression - difference? | Postpartum blues end by < 2 weeks after delivery and mom retains ability to care for herself and baby, postpartum depression is delayed 2 weeks to 12 months after delivery and mom loses capacity to care for herself and baby |
| [OMM] Facet joints - cervical, thoracic, lumbar? | Cervical à BUM (backwards/upwards/medial), thoracic à BUL (backwards/upwards/lateral), lumbar à BUM (these apply to superior facet joints...opposite for inferior facets) |
| Triple-blinded study - what is it? | Pt, doctor & researcher unaware of which tx pt is being given (double blind is when pt and doctor do not know, but researcher does) |
| Opioid overdose - naltrexone vs. naloxone? | Naloxone is best choice in acute setting (IV and rapid acting), naltrexone is for long-term therapy and is available in oral form |
| Ascites - first line tx? | Spironolactone +/- furosemide plus Na+ restrictive diet (spironolactone is good b/c it's K+ sparing, K+ is hard to replete in cirrhotics... paracentesis if that fails) |
| Hepatic adenoma 2/2 OCPs - when should it be surgically resected? | If symptomatic, more than 5 cm, or do not regress after oral contraception discontinuation |
| Burn pt - fluid choice for 1st 24 hours? | Lactated Ringer's (need a fluid that is most similar to ECF b/c capillaries are very leaky) |
| 10 y.o. burn pt - percentages? | 15% head, 13% anterior trunk, 18% posterior trunk, 9% for each upper extremity, 16% each lower extremity, 1% genitalia |
| 4 y.o. f w/ rash of 3 days has had fatigue for 3 mos. She is below the 5th perc for height, has recurrent URIs and rudimentary thumbs at birth. PE shows multiple tan-colored macules >1 cm in size mult, small, red spots 1-2 mm on the lower abdomen - dx? | Fanconi anemia (bone marrow failure, thumb abnormalities, multiple café-au-lait spots, renal anomalies, microcephaly, and short stature) |
| Diverticulosis - most common location? | Sigmoid colon (NOT descending colon) |
| Smoking cessation - first-line pharmacologic tx for smoking cessation? | Varenicline (Chantix) or buproprion |
| Child's teeth eruption - sequence? | Central incisorsà lateral incisors à 1st molars à canines à 2nd molars |
| Pt w/ newly dx diabetes mellitus has increased glucagon and decreased amino acid levels - likely physical finding? | Necrotizing migratory erythema (usu. w/ glucagonoma, amino acids used for gluconeogenesis) |
| Pt asks how many years of experience do you have performing this procedure and you say "enough" having just come out of residency - adequate? | No (you must directly answer the question b/c the pt sees this information as important for coming to informed consent) |
| Mortality rate vs. case fatality rate - difference? | Mortality refers to how many people die out of whole population, case fatality refers to how many people die out of those who have the disease |
| Pregnancy recommended weight gain - underweight; normal; overweight; obese? | 28-40 lbs.; 25-35 lbs.; 15-25 lbs.; 11-20 lbs. |
| McCune-Albright syndrome - clinical presentation? | Precocious puberty, café au lait spots, bone lesions, short stature |
| Male fetal development - which hormone is responsible: regression internal female genitalia; development male internal genitalia; development male external genitalia? | Mullerian inhibiting substance; testosterone; dihydrotestosterone |
| Ectopic pregnancy - what is cut-off β-hCG level that one can see gestational sac w/ transvaginal US? | 1500 (usu. if suspected and < 1500, repeat US in 48 hours) |
| Group A strep - how long are you contagious after initiation of abx? | 1-2 days |
| Pt w/ acute pancreatitis respiratory distress, you want to confirm ARDS as pt does not improve w/ 100% O2 therapy, CXR shows b/l infiltrates - best test to confirm dx? | Measurement of pulmonary capillary wedge pressure (r/o cardiogenic pulmonary edema as it is indistinguishable on CXR...in practice you would probably order BNP and echo first, then go to right heart catheterization) |
| Major Depressive Disorder resistant to multiple SSRIs (monotherapy) - which drug can be added to regimen? | Lithium |
| VIPoma - lab findings; tx? | Hypokalemia (2/2 diarrhea), hypochlorhydria & hyperglycemia; octreotide |
| Osteoarthritis - long-term tx of choice? | Acetaminophen (no > than 4 g/day, chronic NSAID use causes GI side effects) |
| [OMM] Singultus - what is it; omm tx? | Hiccups; myofascial diaphragm release |
| Fugue state - what is it? | Commonly follows a stressor and includes sudden travel, amnesia, & assumption of a new identity |
| Polio - presentation; how do you confirm dx? | Sudden onset asymmetrical muscle weakness that leads to flaccid paralysis and absent DTRs (Guillaian-Barre is symmetrical); isolate virus from oral secretions |
| Pt complains of increased morning glucose before eating breakfast and taking insulin - next step; how do you interpret low and high findings? | Measure glucose at 3am; if low à overtreatment (pt will compensate with higher glucose in morning [Somogyi effect])...if high à early morning growth hormone secretion is antagonizing insulin (dawn phenomenon) |
| 54 y.o. multiparous female c/o 5 month hx of urinary incontinence, she admits to urinary frequency, dribbling, and hesitancy - first step? | UA (All urinary incontinence workups should begin with UA to r/o infxn, hematuria, etc...this lady eventually has clean UA and high postvoid residual volume via cath tx'ed by self-cath [likely 2/2 diabetes or spinal cord trauma]) |
| Group of physicians contract w/ an HMO for a flat fee per pt - term described? | Capitation |
| 5 day old w/ green vomiting, no solid particles, bleed per rectum, abd series shows double-bubble sign, upper GI series shows bird's beak - dx? | Midgut volvulus ("bird's beak" = compression/torsion... "double bubble" = duodenal obstruction...duodenal atresia of Trisomy 21 does not have blood per rectum) |
| Hemodialysis - absolute indications? | AEIOU...Acidosis (metabolic acidosis), Electrolytes (severe hyperkalemia), Intoxications (lithium, aspirin, methanol, ethylene glycol), Overload (CHF), Uremia (uremic pericarditis) |
| Pt w/ Chronic Kidney Disease stage III - why do they have hypocalcemia? | Hyperphosphatemia (complexes w/ ionized Ca2+) & and decreased calcitriol production |
| Anemia of chronic disease vs. thalassemia - iron panel differences? | Anemia of chronic disease has low iron & TIBC, while thalassemia has normal iron & TIBC |
| Sickle cell disease - tx for painful crisis; tx for aplastic crisis; what does hydroxyurea do for sickle cell? | IV fluids; blood transfusion; increases HbF |
| Measles - tx that has shown to reduce morbidity and mortality; how long should kid stay out of school? | Vitamin A supplementation; return to school 4 days after onset of rash (also contagious 5 days before rash) |
| [OMM] SBS compression - cranial findings? | No motion of the cranium |
| Cord compression - physical findings; initial tx? | Hyperreflexia, loss of bowel/bladder control, back pain, muscle weakness, loss of sensation; high does corticosteroids (surgery is sometimes indicated, but steroid first) |
Created by:
michael316