Mehlman
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| chicken + bloody diarrhea | campylobacter or salmonella
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| tx for entamoeba | metronidazole
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| bloody + “appendicitis” | yersinia
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| test for guillian barre | electromyography and nerve conduction
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| CF patient under 10 type of pneumonia | Staph
Staph until 10, then pseudo
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| CP patient over 10 type of pneumo | pseudomonas
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| type of incontinence for mid-urethral sling | stress incontinence
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| 2 tx can use for pyelonephritis | cipro or amp/gent
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| what do you need to check in RA patient before surgery | atlanto instability do CT
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| empric for endocarditis | Vanc. or amp/sulbactum and gent
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| anti-cholinergic to stop pee | oxybutinin
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| cholinergic to help pee | bethanachol
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| tx for MS flares vs maintanence | steroids for flares, interferon for mainanence
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| vestibular neuritis vs labyrinthitis | Labyrinthitis has tinnitus and hearing loss
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| to and fro murmur | PDA
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| murmur associated with rubella | PDA
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| heart problem of baby born to mom who has lupus | third degree heart block
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| heart problem in williams | Supravalvular AS
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| worse with valsalva | HOCM
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| late peaking sys murmur with ejection click | AS
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| Travel + self-limiting watery or brown/green diarrhea | Traveler diarrhea = ETEC HL or HS toxin
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| Abx (clindamycin, beta-lactam, cephalosporin) + diarrhea | C. difficile
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| Dx of C. diff | stool AB toxin test, not stool culture
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| Fever of 104 + abdo distension in C diff | toxic megacolon
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| Tx of C. diff | vancomycin, not metronidazole (updated guidelines as of Feb 2018)
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| Bloody diarrhea + travel | Entamoeba histolytica
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| Tx of E. histolytica | metronidazole + iodoquinol; can give paromomycin
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| Close quarters or military barracks or cruise ship + watery diarrhea | Norwalk virus
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| Child <5 years + watery diarrhea | rotavirus
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| Few organisms causing bloody diarrhea | Shigella
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| Bloody diarrhea + appendicitis-like pain (pseudoappendicitis) in a child | Yersinia enterocolitica
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| Bloody diarrhea + reactive arthritis in an adult | Y. enterocolitica, Campylobacter, Shigella, Salmonella
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| Diarrhea + Guillain-Barre syndrome | Campylobacter
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| GBSyndrome CSF? | albuminocytologic dissociation (high protein + normal cells)
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| GBSyndrome Dx? | electromyography + nerve conduction studies (on NBME)
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| Cardiac ischemia + need to evaluate | ECG stress test first-line
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| Cardiac ischemia + abnormal baseline ECG (e.g., BBB) | Echo stress test (need normal ECG to do ECG stress test)
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| Cardiac ischemia + patient can’t exercise | dobutamine + ECG/echo
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| ECG shows diffuse ST-segment elevations | pericarditis
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| Pericarditis Tx | NSAID, or steroid, or colchicine
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| Central chest pain worse when supine; better when leaning forward | pericarditis
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| Lateral chest pain after viral infection + increased CK | pleurodynia (intercostal muscle spasm)
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| ST-segment depressions in the anterior ECG leads | posterior MI
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| Electrical alternans on ECG | pericardial tamponade / pericardial effusion
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| Pulsus paradoxus (drop in systolic BP >10 mm with inspiration) | cardiac tamponade or severe asthma
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| Beck triad | hypotension + muffled heart sounds + JVD
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| Bloody diarrhea + poultry consumption | Campylobacter jejuni or Salmonella spp.
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| Tx of tamponade | pericardiocentesis or pericardial window
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| Tamponade | do echo before pericardiocentesis if both listed (even though sounds wrong, on 2CK NBME)
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| CPP + lobar pattern (right-lower lobe consolidation + dullness to percussion) | Strep pneumo
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| CPP + lobar pattern, but they say “interstitial” in the vignette description | Mycoplasma, not S. pneumo Empiric Tx for CPP
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| Tx for CPP is pt on Abx past three months | fluoroquinolone over azithro
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| Pneumonia in CF patient <10 years | S. aureus exceeds Pseudomonas
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| Pneumonia in CF patient >10 years | Pseudomonas exceeds S. aureus.
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| Pneumonia after influenza infection | USMLE wants S. aureus
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| Pneumonia + rabbits | F. tularensis
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| Pneumonia + cattle | Coxiella (Q fever)
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| Pneumonia + birds | Chlamydia psittaci
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| Leg swelling + pain + shortness of breath | Pulmonary embolism caused by DVT
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| Tx of PE | Heparin before spiral CT
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| Tx of PE in pregnant woman | V/Q scan, not CT
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| Tx of PE in someone already on warfarin | spiral CT to confirm, then IVC filter
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| Acid-base disturbance in PE | resp. alkalosis (low CO2, high pH, low O2, normal bicarb [too acute to change]) Acid-base disturbance in asthma
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| Acid-base disturbance in aspirin toxicity first 20 mins | resp. alkalosis (low CO2, high pH, normal O2, normal bicarb [too acute to change])
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| Acid-base disturbance in aspirin toxicity after 20 mins | mixed metabolic acidosis-respiratory alkalosis (low CO2, low pH, normal O2, low bicarb)
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| Tx for aspirin toxicity | bicarb (increased excretion through urinary alkalinization)
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| Tx for TCA toxicity | sodium bicarb
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| Normal calcium | 8.4-10.2 mEq/L
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| Tx of hypercalcemia | 10.2-12 -> normal saline (0.9% NaCl)
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| MEHLMANMEDICAL.COM |
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| MEHLMANMEDICAL.COM 4 |
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| Community-acquired pneumonia (CPP) + bilateral CXR infiltrates | Mycoplasma
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| Tx of hypercalcemia | 12-14 -> normal saline (0.9% NaCl) only if asymptomatic; add bisphosphonate (e.g., pamidronate) if symptomatic
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| Tx of hypercalcemia | 14+ -> normal saline (0.9% NaCl) + bisphosphonate
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| High calcium + polyuria | nephrogenic diabetes insipidus (weird, but on NBME)
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| High calcium + confusion | delirium caused by high calcium
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| Low calcium or potassium not responsive to supplementation | cause is low Mg
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| Low calcium or potassium in alcoholic | hypomagnesemia is cause
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| Ataxia, confusion, ophthalmoplegia | Wernicke encephalopathy (B1 deficiency)
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| Retrograde amnesia + confabulation in alcoholic | Korsakoff psychosis
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| Wernicke-Korsakoff syndrome | mammillary bodies
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| Hx of many pregnancies + downward movement of vesicourethral junction | stress incontinence
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| Tx of stress incontinence | pelvic floor exercises (Kegel); if insufficient
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| Hyperactive detrusor or detrusor instability | urge incontinence
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| Need to run to bathroom when sticking key in a door | urge incontinence
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| Incontinence in multiple sclerosis patient or perimenopausal | urge incontinence
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| Tx of urge incontinence | oxybutynin (muscarinic cholinergic antagonist) or mirabegron (beta-3 agonist) Incontinence + high post-void volume (usually 3-400 in question; normal is <50 mL)
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| Tx for overflow incontinence in diabetes | bethanacol (muscarinic cholinergic agonist)
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| Incontinence in BPH | overflow incontinence due to outlet obstruction
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| Tx for overflow incontinence in BPH | insert catheter first; then give alpha-1 blocker of 5-alpha-reductase inhibitor; then TURP if necessary
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| Exquisitely tender prostate on digital rectal exam | prostatitis
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| Prostatitis Tx | ciprofloxacin (fluoroquinolone
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| Costovertebral angle tenderness + fever | pyelonephritis
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| Costovertebral angle tenderness + granular casts | pyelonephritis (correct, super-weird; NOT acute tubular necrosis; this is on 2CK NBME)
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| Tx for pyelonephritis | ciprofloxacin, OR ampicillin + gentamicin
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| Saddle anesthesia + urinary retention | cauda equina syndrome
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| MEHLMANMEDICAL.COM |
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| MEHLMANMEDICAL.COM 5 |
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| Perianal anesthesia + urinary retention or incontinence | conus medullaris syndrome
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| Gradual-onset dementia + no sensory or motor dysfunction | Alzheimer
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| Mini-mental state exam score low + patient tries to do well | Alzheimer
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| Mini-mental state exam score low + patient is apathetic / takes long to perform tasks / does poorly on reverse serial 7s | depression (pseudodementia)
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| Patient complains about memory loss | normal aging, not Alzheimer
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| First-line Tx for Alzheimer | donepezil (cholinesterase inhibitor also give galantamine or rivastigmine
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| NMDA receptor (glutamate receptor) antagonist used in Alzheimer Tx | memantine
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| Step-wise dementia/decline and/or sensory/motor disturbance | vascular dementia
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| Hx of hypertension + dementia + sensory/motor disturbance | vascular dementia
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| Visual hallucinations + Parkinsonism + dementia | Lewy body dementia
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| Apathy + disinhibition + personality change + dementia | frontotemporal dementia (Pick disease)
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| Urinary incontinence + ataxia + CNS dysfunction (wet, wobbly, wacky) | Normal-pressure hydrocephalus
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| Wet, wobbly, wacky + Parkinsonism | still NPH
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| Parkinsonism in young patient | Wilson disease till proven otherwise
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| Parkinsonism in older patient | Parkinson disease
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| Parkinsonism + axial dystonia | progressive supranuclear palsy
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| Tx of UTI | TMP/SMX or nitrofurantoin
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| Tx of cystitis | nitrofurantoin (need not be pregnant)
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| Waiter tip position in kid | upper brachial plexus injury
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| Claw hand | lower brachial plexus
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| Pronated arm + wrist-drop | radial nerve injury
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| Midshaft fracture of humerus | Radial nerve injury
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| Supracondylar fracture of humerus | median nerve injury
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| Surgical neck of humerus fracture | axillary nerve injury
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| Medial epicondylar injury | ulnar nerve injury
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| Weakened biceps + loss of sensation of lateral forearm | musculocutaneous nerve injury
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| Paresthesias + pain following burn or casting | compartment syndrome
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| MEHLMANMEDICAL.COM |
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| Compartment syndrome Dx | measure compartment pressure
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| Compartment syndrome Tx | fasciotomy of uncast
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| Guy lifts heavy box | severe lower back pain + muscle spasm + no radiculopathy
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| Lumbosacral strain diagnosis | DO NOT x-ray
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| Lumbosacral strain Tx | NSAIDs + exercise as tolerated; bedrest is the WRONG answer
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| Guy lifts heavy box | severe lower back pain + radiculopathy
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| Point tenderness over a vertebra in older woman | osteoporosis (compression fracture)
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| Point tenderness over a vertebra in younger patient on steroids | osteoporosis (compression fracture)
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| Point tenderness over a vertebra in patient with autoimmune disease | recognize patient is on steroids -> osteoporosis (compression fracture)
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| Point tenderness over a vertebra in IV drug user | epidural abscess
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| “Step-off” of one vertebra relative to another | spondylolisthesis
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| Back pain worse in the morning and gets better throughout day in male 20s-40s | ankylosing spondylitis
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| Bamboo spine | ankylosing spondylitis
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| Dx of AS | x-ray of sacroiliac joints
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| Back pain worse when standing or walking for long periods of time | lumbar spinal stenosis
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| Radiculopathy down an arm | cervical disc herniation
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| Bilateral paresthesias in the arms in rheumatoid arthritis patient | atlantoaxial subluxation
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| Bilateral paresthesias in the arms in rheumatoid arthritis patient | MR of spine to Dx atlantoaxial subluxation
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| Prior to surgery in rheumatoid arthritis patient | cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation
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| Back pain in elderly patient with hypercalcemia | multiple myeloma or metastases
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| Back in pain in patient with history of other type of cancer | metastases
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| Suspected spinal mets | MRI
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| Metastases to long bones in prostate cancer | osteoblastic (Dx with bone scan); spine do MRI
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| High hemoglobin +/- pruritis after shower +/- plethora +/- splenomegaly | polycythemia vera
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| High hemoglobin + low EPO | polycythemia vera
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| Pruritis after shower | basophilia
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| High hemoglobin + lung disease / low pO2 | secondary polycythemia (high EPO)
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| MEHLMANMEDICAL.COM |
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| Polycythemia + hypercalcemia + smoker + red urine | RCC (paraneoplasic EPO + PTH-rp)
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| Blurry vision or Raynaud or pain in fingers or headache | hyperviscosity syndrome Hyperviscosity syndrome
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| Hereditary spherocytosis | AD, ankyrin or spectrin or band protein deficiency; Tx = splenectomy Treatment for ITP
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| Tx for hereditary hemochromatosis | serial phlebotomy
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| Tx for secondary hemochromatosis (transfusional siderosis) | chelation therapy (deferoxamine)
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| Viral infection + tinnitus + vertigo +/- neurosensory hearing loss | labrynthitis
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| Viral infection + vertigo | vestibular neuritis
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| Tx for multiple sclerosis flares | IV steroids (IV methylprednisolone)
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| Given to MS patients between flares | interferon-beta
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| Tx for spasticity in MS | baclofen (GABA-B receptor agonist)
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| Incontinence in MS | urge (hyperactive detrusor, as mentioned earlier)
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| New-onset murmur + fever | endocarditis till proven otherwise
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| Empiric Tx for endocarditis | vancomycin or ampicillin/sulbactam, PLUS gentamicin
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| Beta-lactam (e.g., nafcillin) or cephalosporin + rash + renal issue | interstitial nephritis
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| Interstitial nephritis | WBCs in the urine (eosinophils)
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| Fixed splitting of S2 | atrial septal defect
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| Holosystolic murmur at left sternal border PLUS either parasternal heave or palpable thrill | VSD
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| Holosystolic murmur at left sternal border PLUS diastolic rumble | also VSD
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| To-and-fro murmur | PDA (on 2CK NBME)
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| Pan-systolic-pan-diastolic murmur | PDA
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| Continuous, machinery-like murmur | PDA
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| Congenital rubella syndrome | PDA
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| Heart problem in neonate of mom with SLE | congenital third-degree heartblock
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| Heart problem in William syndrome | supravalvular aortic stenosis
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| Bicuspid aortic valve | aortic stenosis
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| Mid-systolic (crescendo-decrescendo) murmur + gets worse with Valsalva | HOCM
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| Mid-systolic (crescendo-decrescendo) murmur + no change or softens with Valsalva | aortic stenosis MEHLMANMEDICAL.COM 8
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| MEHLMANMEDICAL.COM |
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| Myxomatous degeneration of mitral valve | mitral valve prolapse
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| Marfan or Ehlers-Danlos syndrome | MVP or aortic regurg
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| Rheumatic heart disease acutely (onset of Group A Strep infection) | mitral regurg
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| Rheumatic heart disease later on (years after infection) | mitral stenosis
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| Mid-systolic click | MVP
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| Late-peaking systolic murmur with ejection click | another way they describe aortic stenosis
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| Bounding pulses + massively wide pulse pressure | aortic regurg
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| Brisk upstroke + precipitous downstroke of pulse | aortic regurg
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| Syncope + angina + dyspnea (SAD) | aortic stenosis
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| Dyspnea in second trimester of pregnancy | mitral stenosis
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| Dyspnea late in pregnancy | peripartum cardiomyopathy
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| Screening at age 50 | mammogram (every two years) + colonoscopy (every ten years)
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| Colon cancer in first-degree relative (sibling or parent) | start at age 40 or ten years before diagnosis in relative, whichever is earlier, and do every 5 years.
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| Breast imaging (if performed) | ultrasound only under age 30; over age 30 do mammogram +/- ultrasound
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| Anuria (no urine output) after removal of catheter | acute urethral obstruction
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| Contrast induced nephropathy; how to prevent | saline hydration beforehand
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| BUN/Cr > 20 | prerenal (hypovolemia)
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| BUN/Cr <20 | not prerenal (15-20 for post-renal, and <15 for intra-renal is wrong on 2CK NBMEs)
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| Blood loss + oliguria | acute tubular necrosis
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| Blood loss + obstetric catastrophe | diffuse cortical necrosis
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| Sickle cell + nephrotic syndrome | focal segmental glomerulosclerosus
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| Sickle cell + red urine | renal papillary necrosis
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| 2+ blood in urine but 0-4 RBCs/HPF on LM | false + blood on dipstick
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| Pleural / supradiaphragmatic plaques | asbestosis
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| Preferred antibiotic in sepsis | ceftriaxone
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| Sepsis Tx in young children | cefotaxime
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| Tx for spontaneous bacterial peritonitis | ceftriaxone
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| Cirrhosis or recent peritoneal dialysis or nephrotic syndrome + fever + abdo pain | SBP
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| Dysphagia to solids and liquids at the same time to start | says neurogenic cause
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| Dysphagia to solids that progresses to solids and liquids | esophageal cancer
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| Halitosis +/- gurgling sound when swallowing +/- regurgitation of undigested food | Zenker
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| Zenker + achalasia initial Dx modality | barium swallow
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| After barium swallow is done and shows bird’s beak appearance | monometry to confirm Dx of achalasia
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| Pt with Hx of GERD + dysphagia | straight to endoscopy to rule out cancer
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| Diabetic pt with new-onset GERD | diabetic gastroparesis
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| Diabetic pt with new-onset GERD | give metoclopramide, not PPI
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| Diabetic gastroparesis before giving med | endoscopy first to rule out physical obstruction
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| Endoscopy negative for diabetic gastroparesis | do gastric-emptying scintigraphy
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| Bulimia nervosa or anorexia | never give buproprion (seizure risk)
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| Electrolyte abnormality in anorexia | hypokalemia
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| Most common cause of death in anorexia | arrhythmia from hypokalemia
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| Refeeding syndrome | worry about hypophosphatemia
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| Tx of anorexia + depression | mirtazapine (alpha-2 antagonist); stimulates appetite
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| Amenorrhea in anorexia | low FSH + low estrogen (hypogonadotropic)
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| Premature ovarian failure + Turner syndrome + menopause | high FSH (low inhibin) + low estrogen
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| Cholelithiasis | Dx with abdo ultrasound; fat, forties, female, fertile
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| Biliary colic + fever | cholecystitis
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| Tx of cholelithiasis + cholecytitis | cholecystectomy
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| Pt doesn’t want surgery or is pregnant | ursodeoxycholic acid (ursodiol)
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| Abdo USS negative in suspected cholecystitis | HIDA scan
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| Gall bladder doesn’t light up on HIDA scan | confirms cholecystitis
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| Cholelithiasis in pregnancy | estrogen upregulates HMG-CoA reductase + progesterone slows biliary peristalsis
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| Trichotillomania (eating one’s hair) + GI symptoms | gastric bezoar (hair ball)
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| Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms | small bowel obstruction (SBO)
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| MEHLMANMEDICAL.COM |
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| Renal failure + friction rub over chest | uremic pericarditis
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| High leukocytes + low leukocyte ALP | CML
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| Metamyelocytes + myelocytes + splenomegaly | CML
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| Tx of CML | imatinib; causes fluid retention / edema
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| Smudge cells + autoimmune hemolytic anemia | CLL
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| Auer rods | AML; composed of myeloperoxidase
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| Tx of AML | DIC caused by Auer rod release into blood
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| Kid with high lymphocytes | ALL or pertussis (weird bc bacterial, but lymphocytes often >30k) Dry cough in winter
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| Young African American woman + dry cough + normal CXR | asthma (activation of mast cells), not sarcoidosis Young African American woman + dry cough + nodularity on CXR
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| Hypercalcemia in sarcoid, why? | epithelioid (activated) macrophages produce 1-alpha hydroxylase, thereby activating vitamin D3
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|
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| Increased calcium in sarcoid | means decreased calcium in feces (bc D3 increased small bowel absorption) Tx for sarcoid
🗑
|
||||
| Outpatient Tx of asthma | SABA, then low-dose ICS, then maximize dose of ICS, then LABA, then use any number of drugs (e.g., mast cell stabilizers, anti-leukotriene, etc.), then oral steroids last resort
🗑
|
||||
| Kid with asthma on SABA inhaler + not effective + next best step? | ICS (fluticasone)
🗑
|
||||
| Kid with asthma on SABA inhaler + most effective way to decrease recurrence? | oral steroids (not next best step, but certainly most effective)
🗑
|
||||
| 40s male + hematuria + hemoptysis | Goodpasture syndrome
🗑
|
||||
| Antibodies in Goodpasture | Anti-GBM (anti-collagen IV)
🗑
|
||||
| Dx of Goodpasture | antibodies first, but confirmatory is renal biopsy showing linear immunofluorescence Hematuria + hemoptysis + “head-itis” (mastoiditis, sinusitis, otitis, nasal septal perforation)
🗑
|
||||
| New name for Wegener | granulomatosis with polyangiitis
🗑
|
||||
| Dx of Wegener | c-ANCA (anti-PR3; anti-proteinase 3)
🗑
|
||||
| Asthma + eosinophilia | Churg-Strauss
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 11 |
🗑
|
||||
| New name for Churg strauss | eosinophilic granulomatosis with polyangiitis
🗑
|
||||
| Dx of CS | p-ANCA (anti-MPO; anti-myeloperoxidase)
🗑
|
||||
| Hematuria in isolation + p-ANCA in serum | microscopic polyangiitis (MP)
🗑
|
||||
| Severe renal disease in Wegener or Goodpasture or MP | rapidly progressive glomerulonephritis (crescentic) High ALP + high direct bilirubin + high amylase or lipase
🗑
|
||||
| High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy | sphincter of Oddi dysfunction (can’t be a stone cuz the gallbladder was removed ages ago)
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy | choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point) Dx and Tx of choledocholithiasis
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy | pancreatic cancer
🗑
|
||||
| Dx of pancreatic cancer | CT abdo with contrast
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative | cholangiocarcinoma
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol | primary biliary cirrhosis (PBC)
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) | PBC Dx of PBC
🗑
|
||||
| Recent cholecystectomy + fever + abdo pain | post-op bile leak
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct | choledochal cyst
🗑
|
||||
| Imaging to view liver or pancreas | CT with contrast
🗑
|
||||
| Imaging to view gallbladder | Ultrasound
🗑
|
||||
| Imaging to view gallbladder in suspected cholecystitis only if USS negative | HIDA scan
🗑
|
||||
| Imaging to view bile ducts | ERCP or MRCP (choose ERCP > MRCP if both listed)
🗑
|
||||
| Teenage girl with Hx of cutaneous candida infections since childhood | chronic mucocutaneous candidiasis MCC
🗑
|
||||
| Bacterial + fungal + protozoal + viral infections since birth | SCID
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 12 |
🗑
|
||||
| Bacterial infections since age 6 months | Bruton
🗑
|
||||
| Bacterial infections only since birth | Bruton (rare as hell to say from birth, but it’s on new 2CK NBME)
🗑
|
||||
| SCID XR variant | common gamma-chain mutation (IL-2 receptor deficiency)
🗑
|
||||
| SCID AR variant | adenosine deaminase deficiency
🗑
|
||||
| Bruton mechanism | tyrosine kinase mutation
🗑
|
||||
| Hyper IgM syndrome | deficiency of CD40 ligand on T cell (can’t activate CD40 on B cell to induce isotype class switching)
🗑
|
||||
|
🗑
|
|||||
| Greasy, scaly scalp + itchy + papules + adult | seborrheic dermatitis
🗑
|
||||
| Tx for SD | azole or selenium shampoo
🗑
|
||||
| Tx for tinea capitis | oral griseofulvin for patient only
🗑
|
||||
| How to decrease risk of tinea capitis | avoidance of sharing of hats
🗑
|
||||
| Tx of onychomycosis (nailbed fungus) | oral terbinafine
🗑
|
||||
| Tx of tinea pedis | topical terbinafine or topical azole
🗑
|
||||
| Tx of tinea corporis (ring worm) | topical azole (clotrimazole or miconazole)
🗑
|
||||
| Tx of cutaneous candida | oral azole
🗑
|
||||
| Tx of oropharyngeal candida | nystatin mouthwash
🗑
|
||||
| Tx of esophageal candidiasis | oral azole, not nystatin mouthwash
🗑
|
||||
| Tx of vaginal candidiasis | topical nystatin before trying oral azole
🗑
|
||||
| Odynophagia (painful swallowing) in immunocompromised pt | esophageal candidiasis till proven otherwise
🗑
|
||||
| CNS fungal infection or fungemia (rigors/chills) | amphotericin B
🗑
|
||||
| Cryptococcal meningitis | amphotericin B + flucytosine, then do fluconazole taper
🗑
|
||||
| Simple fungal pneumonia | fluconazole
🗑
|
||||
| Sporothrix schenckii (rose thorn + finger papule) | itraconazole
🗑
|
||||
| Hypopigmentation on upper back / trunk | tinea versicolor (Malassezia furfur)
🗑
|
||||
| Tx of tinea versicolor | topical selenium
🗑
|
||||
| Most common cause of impetigo | S. aureus now exceeds S. pyogenes
🗑
|
||||
| Tx of impetigo | topical mupirocin
🗑
|
||||
| Beefy red, well-demarcated skin plaque | erysipelas
🗑
|
||||
| Most common cause of erysipelas | Group A Strep (S. pyogenes) >>> S. aureus
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| More diffuse pink skin lesion + tenderness + fever | cellulitis
🗑
|
||||
| Most common cause of cellulitis | S. aureus exceeds S. pyogenes
🗑
|
||||
| Tx of erysipelas + cellulitis | oral dicloxacillin or oral cephalexin
🗑
|
||||
| Wide-complex tachyardia | ventricular tachycardia (VT)
🗑
|
||||
| Narrow-complex tachy | SVT
🗑
|
||||
| Tx for SVT | vagal/carotid massage first; if doesn’t work, then adenosine
🗑
|
||||
| Tx of VT | anti-arrhythmics, e.g., amiodarone
🗑
|
||||
| Tx of SVT or VT in setting of coma / unconsciousness | direct-current countershock
🗑
|
||||
| Tx of first-degree heartblock or second-degree Mobitz I (Wenckebach) | observe
🗑
|
||||
| Tx of second-degree Mobitz II or third-degree heartblock | pacemaker
🗑
|
||||
| First-degree heartblock | PR-interval >200 milliseconds
🗑
|
||||
| Mobitz I | gradually prolonging PR-interval before a QRS drops
🗑
|
||||
| Mobitz II | no gradual prolongation of PR-interval; QRS randomly drops
🗑
|
||||
| Third-degree | HR super slow at 30-40; no relation between p-waves and QRS complexes
🗑
|
||||
| Infective causes of third-degree | Lyme disease, congenital lupus, diphtheria
🗑
|
||||
| Give killed IM influenza vaccine when? | Every year in fall/winter only; start from 6 months of age
🗑
|
||||
| Killed IM Influenza vaccine safe in pregnancy? | Yes, give anytime to pregnant women
🗑
|
||||
| Live-attenuated intranasal influenza vaccine guidelines? | Only give age 2-49 to non-pregnant, non- immunocompromised persons
🗑
|
||||
| Vaccines at age 2, 4, 6 months: HepB, Polio Salk, Pneumo PCV13, DPT, HiB, rotavirus (also give HepB at birth) HPV vaccine when | age 9-45
🗑
|
||||
| Mom’s HepB status unknown | give neonate HepB vaccine; only give immunoglobulin if mom comes back + MMR
🗑
|
||||
| Varicella | one dose between 12-18 months
🗑
|
||||
| Age 65 or older | give Pneumo PCV13 followed by PPSV23 6-12 months later
🗑
|
||||
| Asplenia or sickle cell | PCV13 + PPSV23 + HiB + Meningococcal
🗑
|
||||
| Circular lesion in pancreas seen in pancreatitis | pseudoabscess
🗑
|
||||
| Centri-acinar emphysema | smokers
🗑
|
||||
| Pan-acinar emphysema | alpha-1 anti-trypsin deficiency
🗑
|
||||
| Young adult + non-smoker + has emphysema + relative died of hepatic cirrhosis | alpha-1 anti-trypsin deficiency
🗑
|
||||
| CREST syndrome lung pathology? | can cause pulmonary fibrosis
🗑
|
||||
| Restrictive lung disease | normal or increased FEV1/FVC
🗑
|
||||
| Obstructive lung disease | decreased FEV1/FVC
🗑
|
||||
| Why is FEV1/FVC normal or high in restrictive? | radial traction on outside of airways is sticky (keeps airways from closing)
🗑
|
||||
| Apex to base lung changes when sitting/standing | both ventilation + perfusion increase apex to base
🗑
|
||||
| Most common cause of otitis media | Strep pneumo
🗑
|
||||
| Tx of otitis media | oral amoxicillin only
🗑
|
||||
| Tx of recurrent OM | amoxicillin/clavulanate
🗑
|
||||
| When to do tympanostomy tube | three or more OM in 6 months, or 4 or more in a year
🗑
|
||||
| Most common cause of otitis externa | Pseudomonas
🗑
|
||||
| Tx of otitis externa | topical ciprofloxacin + hydrocortisone drops
🗑
|
||||
| Prevention of OE in someone with constant water exposure (e.g., crew team) | alcohol-acetic acid drops
🗑
|
||||
| Tx of earwax buildup | carbamide peroxide drops
🗑
|
||||
| Low hematocrit chronic disease Low hematocrit anemia |
🗑
|
||||
| + low MCV + low transferrin + low TIBC + transferrin saturation normal or low | anemia of
🗑
|
||||
| + low MCV + high transferrin + high TIBC + transferrin saturation super-low | iron deficiency
🗑
|
||||
| + low MCV + increased red cell distribution width (RDW) | iron deficiency anemia + low MCV + low/low-normal RDW
🗑
|
||||
| + low MCV + low iron + low ferritin | iron deficiency
🗑
|
||||
| + low MCV + normal iron + normal or high ferritin | thalassemia
🗑
|
||||
| Low hematocrit |
🗑
|
||||
| Low hematocrit |
🗑
|
||||
| Low hematocrit |
🗑
|
||||
| Low hematocrit |
🗑
|
||||
| Low hematocrit |
🗑
|
||||
| thalassemia |
🗑
|
||||
| Microcytic anemia that doesn’t improve with iron supplementation | thalassemia Dx of thalassemia
🗑
|
||||
| + low MCV + normal iron + normal ferritin in pregnant woman on iron supplements |
🗑
|
||||
| Low hematocrit + normal MCV + low iron + normal or high ferritin | anemia of chronic disease
🗑
|
||||
| Tx of anemia of chronic disease if renal failure is cause | answer = EPO
🗑
|
||||
| Tx of anemia of chronic disease if renal failure not cause (IBD, RA, SLE, etc.) | CANNOT give EPO; Tx
🗑
|
||||
| underlying condition. |
🗑
|
||||
| High BP + smoker + TIA or stroke or retinal artery occlusion. How to best decrease stroke risk | Answer =
🗑
|
||||
| lisinopril, not smoking cessation |
🗑
|
||||
| Normotensive old pt + TIA or stroke or retinal artery occlusion | atrial fibrillation
🗑
|
||||
| Hypertensive pt + stroke | do carotid duplex ultrasound
🗑
|
||||
| Normotensive pt + stroke | do ECG; if ECG normal
🗑
|
||||
| High BMI female + irregular menstrual cycles | anovulation
🗑
|
||||
| Anovulation + hirsutism | PCOS
🗑
|
||||
| Anovulation. Cause USMLE wants? | insulin resistance
🗑
|
||||
| Why hirsutism in anovulation | abnormal GnRH pulsation causes high LH/FSH ratio
🗑
|
||||
| Why high LH/FSH ratio important in anovulation/PCOS | ovulation stimulated when follicle not ready
🗑
|
||||
| ovulation (anovulation) | follicle retained as cyst
🗑
|
||||
| What’s LH do? | Stimulates theca interna cells (females) and Leydig cells (males) to make androgens
🗑
|
||||
| What’s FSH do? | Stimulates granulosa cells (females) and Sertoli cells (males) to make aromatase; also
🗑
|
||||
| primes follicles |
🗑
|
||||
| Tx for PCOS | if high BMI, weight loss first always on USMLE
🗑
|
||||
| Tx for PCOS if they ask for meds and/or weight loss already tried | OCPs (if not wanting pregnancy);
🗑
|
||||
| clomiphene (if wanting pregnancy) |
🗑
|
||||
| PCOS increases risk of what | endometrial cancer (unopposed estrogen)
🗑
|
||||
| Tx of prostate cancer | flutamide + leuprolide together (if they force a sequence, choose F then L).
🗑
|
||||
| Tx of acute gout | indomethacin (NSAID) first on USMLE; then steroids, then colchicine
🗑
|
||||
| Tx of acute gout if indomethacin + steroids not listed | colchicine
🗑
|
||||
| Tx of acute gout in pt with renal insufficiency or Hx of renal transplant | steroids
🗑
|
||||
| Tx of chronic gout (decrease recurrence) | allopurinol or febuxostat (xanthine oxidase inhibitors)
🗑
|
||||
| Never give which drug to pt with Hx of uric acid stones or over-producer | probenecid (uricosuric)
🗑
|
||||
| What are rasburicase / pegloticase | urate oxidase analogues
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Young kid + self-mutilation + red-orange crystals in diaper | Lesch-Nyhan syndrome (X-linked) Lesch-Nyhan enzyme
🗑
|
||||
| Crystal type in pseudogout | calcium pyrophosphate deposition disease
🗑
|
||||
| Two main causes of pseudogout | primary hyperparathyroidism + hemochromatosis
🗑
|
||||
| Two ways pseudogout presents | monoarthritis of large joint (i.e., knee) or osteoarthritis-like presentation in someone with primary hyperparathyroidism or hemochromatosis
🗑
|
||||
| 32M + dark skin on forearms + increased fasting glucose; Dx? | hemochromatosis (bronze diabetes)
🗑
|
||||
| Same male + painful hands + x-ray shows DIP involvement. Joint pain Dx? | pseudogout
🗑
|
||||
| Tx of pseudogout | same as gout acutely; Tx underlying condition for chronic
🗑
|
||||
| Biggest risk factor for osteoarthritis | obesity
🗑
|
||||
| Tx of osteoarthritis | weight loss; if normal BMI
🗑
|
||||
| Patient with OA taking naproxen (NSAID) + peripheral edema | increased renal retention of sodium
🗑
|
||||
| Patient taking NSAID + edema; why? | NSAID decreases renal blood flow
🗑
|
||||
| compensate for perceived low volume status | water follow sodium
🗑
|
||||
| Tx of rheumatoid arthritis | Two-armed: symptom-relief + disease-modifying anti-rheumatic drugs (DMARDs)
🗑
|
||||
| Symptom-relief for RA | NSAID first, then steroids (these do symptoms only; do not slow disease progression)
🗑
|
||||
| DMARDs for early RA | always methotrexate first; if insufficient, add another DMARD (sulfasalazine or
🗑
|
||||
| leflunomide); if insufficient add anti-TNF-alpha agent |
🗑
|
||||
| Methotrexate MOA | dihydrofolate reductase inhibitor
🗑
|
||||
| Methotrexate side-effects | pulmonary fibrosis + hepatotoxicity + mouth ulcers (neutropenia)
🗑
|
||||
| Sulfasalazine MOA | metabolized into sulfapyridine + mesalamine in the gut by bacteria
🗑
|
||||
| Mesalamine is 5-ASA absorbed as the Tx for RA; only NSAID considered to be DMARD |
🗑
|
||||
| Leflunomide MOA | dihydroorotate dehydrogenase inhibitor (pyrimidine synthesis)
🗑
|
||||
| Most specific Abs in RA | anti-CCP (cyclic citrullinated peptide), not RF (rheumatoid factor)
🗑
|
||||
| X-ray of hands in RA vs OA | Only OA has DIPs involved; RA is PIPs + MCPs
🗑
|
||||
| Symmetry in RA vs OA | RA is symmetrical; OA is not
🗑
|
||||
| Any pt with red, warm, tender knee | joint aspiration (arthrocentesis); septic arthritis till proven otherwise
🗑
|
||||
| Biggest risk factor for septic arthritis | abnormal joint architecture
🗑
|
||||
| Pt groups most likely to get SA | prosthetic joints, RA/OA, recent intense exercise/joint trauma; peds (JRA) MEHLMANMEDICAL.COM 17
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Pt group most likely to get SA | those with prosthetic joints (can’t be more abnormal than fake joint) Pt with OA or RA has red, warm, tender knee
🗑
|
||||
| 17F had kickboxing tournament last weekend + knee is red, warm, tender | arthrocentesis (SA)
🗑
|
||||
| Kid + recurrent knee redness, warmth, pain + fever | Juvenile rheumatoid arthritis (JRA; Still disease) Kid + recurrent joint pain +/- high ESR +/- rash
🗑
|
||||
| Kid + recurrent joint pain + anemia | JRA (anemia of chronic disease)
🗑
|
||||
| Kid with suspected JRA has sore knee | must do arthrocentesis to rule out septic arthritis
🗑
|
||||
| Most common presentation finding in SLE | arthritis (>90%)
🗑
|
||||
| Woman 20s-40s + arthritis + thrombocytopenia | SLE
🗑
|
||||
| Woman 20s-40s + arthritis + mouth ulcer + circular skin lesions | SLE
🗑
|
||||
| Malar rash + low RBCs + low WBCs + low platelets; mechanism for low cell lines? | increased peripheral destruction (antibodies against hematologic cells lines seen in SLE; isolated thrombocytopenia most common) Tx of SLE flare
🗑
|
||||
| SLE + red urine; Dx? | lupus nephritis, more specifically, diffuse proliferative glomerulonephritis (DPGN) Histology of DPGN
🗑
|
||||
| Tx of lupus nephritis | mycophenolate mofetil
🗑
|
||||
| Tx of discoid lupus | hydroxychloroquine
🗑
|
||||
| Most specific Abs for SLE | anti-Smith (RNP), not anti-dsDNA
🗑
|
||||
| Which Abs go up in acute SLE flares | anti-dsDNA (and C3 goes down)
🗑
|
||||
| Drug-induced lupus Abs | anti-histone
🗑
|
||||
| Drugs that cause DIL | Mom is HIPP
🗑
|
||||
| Viral infection + all three cell-lines are down | viral-induced aplastic anemia
🗑
|
||||
| Viral-induced aplastic anemia; next best step in Dx? | bone marrow aspiration
🗑
|
||||
| Viral-induced aplastic anemia; mechanism? | defective bone marrow production (contrast with SLE)
🗑
|
||||
| Viral infection + low platelets | ITP (immune thrombocytopenic purpura)
🗑
|
||||
| Woman 30s-40s with random bruising at different stages of healing | (also ITP; first rule out abuse) Mechanism of ITP
🗑
|
||||
| Dx of ITP | answer = low platelet count; don’t choose increased bleeding time
🗑
|
||||
| ITP Tx | steroids first, then IVIG, then splenectomy
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 18 |
🗑
|
||||
| ITP episode | next best step in management
🗑
|
||||
| ITP episode | most effective way to decrease recurrence
🗑
|
||||
| Family Hx of heme condition treated with splenectomy | hereditary spherocytosis (autosomal dominant)
🗑
|
||||
| Bleeding time meaning? | platelet problem
🗑
|
||||
| PT and aPTT meaning? | clotting factor problem
🗑
|
||||
| Heme findings in ITP | increased BT, normal PT, normal aPTT
🗑
|
||||
| Heme findings in hemophilia | increased aPTT; bleeding time and PT are normal
🗑
|
||||
| Cause of hemophilia | X-linked recessive; hemophilia A (factor VIII def); hemophilia B (factor IX def)
🗑
|
||||
| Tx of hemophilia A | desmopressin for hemophilia A (increases VIII release); then give factor VIII
🗑
|
||||
| Tx of hemophilia B | give factor IX
🗑
|
||||
| Classic hemophilia presentation | hemarthrosis in school-age boy; bleeding after circumcision in neonate
🗑
|
||||
| Inheritance pattern of vWD | AD
🗑
|
||||
| Heme findings in vWD | bleeding time always high; PT always normal; aPTT elevated half the time
🗑
|
||||
| What is main function of vWF? | bridges platelet GpIb to underlying collagen (adhesion, not aggregation)
🗑
|
||||
| What is secondary function of vWF | stabilizes factor VIII in plasma (that’s why aPTT only half time increased)
🗑
|
||||
| vWD presentation | always one platelet problem + one clotting factor problem
🗑
|
||||
| Platelet problem? | epistaxis, bruising, petechiae
🗑
|
||||
| Clotting factor problem | menorrhagia, excessive bleeding with tooth extraction, hemarthrosis (but
🗑
|
||||
| hemarthrosis very very rare in vWD; it is seen in hemophilia) |
🗑
|
||||
| vWD treatment | desmopressin
🗑
|
||||
| Vitamin K deficiency heme parameters? | Increased PT + aPTT; bleeding time normal
🗑
|
||||
| Cause of vitamin K deficiency in adults | chronic Abx knock out colonic flora
🗑
|
||||
| Cause of sickle cell | glutamic acid to valine mutation on beta-chain
🗑
|
||||
| Inheritance of sickle cell | AR
🗑
|
||||
| Nephrotic syndrome in SS | FSGS
🗑
|
||||
| Dark urine in SS | renal papillary necrosis
🗑
|
||||
| HY drugs that cause agranulocytosis | clozapine, ganciclovir, propylthiouracil, methimazole, methotrexate,
🗑
|
||||
| ticlopidine |
🗑
|
||||
| How will agranulocytosis (neutropenia) present on USMLE? | mouth ulcers + fever MEHLMANMEDICAL.COM 19
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Tx for febrile neutropenia / neutropenic fever | immediate broad-spectrum IV Abx Broad-spectrum Abx example?
🗑
|
||||
| PTU and methimazole are used for what? | Tx of Graves
🗑
|
||||
| Ticlopidine is what? | ADP2Y12 blocker anti-platelet agent (clopidogrel, prasugrel, ticagrelor also)
🗑
|
||||
| Strongest indication for anti-coagulation | prosthetic material in heart / prosthetic valve (factoid in isolation)
🗑
|
||||
| Travel + self-limiting watery or brown/green diarrhea | Traveler diarrhea = ETEC HL or HS toxin
🗑
|
||||
| Abx (clindamycin, beta-lactam, cephalosporin) + diarrhea | C. difficile
🗑
|
||||
| Dx of C. diff | stool AB toxin test, not stool culture
🗑
|
||||
| Fever of 104 + abdo distension in C diff | toxic megacolon
🗑
|
||||
| Tx of C. diff | vancomycin, not metronidazole (updated guidelines as of Feb 2018)
🗑
|
||||
| Bloody diarrhea + travel | Entamoeba histolytica
🗑
|
||||
| Tx of E. histolytica | metronidazole + iodoquinol; can give paromomycin
🗑
|
||||
| Close quarters or military barracks or cruise ship + watery diarrhea | Norwalk virus
🗑
|
||||
| Child <5 years + watery diarrhea | rotavirus
🗑
|
||||
| Few organisms causing bloody diarrhea | Shigella
🗑
|
||||
| Bloody diarrhea + appendicitis-like pain (pseudoappendicitis) in a child | Yersinia enterocolitica
🗑
|
||||
| Bloody diarrhea + reactive arthritis in an adult | Y. enterocolitica, Campylobacter, Shigella, Salmonella
🗑
|
||||
| Diarrhea + Guillain-Barre syndrome | Campylobacter
🗑
|
||||
| GBSyndrome CSF? | albuminocytologic dissociation (high protein + normal cells)
🗑
|
||||
| GBSyndrome Dx? | electromyography + nerve conduction studies (on NBME)
🗑
|
||||
| Cardiac ischemia + need to evaluate | ECG stress test first-line
🗑
|
||||
| Cardiac ischemia + abnormal baseline ECG (e.g., BBB) | Echo stress test (need normal ECG to do ECG stress test)
🗑
|
||||
| Cardiac ischemia + patient can’t exercise | dobutamine + ECG/echo
🗑
|
||||
| ECG shows diffuse ST-segment elevations | pericarditis
🗑
|
||||
| Pericarditis Tx | NSAID, or steroid, or colchicine
🗑
|
||||
| Central chest pain worse when supine; better when leaning forward | pericarditis
🗑
|
||||
| Lateral chest pain after viral infection + increased CK | pleurodynia (intercostal muscle spasm)
🗑
|
||||
| ST-segment depressions in the anterior ECG leads | posterior MI
🗑
|
||||
| Electrical alternans on ECG | pericardial tamponade / pericardial effusion
🗑
|
||||
| Pulsus paradoxus (drop in systolic BP >10 mm with inspiration) | cardiac tamponade or severe asthma
🗑
|
||||
| Beck triad | hypotension + muffled heart sounds + JVD
🗑
|
||||
| Bloody diarrhea + poultry consumption | Campylobacter jejuni or Salmonella spp.
🗑
|
||||
| Tx of tamponade | pericardiocentesis or pericardial window
🗑
|
||||
| Tamponade | do echo before pericardiocentesis if both listed (even though sounds wrong, on 2CK NBME)
🗑
|
||||
| CPP + lobar pattern (right-lower lobe consolidation + dullness to percussion) | Strep pneumo
🗑
|
||||
| CPP + lobar pattern, but they say “interstitial” in the vignette description | Mycoplasma, not S. pneumo Empiric Tx for CPP
🗑
|
||||
| Tx for CPP is pt on Abx past three months | fluoroquinolone over azithro
🗑
|
||||
| Pneumonia in CF patient <10 years | S. aureus exceeds Pseudomonas
🗑
|
||||
| Pneumonia in CF patient >10 years | Pseudomonas exceeds S. aureus.
🗑
|
||||
| Pneumonia after influenza infection | USMLE wants S. aureus
🗑
|
||||
| Pneumonia + rabbits | F. tularensis
🗑
|
||||
| Pneumonia + cattle | Coxiella (Q fever)
🗑
|
||||
| Pneumonia + birds | Chlamydia psittaci
🗑
|
||||
| Leg swelling + pain + shortness of breath | Pulmonary embolism caused by DVT
🗑
|
||||
| Tx of PE | Heparin before spiral CT
🗑
|
||||
| Tx of PE in pregnant woman | V/Q scan, not CT
🗑
|
||||
| Tx of PE in someone already on warfarin | spiral CT to confirm, then IVC filter
🗑
|
||||
| Acid-base disturbance in PE | resp. alkalosis (low CO2, high pH, low O2, normal bicarb [too acute to change]) Acid-base disturbance in asthma
🗑
|
||||
| Acid-base disturbance in aspirin toxicity first 20 mins | resp. alkalosis (low CO2, high pH, normal O2, normal bicarb [too acute to change])
🗑
|
||||
| Acid-base disturbance in aspirin toxicity after 20 mins | mixed metabolic acidosis-respiratory alkalosis (low CO2, low pH, normal O2, low bicarb)
🗑
|
||||
| Tx for aspirin toxicity | bicarb (increased excretion through urinary alkalinization)
🗑
|
||||
| Tx for TCA toxicity | sodium bicarb
🗑
|
||||
| Normal calcium | 8.4-10.2 mEq/L
🗑
|
||||
| Tx of hypercalcemia | 10.2-12 -> normal saline (0.9% NaCl)
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 4 |
🗑
|
||||
| Community-acquired pneumonia (CPP) + bilateral CXR infiltrates | Mycoplasma
🗑
|
||||
| Tx of hypercalcemia | 12-14 -> normal saline (0.9% NaCl) only if asymptomatic; add bisphosphonate (e.g., pamidronate) if symptomatic
🗑
|
||||
| Tx of hypercalcemia | 14+ -> normal saline (0.9% NaCl) + bisphosphonate
🗑
|
||||
| High calcium + polyuria | nephrogenic diabetes insipidus (weird, but on NBME)
🗑
|
||||
| High calcium + confusion | delirium caused by high calcium
🗑
|
||||
| Low calcium or potassium not responsive to supplementation | cause is low Mg
🗑
|
||||
| Low calcium or potassium in alcoholic | hypomagnesemia is cause
🗑
|
||||
| Ataxia, confusion, ophthalmoplegia | Wernicke encephalopathy (B1 deficiency)
🗑
|
||||
| Retrograde amnesia + confabulation in alcoholic | Korsakoff psychosis
🗑
|
||||
| Wernicke-Korsakoff syndrome | mammillary bodies
🗑
|
||||
| Hx of many pregnancies + downward movement of vesicourethral junction | stress incontinence
🗑
|
||||
| Tx of stress incontinence | pelvic floor exercises (Kegel); if insufficient
🗑
|
||||
| Hyperactive detrusor or detrusor instability | urge incontinence
🗑
|
||||
| Need to run to bathroom when sticking key in a door | urge incontinence
🗑
|
||||
| Incontinence in multiple sclerosis patient or perimenopausal | urge incontinence
🗑
|
||||
| Tx of urge incontinence | oxybutynin (muscarinic cholinergic antagonist) or mirabegron (beta-3 agonist) Incontinence + high post-void volume (usually 3-400 in question; normal is <50 mL)
🗑
|
||||
| Tx for overflow incontinence in diabetes | bethanacol (muscarinic cholinergic agonist)
🗑
|
||||
| Incontinence in BPH | overflow incontinence due to outlet obstruction
🗑
|
||||
| Tx for overflow incontinence in BPH | insert catheter first; then give alpha-1 blocker of 5-alpha-reductase inhibitor; then TURP if necessary
🗑
|
||||
| Exquisitely tender prostate on digital rectal exam | prostatitis
🗑
|
||||
| Prostatitis Tx | ciprofloxacin (fluoroquinolone
🗑
|
||||
| Costovertebral angle tenderness + fever | pyelonephritis
🗑
|
||||
| Costovertebral angle tenderness + granular casts | pyelonephritis (correct, super-weird; NOT acute tubular necrosis; this is on 2CK NBME)
🗑
|
||||
| Tx for pyelonephritis | ciprofloxacin, OR ampicillin + gentamicin
🗑
|
||||
| Saddle anesthesia + urinary retention | cauda equina syndrome
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 5 |
🗑
|
||||
| Perianal anesthesia + urinary retention or incontinence | conus medullaris syndrome
🗑
|
||||
| Gradual-onset dementia + no sensory or motor dysfunction | Alzheimer
🗑
|
||||
| Mini-mental state exam score low + patient tries to do well | Alzheimer
🗑
|
||||
| Mini-mental state exam score low + patient is apathetic / takes long to perform tasks / does poorly on reverse serial 7s | depression (pseudodementia)
🗑
|
||||
| Patient complains about memory loss | normal aging, not Alzheimer
🗑
|
||||
| First-line Tx for Alzheimer | donepezil (cholinesterase inhibitor also give galantamine or rivastigmine
🗑
|
||||
|
🗑
|
|||||
| NMDA receptor (glutamate receptor) antagonist used in Alzheimer Tx | memantine
🗑
|
||||
| Step-wise dementia/decline and/or sensory/motor disturbance | vascular dementia
🗑
|
||||
| Hx of hypertension + dementia + sensory/motor disturbance | vascular dementia
🗑
|
||||
| Visual hallucinations + Parkinsonism + dementia | Lewy body dementia
🗑
|
||||
| Apathy + disinhibition + personality change + dementia | frontotemporal dementia (Pick disease)
🗑
|
||||
| Urinary incontinence + ataxia + CNS dysfunction (wet, wobbly, wacky) | Normal-pressure hydrocephalus
🗑
|
||||
| Wet, wobbly, wacky + Parkinsonism | still NPH
🗑
|
||||
| Parkinsonism in young patient | Wilson disease till proven otherwise
🗑
|
||||
| Parkinsonism in older patient | Parkinson disease
🗑
|
||||
| Parkinsonism + axial dystonia | progressive supranuclear palsy
🗑
|
||||
| Tx of UTI | TMP/SMX or nitrofurantoin
🗑
|
||||
| Tx of cystitis | nitrofurantoin (need not be pregnant)
🗑
|
||||
| Waiter tip position in kid | upper brachial plexus injury
🗑
|
||||
| Claw hand | lower brachial plexus
🗑
|
||||
| Pronated arm + wrist-drop | radial nerve injury
🗑
|
||||
| Midshaft fracture of humerus | Radial nerve injury
🗑
|
||||
| Supracondylar fracture of humerus | median nerve injury
🗑
|
||||
| Surgical neck of humerus fracture | axillary nerve injury
🗑
|
||||
| Medial epicondylar injury | ulnar nerve injury
🗑
|
||||
| Weakened biceps + loss of sensation of lateral forearm | musculocutaneous nerve injury
🗑
|
||||
| Paresthesias + pain following burn or casting | compartment syndrome
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Compartment syndrome Dx | measure compartment pressure
🗑
|
||||
| Compartment syndrome Tx | fasciotomy of uncast
🗑
|
||||
| Guy lifts heavy box | severe lower back pain + muscle spasm + no radiculopathy
🗑
|
||||
| Lumbosacral strain diagnosis | DO NOT x-ray
🗑
|
||||
| Lumbosacral strain Tx | NSAIDs + exercise as tolerated; bedrest is the WRONG answer
🗑
|
||||
| Guy lifts heavy box | severe lower back pain + radiculopathy
🗑
|
||||
| Point tenderness over a vertebra in older woman | osteoporosis (compression fracture)
🗑
|
||||
| Point tenderness over a vertebra in younger patient on steroids | osteoporosis (compression fracture)
🗑
|
||||
| Point tenderness over a vertebra in patient with autoimmune disease | recognize patient is on steroids -> osteoporosis (compression fracture)
🗑
|
||||
|
🗑
|
|||||
| Point tenderness over a vertebra in IV drug user | epidural abscess
🗑
|
||||
| “Step-off” of one vertebra relative to another | spondylolisthesis
🗑
|
||||
| Back pain worse in the morning and gets better throughout day in male 20s-40s | ankylosing spondylitis
🗑
|
||||
| Bamboo spine | ankylosing spondylitis
🗑
|
||||
| Dx of AS | x-ray of sacroiliac joints
🗑
|
||||
| Back pain worse when standing or walking for long periods of time | lumbar spinal stenosis
🗑
|
||||
| Radiculopathy down an arm | cervical disc herniation
🗑
|
||||
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | atlantoaxial subluxation
🗑
|
||||
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | MR of spine to Dx atlantoaxial subluxation
🗑
|
||||
| Prior to surgery in rheumatoid arthritis patient | cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation
🗑
|
||||
|
🗑
|
|||||
| Back pain in elderly patient with hypercalcemia | multiple myeloma or metastases
🗑
|
||||
| Back in pain in patient with history of other type of cancer | metastases
🗑
|
||||
| Suspected spinal mets | MRI
🗑
|
||||
| Metastases to long bones in prostate cancer | osteoblastic (Dx with bone scan); spine do MRI
🗑
|
||||
| High hemoglobin +/- pruritis after shower +/- plethora +/- splenomegaly | polycythemia vera
🗑
|
||||
| High hemoglobin + low EPO | polycythemia vera
🗑
|
||||
| Pruritis after shower | basophilia
🗑
|
||||
| High hemoglobin + lung disease / low pO2 | secondary polycythemia (high EPO)
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Polycythemia + hypercalcemia + smoker + red urine | RCC (paraneoplasic EPO + PTH-rp)
🗑
|
||||
| Blurry vision or Raynaud or pain in fingers or headache | hyperviscosity syndrome Hyperviscosity syndrome
🗑
|
||||
| Hereditary spherocytosis | AD, ankyrin or spectrin or band protein deficiency; Tx = splenectomy Treatment for ITP
🗑
|
||||
| Tx for hereditary hemochromatosis | serial phlebotomy
🗑
|
||||
| Tx for secondary hemochromatosis (transfusional siderosis) | chelation therapy (deferoxamine)
🗑
|
||||
| Viral infection + tinnitus + vertigo +/- neurosensory hearing loss | labrynthitis
🗑
|
||||
| Viral infection + vertigo | vestibular neuritis
🗑
|
||||
| Tx for multiple sclerosis flares | IV steroids (IV methylprednisolone)
🗑
|
||||
| Given to MS patients between flares | interferon-beta
🗑
|
||||
| Tx for spasticity in MS | baclofen (GABA-B receptor agonist)
🗑
|
||||
| Incontinence in MS | urge (hyperactive detrusor, as mentioned earlier)
🗑
|
||||
| New-onset murmur + fever | endocarditis till proven otherwise
🗑
|
||||
| Empiric Tx for endocarditis | vancomycin or ampicillin/sulbactam, PLUS gentamicin
🗑
|
||||
| Beta-lactam (e.g., nafcillin) or cephalosporin + rash + renal issue | interstitial nephritis
🗑
|
||||
| Interstitial nephritis | WBCs in the urine (eosinophils)
🗑
|
||||
| Fixed splitting of S2 | atrial septal defect
🗑
|
||||
| Holosystolic murmur at left sternal border PLUS either parasternal heave or palpable thrill | VSD
🗑
|
||||
| Holosystolic murmur at left sternal border PLUS diastolic rumble | also VSD
🗑
|
||||
| To-and-fro murmur | PDA (on 2CK NBME)
🗑
|
||||
| Pan-systolic-pan-diastolic murmur | PDA
🗑
|
||||
| Continuous, machinery-like murmur | PDA
🗑
|
||||
| Congenital rubella syndrome | PDA
🗑
|
||||
| Heart problem in neonate of mom with SLE | congenital third-degree heartblock
🗑
|
||||
| Heart problem in William syndrome | supravalvular aortic stenosis
🗑
|
||||
| Bicuspid aortic valve | aortic stenosis
🗑
|
||||
| Mid-systolic (crescendo-decrescendo) murmur + gets worse with Valsalva | HOCM
🗑
|
||||
| Mid-systolic (crescendo-decrescendo) murmur + no change or softens with Valsalva | aortic stenosis MEHLMANMEDICAL.COM 8
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Myxomatous degeneration of mitral valve | mitral valve prolapse
🗑
|
||||
| Marfan or Ehlers-Danlos syndrome | MVP or aortic regurg
🗑
|
||||
| Rheumatic heart disease acutely (onset of Group A Strep infection) | mitral regurg
🗑
|
||||
| Rheumatic heart disease later on (years after infection) | mitral stenosis
🗑
|
||||
| Mid-systolic click | MVP
🗑
|
||||
| Late-peaking systolic murmur with ejection click | another way they describe aortic stenosis
🗑
|
||||
| Bounding pulses + massively wide pulse pressure | aortic regurg
🗑
|
||||
| Brisk upstroke + precipitous downstroke of pulse | aortic regurg
🗑
|
||||
| Syncope + angina + dyspnea (SAD) | aortic stenosis
🗑
|
||||
| Dyspnea in second trimester of pregnancy | mitral stenosis
🗑
|
||||
| Dyspnea late in pregnancy | peripartum cardiomyopathy
🗑
|
||||
| Screening at age 50 | mammogram (every two years) + colonoscopy (every ten years)
🗑
|
||||
| Colon cancer in first-degree relative (sibling or parent) | start at age 40 or ten years before diagnosis in relative, whichever is earlier, and do every 5 years.
🗑
|
||||
|
🗑
|
|||||
| Breast imaging (if performed) | ultrasound only under age 30; over age 30 do mammogram +/- ultrasound
🗑
|
||||
| Anuria (no urine output) after removal of catheter | acute urethral obstruction
🗑
|
||||
| Contrast induced nephropathy; how to prevent | saline hydration beforehand
🗑
|
||||
| BUN/Cr > 20 | prerenal (hypovolemia)
🗑
|
||||
| BUN/Cr <20 | not prerenal (15-20 for post-renal, and <15 for intra-renal is wrong on 2CK NBMEs)
🗑
|
||||
| Blood loss + oliguria | acute tubular necrosis
🗑
|
||||
| Blood loss + obstetric catastrophe | diffuse cortical necrosis
🗑
|
||||
| Sickle cell + nephrotic syndrome | focal segmental glomerulosclerosus
🗑
|
||||
| Sickle cell + red urine | renal papillary necrosis
🗑
|
||||
| 2+ blood in urine but 0-4 RBCs/HPF on LM | false + blood on dipstick
🗑
|
||||
| Pleural / supradiaphragmatic plaques | asbestosis
🗑
|
||||
| Preferred antibiotic in sepsis | ceftriaxone
🗑
|
||||
| Sepsis Tx in young children | cefotaxime
🗑
|
||||
| Tx for spontaneous bacterial peritonitis | ceftriaxone
🗑
|
||||
| Cirrhosis or recent peritoneal dialysis or nephrotic syndrome + fever + abdo pain | SBP
🗑
|
||||
| Dysphagia to solids and liquids at the same time to start | says neurogenic cause
🗑
|
||||
| Dysphagia to solids that progresses to solids and liquids | esophageal cancer
🗑
|
||||
| Halitosis +/- gurgling sound when swallowing +/- regurgitation of undigested food | Zenker
🗑
|
||||
| Zenker + achalasia initial Dx modality | barium swallow
🗑
|
||||
| After barium swallow is done and shows bird’s beak appearance | monometry to confirm Dx of achalasia
🗑
|
||||
| Pt with Hx of GERD + dysphagia | straight to endoscopy to rule out cancer
🗑
|
||||
| Diabetic pt with new-onset GERD | diabetic gastroparesis
🗑
|
||||
| Diabetic pt with new-onset GERD | give metoclopramide, not PPI
🗑
|
||||
| Diabetic gastroparesis before giving med | endoscopy first to rule out physical obstruction
🗑
|
||||
| Endoscopy negative for diabetic gastroparesis | do gastric-emptying scintigraphy
🗑
|
||||
| Bulimia nervosa or anorexia | never give buproprion (seizure risk)
🗑
|
||||
| Electrolyte abnormality in anorexia | hypokalemia
🗑
|
||||
| Most common cause of death in anorexia | arrhythmia from hypokalemia
🗑
|
||||
| Refeeding syndrome | worry about hypophosphatemia
🗑
|
||||
| Tx of anorexia + depression | mirtazapine (alpha-2 antagonist); stimulates appetite
🗑
|
||||
| Amenorrhea in anorexia | low FSH + low estrogen (hypogonadotropic)
🗑
|
||||
| Premature ovarian failure + Turner syndrome + menopause | high FSH (low inhibin) + low estrogen
🗑
|
||||
| Cholelithiasis | Dx with abdo ultrasound; fat, forties, female, fertile
🗑
|
||||
| Biliary colic + fever | cholecystitis
🗑
|
||||
| Tx of cholelithiasis + cholecytitis | cholecystectomy
🗑
|
||||
| Pt doesn’t want surgery or is pregnant | ursodeoxycholic acid (ursodiol)
🗑
|
||||
| Abdo USS negative in suspected cholecystitis | HIDA scan
🗑
|
||||
| Gall bladder doesn’t light up on HIDA scan | confirms cholecystitis
🗑
|
||||
| Cholelithiasis in pregnancy | estrogen upregulates HMG-CoA reductase + progesterone slows biliary peristalsis
🗑
|
||||
|
🗑
|
|||||
| Trichotillomania (eating one’s hair) + GI symptoms | gastric bezoar (hair ball)
🗑
|
||||
| Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms | small bowel obstruction (SBO)
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| Renal failure + friction rub over chest | uremic pericarditis
🗑
|
||||
| High leukocytes + low leukocyte ALP | CML
🗑
|
||||
| Metamyelocytes + myelocytes + splenomegaly | CML
🗑
|
||||
| Tx of CML | imatinib; causes fluid retention / edema
🗑
|
||||
| Smudge cells + autoimmune hemolytic anemia | CLL
🗑
|
||||
| Auer rods | AML; composed of myeloperoxidase
🗑
|
||||
| Tx of AML | DIC caused by Auer rod release into blood
🗑
|
||||
| Kid with high lymphocytes | ALL or pertussis (weird bc bacterial, but lymphocytes often >30k) Dry cough in winter
🗑
|
||||
| Young African American woman + dry cough + normal CXR | asthma (activation of mast cells), not sarcoidosis Young African American woman + dry cough + nodularity on CXR
🗑
|
||||
| Hypercalcemia in sarcoid, why? | epithelioid (activated) macrophages produce 1-alpha hydroxylase, thereby activating vitamin D3
🗑
|
||||
| Increased calcium in sarcoid | means decreased calcium in feces (bc D3 increased small bowel absorption) Tx for sarcoid
🗑
|
||||
| Outpatient Tx of asthma | SABA, then low-dose ICS, then maximize dose of ICS, then LABA, then use any number of drugs (e.g., mast cell stabilizers, anti-leukotriene, etc.), then oral steroids last resort
🗑
|
||||
| Kid with asthma on SABA inhaler + not effective + next best step? | ICS (fluticasone)
🗑
|
||||
| Kid with asthma on SABA inhaler + most effective way to decrease recurrence? | oral steroids (not next best step, but certainly most effective)
🗑
|
||||
| 40s male + hematuria + hemoptysis | Goodpasture syndrome
🗑
|
||||
| Antibodies in Goodpasture | Anti-GBM (anti-collagen IV)
🗑
|
||||
| Dx of Goodpasture | antibodies first, but confirmatory is renal biopsy showing linear immunofluorescence Hematuria + hemoptysis + “head-itis” (mastoiditis, sinusitis, otitis, nasal septal perforation)
🗑
|
||||
| New name for Wegener | granulomatosis with polyangiitis
🗑
|
||||
| Dx of Wegener | c-ANCA (anti-PR3; anti-proteinase 3)
🗑
|
||||
| Asthma + eosinophilia | Churg-Strauss
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 11 |
🗑
|
||||
| New name for Churg strauss | eosinophilic granulomatosis with polyangiitis
🗑
|
||||
| Dx of CS | p-ANCA (anti-MPO; anti-myeloperoxidase)
🗑
|
||||
| Hematuria in isolation + p-ANCA in serum | microscopic polyangiitis (MP)
🗑
|
||||
| Severe renal disease in Wegener or Goodpasture or MP | rapidly progressive glomerulonephritis (crescentic) High ALP + high direct bilirubin + high amylase or lipase
🗑
|
||||
| High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy | sphincter of Oddi dysfunction (can’t be a stone cuz the gallbladder was removed ages ago)
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy | choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point) Dx and Tx of choledocholithiasis
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy | pancreatic cancer
🗑
|
||||
| Dx of pancreatic cancer | CT abdo with contrast
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative | cholangiocarcinoma
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol | primary biliary cirrhosis (PBC)
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) | PBC Dx of PBC
🗑
|
||||
| Recent cholecystectomy + fever + abdo pain | post-op bile leak
🗑
|
||||
| High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct | choledochal cyst
🗑
|
||||
| Imaging to view liver or pancreas | CT with contrast
🗑
|
||||
| Imaging to view gallbladder | Ultrasound
🗑
|
||||
| Imaging to view gallbladder in suspected cholecystitis only if USS negative | HIDA scan
🗑
|
||||
| Imaging to view bile ducts | ERCP or MRCP (choose ERCP > MRCP if both listed)
🗑
|
||||
| Teenage girl with Hx of cutaneous candida infections since childhood | chronic mucocutaneous candidiasis MCC
🗑
|
||||
| Bacterial + fungal + protozoal + viral infections since birth | SCID
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| MEHLMANMEDICAL.COM 12 |
🗑
|
||||
| Bacterial infections since age 6 months | Bruton
🗑
|
||||
| Bacterial infections only since birth | Bruton (rare as hell to say from birth, but it’s on new 2CK NBME)
🗑
|
||||
| SCID XR variant | common gamma-chain mutation (IL-2 receptor deficiency)
🗑
|
||||
| SCID AR variant | adenosine deaminase deficiency
🗑
|
||||
| Bruton mechanism | tyrosine kinase mutation
🗑
|
||||
| Hyper IgM syndrome | deficiency of CD40 ligand on T cell (can’t activate CD40 on B cell to induce isotype class switching)
🗑
|
||||
|
🗑
|
|||||
| Greasy, scaly scalp + itchy + papules + adult | seborrheic dermatitis
🗑
|
||||
| Tx for SD | azole or selenium shampoo
🗑
|
||||
| Tx for tinea capitis | oral griseofulvin for patient only
🗑
|
||||
| How to decrease risk of tinea capitis | avoidance of sharing of hats
🗑
|
||||
| Tx of onychomycosis (nailbed fungus) | oral terbinafine
🗑
|
||||
| Tx of tinea pedis | topical terbinafine or topical azole
🗑
|
||||
| Tx of tinea corporis (ring worm) | topical azole (clotrimazole or miconazole)
🗑
|
||||
| Tx of cutaneous candida | oral azole
🗑
|
||||
| Tx of oropharyngeal candida | nystatin mouthwash
🗑
|
||||
| Tx of esophageal candidiasis | oral azole, not nystatin mouthwash
🗑
|
||||
| Tx of vaginal candidiasis | topical nystatin before trying oral azole
🗑
|
||||
| Odynophagia (painful swallowing) in immunocompromised pt | esophageal candidiasis till proven otherwise
🗑
|
||||
| CNS fungal infection or fungemia (rigors/chills) | amphotericin B
🗑
|
||||
| Cryptococcal meningitis | amphotericin B + flucytosine, then do fluconazole taper
🗑
|
||||
| Simple fungal pneumonia | fluconazole
🗑
|
||||
| Sporothrix schenckii (rose thorn + finger papule) | itraconazole
🗑
|
||||
| Hypopigmentation on upper back / trunk | tinea versicolor (Malassezia furfur)
🗑
|
||||
| Tx of tinea versicolor | topical selenium
🗑
|
||||
| Most common cause of impetigo | S. aureus now exceeds S. pyogenes
🗑
|
||||
| Tx of impetigo | topical mupirocin
🗑
|
||||
| Beefy red, well-demarcated skin plaque | erysipelas
🗑
|
||||
| Most common cause of erysipelas | Group A Strep (S. pyogenes) >>> S. aureus
🗑
|
||||
| MEHLMANMEDICAL.COM |
🗑
|
||||
| More diffuse pink skin lesion + tenderness + fever | cellulitis
🗑
|
||||
| Most common cause of cellulitis | S. aureus exceeds S. pyogenes
🗑
|
||||
| Tx of erysipelas + cellulitis | oral dicloxacillin or oral cephalexin
🗑
|
||||
| Wide-complex tachyardia | ventricular tachycardia (VT)
🗑
|
||||
| Narrow-complex tachy | SVT
🗑
|
||||
| Tx for SVT | vagal/carotid massage first; if doesn’t work, then adenosine
🗑
|
||||
| Tx of VT | anti-arrhythmics, e.g., amiodarone
🗑
|
||||
| Tx of SVT or VT in setting of coma / unconsciousness | direct-current countershock
🗑
|
||||
| Tx of first-degree heartblock or second-degree Mobitz I (Wenckebach) | observe
🗑
|
||||
| Tx of second-degree Mobitz II or third-degree heartblock | pacemaker
🗑
|
||||
| First-degree heartblock | PR-interval >200 milliseconds
🗑
|
||||
| Mobitz I | gradually prolonging PR-interval before a QRS drops
🗑
|
||||
| Mobitz II | no gradual prolongation of PR-interval; QRS randomly drops
🗑
|
||||
| Third-degree | HR super slow at 30-40; no relation between p-waves and QRS complexes
🗑
|
||||
| Infective causes of third-degree | Lyme disease, congenital lupus, diphtheria
🗑
|
||||
| Give killed IM influenza vaccine when? | Every year in fall/winter only; start from 6 months of age
🗑
|
||||
| Killed IM Influenza vaccine safe in pregnancy? | Yes, give anytime to pregnant women
🗑
|
||||
| Live-attenuated intranasal influenza vaccine guidelines? | Only give age 2-49 to non-pregnant, non- immunocompromised persons
🗑
|
||||
| Vaccines at age 2, 4, 6 months: HepB, Polio Salk, Pneumo PCV13, DPT, HiB, rotavirus (also give HepB at birth) HPV vaccine when | age 9-45
🗑
|
||||
| Mom’s HepB status unknown | give neonate HepB vaccine; only give immunoglobulin if mom comes back + MMR
🗑
|
||||
| Varicella | one dose between 12-18 months
🗑
|
||||
| Age 65 or older | give Pneumo PCV13 followed by PPSV23 6-12 months later
🗑
|
||||
| Asplenia or sickle cell | PCV13 + PPSV23 + HiB + Meningococcal
🗑
|
||||
| Circular lesion in pancreas seen in pancreatitis | pseudoabscess
🗑
|
||||
| Centri-acinar emphysema | smokers
🗑
|
||||
| Pan-acinar emphysema | alpha-1 anti-trypsin deficiency
🗑
|
||||
| Young adult + non-smoker + has emphysema + relative died of hepatic cirrhosis | alpha-1 anti-trypsin deficiency
🗑
|
||||
| CREST syndrome lung pathology? | can cause pulmonary fibrosis
🗑
|
||||
| Restrictive lung disease | normal or increased FEV1/FVC
🗑
|
||||
| Obstructive lung disease | decreased FEV1/FVC
🗑
|
||||
| Why is FEV1/FVC normal or high in restrictive? | radial traction on outside of airways is sticky (keeps airways from closing)
🗑
|
||||
| Apex to base lung changes when sitting/standing | both ventilation + perfusion increase apex to base
🗑
|
||||
| Most common cause of otitis media | Strep pneumo
🗑
|
||||
| Tx of otitis media | oral amoxicillin only
🗑
|
||||
| Tx of recurrent OM | amoxicillin/clavulanate
🗑
|
||||
| When to do tympanostomy tube | three or more OM in 6 months, or 4 or more in a year
🗑
|
||||
| Most common cause of otitis externa | Pseudomonas
🗑
|
||||
| Tx of otitis externa | topical ciprofloxacin + hydrocortisone drops
🗑
|
||||
| Prevention of OE in someone with constant water exposure (e.g., crew team) | alcohol-acetic acid drops
🗑
|
||||
| Tx of earwax buildup | carbamide peroxide drops
🗑
|
||||
| Low hematocrit + low MCV + low transferrin + low TIBC + transferrin saturation normal or low | anemia of chronic disease
🗑
|
||||
| Low hematocrit + low MCV + high transferrin + high TIBC + transferrin saturation super-low | iron deficiency anemia
🗑
|
||||
| Low hematocrit + low MCV + increased red cell distribution width (RDW) | iron deficiency anemia
🗑
|
||||
| Low hematocrit + low MCV + low iron + low ferritin | iron deficiency
🗑
|
||||
| Low hematocrit + low MCV + normal iron + normal or high ferritin | thalassemia
🗑
|
||||
| iron deficiency anemia + low MCV + low/low-normal RDW | thalassemia
🗑
|
||||
| Microcytic anemia that doesn’t improve with iron supplementation | thalassemia
🗑
|
||||
| Low hematocrit + normal MCV + low iron + normal or high ferritin | anemia of chronic disease
🗑
|
||||
| Tx of anemia of chronic disease if renal failure is cause | answer = EPO
🗑
|
||||
| Tx of anemia of chronic disease if renal failure not cause (IBD, RA, SLE, etc.) | CANNOT give EPO; Tx underlying condition.
🗑
|
||||
| Dx of thalassemia + low MCV + normal iron + normal ferritin in pregnant woman on iron supplements | thalassemia
🗑
|
||||
| High BP + smoker + TIA or stroke or retinal artery occlusion. How to best decrease stroke risk | Answer = lisinopril, not smoking cessation
🗑
|
||||
| Normotensive old pt + TIA or stroke or retinal artery occlusion | atrial fibrillation
🗑
|
||||
| Hypertensive pt + stroke | do carotid duplex ultrasound
🗑
|
||||
| Normotensive pt + stroke | do ECG; if ECG normal
🗑
|
||||
| High BMI female + irregular menstrual cycles | anovulation
🗑
|
||||
| Anovulation + hirsutism | PCOS
🗑
|
||||
| Anovulation. Cause USMLE wants? | insulin resistance
🗑
|
||||
| Why hirsutism in anovulation | abnormal GnRH pulsation causes high LH/FSH ratio
🗑
|
||||
| Why high LH/FSH ratio important in anovulation/PCOS | ovulation stimulated when follicle not ready
🗑
|
||||
| ovulation (anovulation) | follicle retained as cyst
🗑
|
||||
| What’s LH do? | Stimulates theca interna cells (females) and Leydig cells (males) to make androgens
🗑
|
||||
| What’s FSH do? | Stimulates granulosa cells (females) and Sertoli cells (males) to make aromatase; also primes follicles
🗑
|
||||
| Tx for PCOS | if high BMI, weight loss first always on USMLE
🗑
|
||||
| Tx for PCOS if they ask for meds and/or weight loss already tried | OCPs (if not wanting pregnancy); clomiphene (if wanting pregnancy)
🗑
|
||||
| PCOS increases risk of what | endometrial cancer (unopposed estrogen)
🗑
|
||||
| Tx of prostate cancer | flutamide + leuprolide together (if they force a sequence, choose F then L).
🗑
|
||||
| Tx of acute gout | indomethacin (NSAID) first on USMLE; then steroids, then colchicine
🗑
|
||||
| Tx of acute gout if indomethacin + steroids not listed | colchicine
🗑
|
||||
| Tx of acute gout in pt with renal insufficiency or Hx of renal transplant | steroids
🗑
|
||||
| Tx of chronic gout (decrease recurrence) | allopurinol or febuxostat (xanthine oxidase inhibitors)
🗑
|
||||
| Never give which drug to pt with Hx of uric acid stones or over-producer | probenecid (uricosuric)
🗑
|
||||
| What are rasburicase / pegloticase | urate oxidase analogues
🗑
|
||||
| Young kid + self-mutilation + red-orange crystals in diaper | Lesch-Nyhan syndrome (X-linked) Lesch-Nyhan enzyme
🗑
|
||||
| Crystal type in pseudogout | calcium pyrophosphate deposition disease
🗑
|
||||
| Two main causes of pseudogout | primary hyperparathyroidism + hemochromatosis
🗑
|
||||
| Two ways pseudogout presents | monoarthritis of large joint (i.e., knee) or osteoarthritis-like presentation in someone with primary hyperparathyroidism or hemochromatosis
🗑
|
||||
| 32M + dark skin on forearms + increased fasting glucose; Dx? | hemochromatosis (bronze diabetes)
🗑
|
||||
| Same male + painful hands + x-ray shows DIP involvement. Joint pain Dx? | pseudogout
🗑
|
||||
| Tx of pseudogout | same as gout acutely; Tx underlying condition for chronic
🗑
|
||||
| Biggest risk factor for osteoarthritis | obesity
🗑
|
||||
| Tx of osteoarthritis | weight loss; if normal BMI
🗑
|
||||
| Patient with OA taking naproxen (NSAID) + peripheral edema | increased renal retention of sodium
🗑
|
||||
| Patient taking NSAID + edema; why? | NSAID decreases renal blood flow
🗑
|
||||
| compensate for perceived low volume status | water follow sodium
🗑
|
||||
| Tx of rheumatoid arthritis | Two-armed: symptom-relief + disease-modifying anti-rheumatic drugs (DMARDs)
🗑
|
||||
| Symptom-relief for RA | NSAID first, then steroids (these do symptoms only; do not slow disease progression)
🗑
|
||||
| DMARDs for early RA | always methotrexate first; if insufficient, add another DMARD (sulfasalazine or leflunomide); if insufficient add anti-TNF-alpha agent
🗑
|
||||
| Methotrexate MOA | dihydrofolate reductase inhibitor
🗑
|
||||
| Methotrexate side-effects | pulmonary fibrosis + hepatotoxicity + mouth ulcers (neutropenia)
🗑
|
||||
| Sulfasalazine MOA | metabolized into sulfapyridine + mesalamine in the gut by bacteria
🗑
|
||||
| Mesalamine is | 5-ASA absorbed as the Tx for RA; only NSAID considered to be DMARD
🗑
|
||||
| Leflunomide MOA | dihydroorotate dehydrogenase inhibitor (pyrimidine synthesis)
🗑
|
||||
| Most specific Abs in RA | anti-CCP (cyclic citrullinated peptide), not RF (rheumatoid factor)
🗑
|
||||
| X-ray of hands in RA vs OA | Only OA has DIPs involved; RA is PIPs + MCPs
🗑
|
||||
| Symmetry in RA vs OA | RA is symmetrical; OA is not
🗑
|
||||
| Any pt with red, warm, tender knee | joint aspiration (arthrocentesis); septic arthritis till proven otherwise
🗑
|
||||
| Biggest risk factor for septic arthritis | abnormal joint architecture
🗑
|
||||
| Pt groups most likely to get SA | prosthetic joints, RA/OA, recent intense exercise/joint trauma; peds (JRA)
🗑
|
||||
| Pt group most likely to get SA | those with prosthetic joints (can’t be more abnormal than fake joint) Pt with OA or RA has red, warm, tender knee
🗑
|
||||
| 17F had kickboxing tournament last weekend + knee is red, warm, tender | arthrocentesis (SA)
🗑
|
||||
| Kid + recurrent knee redness, warmth, pain + fever | Juvenile rheumatoid arthritis (JRA; Still disease) Kid + recurrent joint pain +/- high ESR +/- rash
🗑
|
||||
| Kid + recurrent joint pain + anemia | JRA (anemia of chronic disease)
🗑
|
||||
| Kid with suspected JRA has sore knee | must do arthrocentesis to rule out septic arthritis
🗑
|
||||
| Most common presentation finding in SLE | arthritis (>90%)
🗑
|
||||
| Woman 20s-40s + arthritis + thrombocytopenia | SLE
🗑
|
||||
| Woman 20s-40s + arthritis + mouth ulcer + circular skin lesions | SLE
🗑
|
||||
| Malar rash + low RBCs + low WBCs + low platelets; mechanism for low cell lines? | increased peripheral destruction (antibodies against hematologic cells lines seen in SLE; isolated thrombocytopenia most common) Tx of SLE flare
🗑
|
||||
| SLE + red urine; Dx? | lupus nephritis, more specifically, diffuse proliferative glomerulonephritis (DPGN) Histology of DPGN
🗑
|
||||
| Tx of lupus nephritis | mycophenolate mofetil
🗑
|
||||
| Tx of discoid lupus | hydroxychloroquine
🗑
|
||||
| Most specific Abs for SLE | anti-Smith (RNP), not anti-dsDNA
🗑
|
||||
| Which Abs go up in acute SLE flares | anti-dsDNA (and C3 goes down)
🗑
|
||||
| Drug-induced lupus Abs | anti-histone
🗑
|
||||
| Drugs that cause DIL | Mom is HIPP
🗑
|
||||
| Viral infection + all three cell-lines are down | viral-induced aplastic anemia
🗑
|
||||
| Viral-induced aplastic anemia; next best step in Dx? | bone marrow aspiration
🗑
|
||||
| Viral-induced aplastic anemia; mechanism? | defective bone marrow production (contrast with SLE)
🗑
|
||||
| Viral infection + low platelets | ITP (immune thrombocytopenic purpura)
🗑
|
||||
| Woman 30s-40s with random bruising at different stages of healing | (also ITP; first rule out abuse) Mechanism of ITP
🗑
|
||||
| Dx of ITP | answer = low platelet count; don’t choose increased bleeding time
🗑
|
||||
| ITP Tx | steroids first, then IVIG, then splenectomy
🗑
|
||||
| ITP episode | next best step in management
🗑
|
||||
| ITP episode | most effective way to decrease recurrence
🗑
|
||||
| Family Hx of heme condition treated with splenectomy | hereditary spherocytosis (autosomal dominant)
🗑
|
||||
| Bleeding time meaning? | platelet problem
🗑
|
||||
| PT and aPTT meaning? | clotting factor problem
🗑
|
||||
| Heme findings in ITP | increased BT, normal PT, normal aPTT
🗑
|
||||
| Heme findings in hemophilia | increased aPTT; bleeding time and PT are normal
🗑
|
||||
| Cause of hemophilia | X-linked recessive; hemophilia A (factor VIII def); hemophilia B (factor IX def)
🗑
|
||||
| Tx of hemophilia A | desmopressin for hemophilia A (increases VIII release); then give factor VIII
🗑
|
||||
| Tx of hemophilia B | give factor IX
🗑
|
||||
| Classic hemophilia presentation | hemarthrosis in school-age boy; bleeding after circumcision in neonate
🗑
|
||||
| Inheritance pattern of vWD | AD
🗑
|
||||
| Heme findings in vWD | bleeding time always high; PT always normal; aPTT elevated half the time
🗑
|
||||
| What is main function of vWF? | bridges platelet GpIb to underlying collagen (adhesion, not aggregation)
🗑
|
||||
| What is secondary function of vWF | stabilizes factor VIII in plasma (that’s why aPTT only half time increased)
🗑
|
||||
| vWD presentation | always one platelet problem + one clotting factor problem
🗑
|
||||
| Platelet problem? | epistaxis, bruising, petechiae
🗑
|
||||
| Clotting factor problem | menorrhagia, excessive bleeding with tooth extraction, hemarthrosis (but hemarthrosis very very rare in vWD; it is seen in hemophilia)
🗑
|
||||
| vWD treatment | desmopressin
🗑
|
||||
| Vitamin K deficiency heme parameters? | Increased PT + aPTT; bleeding time normal
🗑
|
||||
| Cause of vitamin K deficiency in adults | chronic Abx knock out colonic flora
🗑
|
||||
| Cause of sickle cell | glutamic acid to valine mutation on beta-chain
🗑
|
||||
| Inheritance of sickle cell | AR
🗑
|
||||
| Nephrotic syndrome in SS | FSGS
🗑
|
||||
| Dark urine in SS | renal papillary necrosis
🗑
|
||||
| HY drugs that cause agranulocytosis | clozapine, ganciclovir, propylthiouracil, methimazole, methotrexate, ticlopidine
🗑
|
||||
| How will agranulocytosis (neutropenia) present on USMLE? | mouth ulcers + fever MEHLMANMEDICAL.COM 19
🗑
|
||||
| Tx for febrile neutropenia / neutropenic fever | immediate broad-spectrum IV Abx Broad-spectrum Abx example?
🗑
|
||||
| PTU and methimazole are used for what? | Tx of Graves
🗑
|
||||
| Ticlopidine is what? | ADP2Y12 blocker anti-platelet agent (clopidogrel, prasugrel, ticagrelor also)
🗑
|
||||
| Strongest indication for anti-coagulation | prosthetic material in heart / prosthetic valve (factoid in isolation)
🗑
|
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