USMLE Step 2 CK

Study online at quizlet.com/_28lh45

1. Anabolic steroid aggression

androgen-stimulated erythropoiesis
decreased HDL
2. phencyclidine

hallucination
agitation
midriasis
tachycardia & HTN (cocaine also)
NYSTAGMUS
seizure
HYPERTHERMIA
3. Basal cell Ca skin-colored nodule with ulcer
most common skin cancer
4. Bordetella Pertussis Macrolide (Azithromycin, Clarithromyci, Erythromycin)
Prophylaxis to all close contacts
5. Erythromicin in neonates ass. with pyloric stenosis
6. Child w/ unilateral cervical lymphadenitis
Ex and Rx

Ex: Strep & Staph

Rx: Clindamycin
7. Gonococcal eye inf. in NB

2-5 days
Most DESTRUCTIVE
can cause Corneal PERFORATION and permanent BLINDNESS
Rx: IV or IM Ceftriaxone pr Cefotaxime
8. Chlamydial eye inf. in NB 5-14 days
Rx: Oral erythrmycin (although it is ass. with PYLORIC STENOSIS)
9. Stevens-Johnson syndrome
vs.
Toxic Epidermal Necrolysis

Body surface involvement (bullae,

desquamation):
<10% - SJS
>30% - TEN
10. Factors such as tuberculosis, histoplasmosis, and herpes simplex virus are sometimes
associated with what type of skin lesion?

Erythema Multiforme
11. Cerebellopontine angle tumor

acoustic neuroma (Schwannoma)

12. Lacunar infarct in Thalamus

Pure Sensory loss

Transient hemiparesis, athetosis, ballistic
movements
13. Lacunar infarct in Internal Capsule

Pure Motor loss

14. CML Rx

Imatinib (Gleevec)
15. Imatinib MOA

Tyrosine kinase inhibitor of BCR-ABL and c-kit

16. Euthyroid Sick Syndrome "low T3 syndrome"
decreased T3 due to decreased peripheral deiodination of T4 due to caloric deprivation
17. Rx of Uric Acid Stone

Alkalinization of the urine

Potassium Citrate
18. Postconcussive syndrome

Can include Headache, nausea, vomiting, memory loss, dizziness, double vision,
blurred vision, emotional lability, sleep disturbances lasting up to several months
after an accident.
19. Rx of Pregnant w/ Asymptomatic Bacteriuria Amoxicillin
Nitrofurantoin
Cephalexin
20. Status Epilepticus complication Seizure lasting >30 minutes
Recent studies suggest that a brain that seized for >5 minutes is at increased risk
of developing permanent injury due to excitatory cytotoxicity.
NEURONAL DAMAGE
CORTICAL LAMINAR NECROSIS
21. Imaging in Developmental Dysplasia of the
Hip

Dx: age <6 months - USG;Tx: Pavlik hip harness

Dx: age >4-6 months - X-RAYs
22. Enlarged Lateral Ventricles seen in ....

Schizophrenia
23. Structural abnormalities in the
ORBITOFRONTAL CORTEX and BASAL
GANGLIA are associated with

Obsessive-compulsive disorder
24. Small HIPPOCAMPUS

PTSD
25. Small AMYGDALA and left Temporal Lobe

Panic disorder
26. Depression
SIGECAPS:

"S"leep
loss of "I"nterest
"G"uilt
low "E"nergy
impaired "C"oncentration
"A"ppetite
"P"sychomotor retardation or agitation
"S"uicidal thoughts

>4 symptoms
27. Diabetic retinopathy

neovascularization, microaneurysms, hard exudates, cotton wool spots

28. Charcot foot

Neurogenic arthropathy
In patients with long-standing, poorly controlled diabetes and peripheral neuropathy, a red, hot, swollen
foot without open ulceration should raise the suspicion of Charcot neuroarthropathy.
29. Monofilament screening
test

Neuropathy
30. First-line
AntiHypertensive drugs
in Pregnancy

MethylDopa
Labetalol
Hydralazine
Nifedipine
31. MCC of inherited Hypercoagulability

Factor V Leiden
32. Metabolic abnormalities in Hyperlipidemia (decr LDL surface receptors &/or decr LDL receptor activity)
HYPOthyroidism HYPOnatremia
Creatinine Kinase
ALT/AST
33. Diabetic CN III neuropathy

Only somatic fibers are affected, parasympathetic NOT affected.

Ptosis
"Down and out" gaze
Accommodation and light reflex INTACT (in contrast to Oculomotor nerve
compression)
34. Ischemic vs Hemorrhagic Stroke

Ischemic: No pain, No impaired consciousness

Hemorrhagic: Headache + neurologic deficits gradually worsens as the hemorrhage

expands
35. Arcuate fasciculus
36. What is Anosognosia? Where
is the lesion?

Denial of deficits
Nondominant (Right) Parietal lobe
37. What is Apraxia?

inability to perform previously learned motor acts in the presence of adequate motor strength
Contralateral Nondominant (Right) Parietal lobe
38. Tick Paralysis

Tick paralysis is a toxin-mediated cause of acute flaccid paralysis.

RX: Tick removal results in rapid improvement of all symptoms.
39. Tick paralysis GBS has autonomic abnormalities (tachycardia, urinary retention, arrhythmias, orthostatic
vs hypotension)
GBS CSF: Albuminocytologic dissociation (high protein with few cells)
40. Parkinson disease accumulation of alpha-synuclein within the neurons of the substantia nigra pars compacta, which
ultimately leads to the death of these neurons.
41. Benzodiazepine antidote flumazenil
42. Alcohol withdrawal Long-acting benzodiazepines
43. Barbiturate antidote

alkaline diuresis, hemodialysis

44. Opioid antidote naloxone
45. Heparin
antidote

protamine sulfate
46. Methanol Fomepizole, ethanol
antidote
47. Idiopathic
Intracranial
Hypertension

obese female
Headache
double vision on eye movement (6th CN palsy)
papilledema
opening pressure on LP ( >250 mmH2O)
48. Pick's disease Same as frontotemporal dementia, more common in women, personality and language changes are prominent
49. Primary Lung>Breast>Unknown>Melanoma>Colon
locations of
the Brain
metastasis
50. Multiple Brain lung, melanoma
Metastases
51. Solitary Brain Breast, COlon, and Renal Ca
Metastases
52. Alcoholic CNS disorder distinguished by:
cerebellar truncal ataxia,
degeneration wide-based gait,
intention tremor, and
nystagmus;
causes atrophy and granule cell loss in the anterior vermis followed by Purkinje cell loss and Bergmann astrocyosis
53. Bulbar dysarthria, dysphagia, tongue atrophy, tongue fasciculations, impaired speech, dyspnea, respiratory dysfunction
symptoms
54. Amyotrophic 45 year old with gradual progressive weakness over the past 3-4 months, particularly in the LUE.
lateral Progressive deterioration of motor nerve cells resulting in total loss of voluntary muscle control, symptoms advance
sclerosis from muscle weakness, hyperreflexia & fasciculations in the arms and legs, to the muscles of speech, swallowing,
and breathing to total paralysis and death; also know a Lou Gehrig disease
55. Lhermitte sign Physical exam finding: sudden electric like shocks extending down the spine when flexing the neck. Clinically
indicates multiple sclerosis & cervical spinal cord injury
56. Uhthoff
phenomenon

elevated body temperature (say from hot baths) unmasks prior MS deficits?
Worsening of MS symptoms with heat
57. Tx of Agitation in HALOPERIDOL
elderly
(!!! BENZODIAZEPINEs are contraindicated in older patients due to increased risk of adverse effects,
paradoxical worsening of the agitation and slow excretion rate, making their effects very long-lasting.
58. oscillopsia

sensation of objects moving around in the visual field when looking in any direction
59. Cryptococcal Presents subacutely w/ HA/fever/malaise.
meningoencephalitis
Tx Dx: CSF: high OP, low gluc, high prot, low WBC, india ink stain, crypt antigen +

Tx: Amphotericin B + Flucytosine

maintainence: fluconazole
60. CMV esophagitis

intranuclear/cytoplasmic inclusions. Tx- ganciclovir IV

Large linear esophageal ulcers in and AIDs patient

61. HSV esophagitis

Multiple, well circumscribed, "volcano like" (small and deep) appearance of esophageal ulcers
in a patient with HIV

ballooning degeneration, eosinophilic intranuclear inclusions. Acyclovir

62. DOC in PCP patient intolerant to
TMP-SMX?

Pentamidine
63. Sheep breeder

liver mass with hydatid cyst (big cyst with daughter cysts) worker?
64. Pig farmer

Neurocysticercosis
65. Serpiginous lesion of
the skin

Cutaneous larva migrans - Ancylostoma braziliense, the dog and cat hookworm.
66. Bacillary
angiomatosis

Bartonella henselae/quintana. IMCD patients. Cutaneous and visceral (liver) angioma-like blood vessel
growths. Tx- Abx (erythromycin, tetracyclines)
67. Cat-scratch disease: Bartonella henselae
Ex & TX Azithromycin (5 days)
68. PPSV23 indications: Pneumococcal polysaccharide vaccine

T cell INdependent B cell response

PPSV is recommended for:

ALL adults who are >65 years and
2-64 years with Current smokers, Chronic medical conditions including Heart or Lung, Diabetes, & Chronic
renal failure
69. PCV13 indications: Pneumococcal conjugate vaccine

T-cell dependent B cells response

Indications:
PCV13 is recommended for:
ALL children <5 years old,
ALL adults >65 years, and
>6 years with
CSF leaks, Sickle cell, Cochlear implants, Asplenia, Immunocompromised, Chronic renal failure

>65 - 1 dose of PCV13 followed by PPSV23 in 6-12 months

70. Toxoplasmosis: Tx: Sulfadiazine & Pyrimethamine
Treatment & Px: TMP-SMX
Prophylaxis
71. Coccidiomycosis
endemic

www.img.medscape.com/article/821/652/821652-figure.jpg
72. Histoplasmosis
endemic

73. Blastomycosis
endemic

74. Jarish-Herxheimer
reaction

Immune mediated reaction precipitated by the destruction of a large number of spirochetes due to the
antibiotic injection
Caused by release of bacterial ENDOTOXIN following antimicrobial therapy results in high fever, chills,
hypotension, myalgia, leukocytosis

Tx: Aspirin, antipyretic; it will PASS

75. TX of Nocardiosis vs TMP-SFX vs High dose PENICILLIN
Actinomycosis
76. Actinomycosis Cervicofacial actinomycosis presents as slowly progressing , NONtender, indurate
TX: High dose PENICILLIN
77. BUN levels >... in patients Uremic Pericarditis: BUN>60
with Pericarditis, to
Hemodialysis!
78. oxalate crystals

envelope shaped
79. cystine crystals

hexagonal
80. Digital clubbing etiology:

81. clubbing pathophysiology
82. Glucocorticoid-induced
neutrophilia pathogenesis
Lung malignancy
Cystic fibrosis
Right-to-left Shunt
Megakaryocytes skip fragmentation within pulmonary circulation. They become entrapped in the distal
fingertips due to their large size and release PDGF & VEGF which promotes connective tissue
hypertrophy
Mobilization of the marginated neutrophil pool.
83. Legionella pneumonia

Ex: water supplies (cruise ships & hotels)

Sx: Bilateral lung infiltrates, Diarrhea, Confusion, Hyponatremia
Dx:Legionella urine Ag test
Tx: Fluoroquinolones (-floxacin) or Macrolides
84. Acute bronchitis

- viral etiology, short term, MCC of blood-tinged sputum, self limited

85. when to perform Non-
stress test?

- High risk pregnansy starting at 32-34

- loss of fetal movements
86. cholesteatoma

- collection of skin cells and cholesterol in a sac within the middle ear

- cystlike mass composed of epithelial cells and cholesterol occurring in the middle ear; may be
associated with chronic otitis media
87. tamoxifen risks?

Breast, Ovary'de inhibitory

Endometrium'da excitatory=> Cancer

88. Exchange transfusion

- Treatment of Hemolytic Disease of the Newborn after birth: _________ to replace damaged blood with fresh
blood
- MI, Stroke, priapism in sickle cell patient treatment
89. Condyloma Lata

2 Syphilis
Moist, smooth, flat, velvety lesion
90. Condyloma
accuminata

Genital wart
genital wart. HPV 6, 11, 16, 18
91. When
Angioedema due
to ACEI
happens?

Can happen at ANY TIME

92. Bullous
myringitis

-Caused by viral infection, Mycoplasma pneumonia

A type of OTITIS media infection, but causes MORE PAIN. Presence of BLISTERS (BULLA) on a reddened and
BULGING tympanic membrane. CONDUCTIVE hearing loss. Caused by different types of pathogens
(mycoplasma, viral, bacteria). Treat the same as bacterial AOM
93. Intense pruritus
in pregnancy,
dx?

Intrahepatic cholestasis of Pregnancy

- bile acids
- pruritis worsening at NIGHT esp significant on the PALMS and SOLES
94. Milk protein
allergy

Sx: severe reflux or vomiting plus painless bloody stools. Eczema. Avoid all dairy and soy. Can breast feed if mom
doesn't eat those either or do hydrolized formula. Almost all can tolerate dairy and soy by one year of age.
Milk protein intolerance that is IgE mediated and can cause anaphylaxis & trigger eczema
Tx: Extensively Hyrolyzed CM Formulas (hypoallergenic) indications:
95. Laryngomalacia

Unusual flaccidity of laryngeal structures.

This condition refers to collapse of the supraglottic structures during inspiration.

Sx: Stridor worsens in SUPINE position & improves in PRONE position

Tx: Reassurance in most cases (USUALLY Self-resolves by 18 months)
96. MC complication in Sickle Cell Trait patients? Painless Hematuria
97. Impetigo tx? Bullous vs Non-bullous

Non-bullous: topical MUPIROCIN

Bullous: Oral Abs(Cephalexin, dicloxacillin, or clindamycin)

98. Colon watershed areas

1. splenic flexure
2. rectosigmoid junction
99. Tx of Gastric MALT lymphoma w/o metastasis H. Pylori eradication: PPI+Amoxicillin+Chlarythromycin

(if metastasis: CHOP therapy)

100. MEN 1 3 P's:
Parathyroid
Pituitary (prolactin or GH),
Pancreatic endocrine (ZES)
101. MEN 2a

mutation in germline RET (nerual crest cells)

Medullary thyroid cancer

Pheochromocytoma
Parathyroidism
102. MEN 2b

Medullary thyroid cancer

Pheochromocytoma
Mucosal neuromas
103. Acalculous cholecystitis Ex: Extensive burns
Severe trauma
Prolonged TPN
Prolonged fasting
Mechanical ventilation
104. Strawberry cervix

Trichomonas vaginalis
- Punctuate hemorrhages
105. Breast ca screening 50-75
Mammogram every 2 years
106. Cervical ca screening 21-65
Pap smear every 3 years
107. Colon cancer screening 50-75
Occult blood test annually, or
Colonoscopy every 10 year
108. Hyperlipidemia ca screening Men >35
Lipid panel avery 5 years
109. Osteoporosis screening Women >65
DEXA
110. Lynch syndrome (HNPCC)
subgroups

1. Lynch syndrome I: Hereditary site SPECIFIC COLON ca

2. Lynch syndrome II: Cancer FAMILY syndrome (high risk of extracolonic tumors, the most
common of which is ENDOMETRIAL CARCINOMA)
111. Congenital Toxoplasmosis

Chorioretinitis, hydrocephalus, INTRACRANIAL calcifications

112. Congenital CMV

PERIVENTRICULAR calcifications, retinitis, hearing loss, seizures, and hepatosplenomegaly

113. Quadruple test in pregnancy,
when? Which markers?

15-20 weeks
- AFP, beta-hCG, Estriol, Inhibin A
114. HPV vaccines
indications

All women age 9-26

Men age 9-21 (those having MSM up to 26)
Immunocompromised age 9-26
NOT indicated in PREGNANT women
115. Basal cell carcinoma

- location is important- typically they occur in the upper face--mostly near the inner canthus of the eye)

Histology: groups of basal cells with PALISADING outer layer, locally invasive but do NOT metastasize
116. SCC location

LOWER Lip
Histology: keratin pearls
the ulcers have HEAPED UP margins, remember the secondary causes here--long standing osteomyelitis
ULCER, burns WOUND etc.

Locally invasive and may spread to LN but rarely mets

117. Metatarsus
adductus

Most common congenital abnormality (13% of infants). Presents as medial deviation of forefoot relative to
hindfoot.
- Most frequent in 1st-born infants.
- 10% associated with Acetabular dysplasia
- Usually resolves SPONTANEOUSLY.
118. Internal tibial torsion

Very common at birth and quickly fixes itself within 1st year of
age. Minority of cases persist.
Diagnosis is done by "thigh-foot angle" in prone position.
Usually it will SPONTANEOUSLY resolve by 5-6 y.o. in the
cases that persist.
119. Emergency contraception options

Copper IUD - 99%

Ulipristal pill - >85%
Levonorgestrel pill - 85%
OCPs - 75%
120. Vitamin ... has been shown to reduce the morbidity and mortality
rates of patients with MEASLES

Vitamin A
121. ... infusion maintains patency of the ductus arteriosus. Prostaglandin E1
122. ... is the DOC in treating Primary Biliary Cirrhosis, as it slows
disease.

Ursodeoxycholic acid
123. Patellofemoral syndrome

abnormal lateral tracking of the patella

an overuse disorder that can lead to damage of the patellar cartilage

Woman with anterior knee pain x 3 months, sharp and worse when climbing and
descending stair

-aka patellafemoral pain syndrome or "Runner's knee

Dx: Patellofemoral compression test

124. Fetal hydantoin syndrome

prenatal exposure to Phenytoin or Carbamazepine; nail/digit hypoplasia,

dysmorphic facies, MR, growth deficiency
CLEFT palate & EXCESS HAIR
125. Rheumatoid Arthritis therapy:

NSAIDs and Glucocorticoids are symptomatic tx.

DMARDS:
1. Non-biologic:
a) METHOTREXATE: preferred initial drug
b) Hydroxychloroquin, Azathioprine

2. Biologic: (Etanercept, Infliximab, Adalimumab)

126. Patients should be tested for ... before starting Hepatitis B and C and Tuberculosis
METHOTREXATE.
127. Contraindication of
METHOTREXATE

PREGNANCY
Severe RENAL insufficiency
LIVER Disease
Excessive ALCOHOL intake
128. Why Ocreotide is given in because it is Somatostatin analogue which decreases SPLANCNIC BLOOD FLOW
GI bleeding
129. Antithyroid drug Side
Effects

Allergic reax(most common, 2%)

Agranulocytosis (most serious, 0.3%)

Methimazole: 1st-trimester TERATOGEN, CHOLESTASIS

PTU: severe LIVER failure (BLACK box warning), ANCA-associated vasculitis

130. JUVENILE
ANGIOFIBROMA

An adolescent who present with a nasal obstruction, visible NASAL MASS, and frequent EPISTAXIS is
considered to have ..., unless proven otherwise.
131. Spondylolisthesis

Slipping of one vertebrae above or below another is known as__

132. Ichthyosis vulgaris

increased thickness of the stratum corneum, absent granular layer

aka. lizard skin, dry and rough skin with horny plates over the extensor surfaces of the limbs
Autosomal Dominant disorder of keratinization caused by the decreased or lack of proFILAGGRIN
synthesis which affects the granular and cornified layers
133. MGUS

MC monoclonal gammopathy; may progress to myeloma (1% per year risk)

M spike without the clinical features of Multiple Myeloma
134. Difference between MGUS:
MGUS and MM? ABSENCE of anemia, HyperCalcemia, Lytic Lesions & Renal failure
<3g/dL M proteins on SPEP (ElectroPhoresis);
<10% of plasma cell
135. Glucocorticoid Fatigue, Loss of appetite, HYPOGLYCEMIA, HYPONATREMIA, EOSINOPHILIA
deficiency symptoms
136. Hepatorenal syndrome Progressive renal failure associated with hepatic failure characterized by a sudden decrease in urinary
output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and
increased urine osmolarity

Px: The hallmark of HRS is renal vasoconstriction & systemic vasodilation

Tx: Liver transplantation is the only treatment

137. Contraceptive methods PROGESTIN-only oral contraceptives (most preferred)
in pregnant women Barrier
Sterilization
IUD
138. High dose ... may cause Glucocorticoids
...-induced psychosis.
139. Which antipsychotic is Ziprasidone
associated with QT
prolongation.
140. Side effects and SE: Weight gain, Dyslipidemia, Hyperglycemia
Monitoring 2nd-gen Highest risk: Olanzapine, Clozapine
antipsychotics. Low risk: Aripiprazole, Ziprasidone

Monitoring:
BMI: 0, Monthly
Glu, Lipid panel, BP, Waist circumference: 0, 3 mo & annually
141. Neonatal abstinence
syndrome

withdrawal to OPIATEs

newborn presents with irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing,
tachypnea, poor feeding, vomiting, and diarrhea
142. Erythema marginatum

less common feature of RF

characterized by bright pink, non-pruritic, maplike macular lesions occuring mainly on the trunk and
proximal extremities which may be exacerbated by heat
143. HSV retinitis

Painful, with conjunctivitis and KERATITIS (vs CMV retinitis, NO

keratitis, NO PAIN)
144. CMV retinitis

MCC of blindness in AIDS; Rx. ganciclovir (foscarnet if

unsuccessful)
HIV CD4<50
Yellow-white retinal patches, Retinal hemorrhages.
145. Acute Migraine treatment

146. Migraine prophylaxis

-Blockers: Propranolol
147. ... are the DOC fot treating and preventing Chemotherapy
induced nausea&vomiting.

Serotonin antagonists that block 5HT3 receptors

(ONDANSETRON)
148. Colonoscopy in UC patients

8 years after initial diagnosis, then every 1-2 year

149. Brain death

150. Sterwise treatment of Cirrhosis 1. Na & WATER restriction

2. Spironolactone
3. Loop diuretic
4. Frequent abdominal paracentesis
151. Snellen chart

Which of the following is the preferred method for the testing of distant
visual acuity?
152. Pancreatic ... on CT is considered diagnostic for Chronic calcification
pancreatitis.
153. When Meningococcal vaccination is administered

at age 11-12, followed by a booster dose at age 16 due to risk of college

outbreaks.
154. Steroid-induced folliculitis (Steroid
acne)

Monomorphous pink papules, absence of comedones

Secondary to prednisone used for SLE flare. Steroid acne is characterized by
monomorphous pink papules and absence of comedones.
155. Beta 2 microglobulin deposition within with ESRD or Chronic Hemodialysis
the carpal tunnel causes CTS in
patients ______
156. Beta 2 microglobulin ______ is a component of leukocyte antigen (HLA) molecules
Long standing dialysis amyloidosis
Marker for Leukemia, Lymphoma, and MM
157. Carpal Tunnel Syndrome fluid accumulation in 3rd trimester
pathogenesis in Pregnancy
158. Phototoxic acne medication Doxycycline
Tetraciclines are important cause of phototoxic drug eruptions
159. Asymptomatic elevation of ALP in Paget's disease of bone (Osteitis deformans)
elderly
160. Secondary Hyperparathyroidism

chronic renal failure--> inability to synthesize active vitamin D, inability to excrete

phosphate leads to hyperphosphatemia--> elevated PTH--> bone demineralization,
vascular calcification, skin ulceration
161. T4, T3 & TSH levels in pregnancy b-hCG stimulates Thyroid hormone production => T4 & T3
TBG binds extra T4, which results in a significant in total T4
b-hCG & T4 in 1st trimester SUPPRESS TSH secretion
162. Radiation to the neck during PAPILLARY carcinoma
childhood Spread via LYMPHATIC
163. Thyroid cancers

Epithelial (thyroid folicular cells)

PAPILLARY (>70%, RADIATION)
Follicular (20%)
Anaplastic (5%)

Parafollicular C-cells: Medullary (4%)

164. The ____ test or _____-____ test differentiates maternal from fetal blood in patients with
vaginal bleeding.

Apt test or Kleihauer-Betke test

165. Antibiotic that causes aplastic anemia? What is another side effect?

Chloramphenicol
166. ____ and ____ are the most appropriate appropriate
diagnostic tests for acute Hep B.

HBsAg and IgM anti-HBc

In window period IgM Anti-HBc may be the only detectable marker.

(!!!HBV DNA is NOT used to diagnose Hepatitis B, however it is used to
assess the RESPONSE to ANTIVIRAL therapy)
167. Raloxifene

Selective Estrogen Receptor Modulator (SERM)

unlike TAMOXIFEN does NOT increase the risk of endometrial cancer
CV risk and THROMBOEMBOLISM (black box warnings), may increase
TGs, myalgia
168. Palivizumab
MOA: Antibody to RSV. Gives prophylaxis in high-risk patients:
Preterm birth <29 weeks gestation
Chronic lung disease of prematurity
Hemodynamically dignificant congenital heart disease

To prevent complications (Apnea&Respiratory failure) due to RSV-

associated bronchiolitis
169. Ewing vs Osteosarcoma
170. Otosclerosis

hardening of the bony tissue of the middle ear

MCC of conductive hearing loss in ADULTs(female in her 20-30s)
171. Pinealoma

Perinaud's syndrome(Dorsal Midbrain syndrome):

Upper eyelid retraction,
paralysis of upward gaze ("sun-setting sign")
pupillary abnormalities
Ptosis

Obstructive Hydrocephalus: the aqueduct of Sylvius

Central Precocious puberty

172. Primary What autoimmune liver disease is characterized by affecting a middle-aged woman with jaundice, pruritus, fatigue,
biliary xanthomas, increased direct bilirubin levels, and antimitochondrial Abs?
cirrhosis autoimmune destruction of intrahepatic bile ducts
173. Stye

infection/abscess in the follicle of an eyelash

174. Chalazion

A chronic granulomatous inflammation of a meibomian gland in the eyelid

small, hard, cystic mass PainLESS

Treat with warm compresses

175. Hordeolum

a pus-filled lesion on the eyelid resulting from an infection in a sebaceous gland; also known
as a stye
(stye) red, painful pustule that is a localized infection of hair follicle at eyelid margin
176. __ is the single most important PT
prognostic indicator in Acute Liver
Failure.
177. Heparin-induced thrombocytopenia

Type 2: Development of IgG antibodies against heparin- bound platelet factor 4 (PF4).
Antibody-heparin-PF4 complex activates platelets leading to thrombosis and
thrombocytopenia.
178. ______ are very sensitive and specific for Infectious
Mononucleosis, BUT may be NEGATIVE EARLY in the
illness.

Heterophile antibodies
179. Functional hypothalamic amenorrhea

excessive physical training, anorexia nervosa, marijuana use, starvation,

stress, depression

Functional hypothalamic amenorrhea (FHA) is defined as a non-organic

and reversible disorder in which the impairment of GnRH pulsatile
secretion plays a key role.
There are main three types of FHA: STRESS-related amenorrhea, WEIGHT
LOSS-related amenorrhea and EXERCISE-related amenorrhea. The
180. Universal vaccination against Hepatitis B has Membranous
dramatically reduced rates of hepatitis B virus-
associated ______ nephropathy
181. Pencil-in-cup deformity

common deformity noted on x-ray in psoriatic arthritis

The appearance results from periarticular erosions and bone resorption
giving the appearance of a pencil in a cup.
182. Ivory phalanx

Ivory phalanx is a finding of increased radiodensity of an entire

phalanx as a result of periosteal and endosteal bone formation.

This sign is a UNIQUE and SPECIFIC radiographic manifestation of

PSORIATIC arthritis, yet it is uncommon.
183. Bath salts amphetamine like chemicals
Results in agitation, paranoia, hallucinations, chest pain, tachycardia,
hypertension, suicidality (PCP like symptoms, but lasts LONGER)
The effects of Bath salts may take several days or weeks to
subside.
184. Untreated asymptomatic Bacteriuria (>100,000 colonies/ml)
in PREGNANCY can lead to ____ , ____, ____, ____ & _____.

Cystitis, pyelonephritis, PRETERM birth, LOW birth WEIGHt, &

PERINATAL mortality.
185. Biliary cyst

Age < 10. Adominal pain, jaundice, palpable mass in RUQ. Acholic
stools also seen in biliary atresia in infants. Tx surgical resection.
186. Infertility in Cystic Fibrosis patients: Male vs Female Male 98%
Female 20%
187. Patients with Tourette syndrome have a significantly increased risk
of developing ____ and ____.

ADHD (60%) and OCD (27%)

188. Recurrent hemarthrosis causes ____ deposition leading to synovitis Hemosiderin, fibrosis (Hemophilic arthropathy)
and ___ within the joint.
189. Contraindications to Radioactive iodine therapy (in Graves disease) Pregnancy
are _____ and ____ Severe ophthalmopathy
190. Surveillance in Cirrhosis Compensated:
USG+/-AFP every 6 months for HCC
EGD for Varices
191. Acute Mastitis

This is caused by breast abscess and is due to increased risk

of bacterial infection through cracks in the nipple associated
with breast-feeding.
S. aureus is the most common cause. It causes a purulent
discharge.
Treatment:
Frequent breastfeeding or pumping
DICLOXACILLIN or CEPHALEXIN (if MRSA then use
Clindamycin, TMP-SMX, or Vancomycin)
Analgesia
192. Fibromyalgia treatment

Regular aerobic EXERCISE and Good SLEEP hygiene.

Medications reserved for those who fail above treatment.
193. Because splenic macrophages are not present to remove
extraneous DNA from RBCs, there will be an increase of _______
______ bodies on a blood smear.

Howell Jolly bodies

194. Clusters of denatured hemoglobin seen on peripheral smear due to
hemolysis or G6PD deficiency

Heinz bodies

They are extracted by phagocytes (bite cells).

195. TdT is expressed only by ____ and ____ lymphoblasts. Pre B, Pre T
196. Peroxidase positive granules: Lymphoblasts vs Myeloblasts Lymphoblasts - absent
Myeloblasts - present
197. Medications associated with Acute Pancreatitis Didanosine
Azathioprine
Valproic acid
198. Infections associated with Acute Pancreatitis CMV
Legionella
Aspergillus
199. ____ is used almost exclusively for Childhood ABSENCE SEIZUREs. Ethosuximide
Possible side effects:
Drowsiness
N&V
Hyperactivity
Sleep disturbances

(ETHOSUXIMIDE & VALPROATE are the DOC for

initial therapy of ABSENCE SEIZUREs.)
200. ____ and ____ are first-line drugs for the treatment of Primary Generalized PHENYTOIN & CARBAMAZEPINE
TONIC-CLONIC SEIZUREs or PARTIAL SEIZUREs MOA: block voltage-dependant Sodium channels on
the neuron's membrane (both)
201. Side effects of Phenytoin and Carbamazepine Side effects:
Stevens-Johnson syndrome & Toxic Epidermal
Necrolysis (both)
Gingival Hypertrophy, LAP, Hirsutism & Rash
(Phenitoin only)
202. MOA of Phenytoin and Carbamazepine MOA: block voltage-dependant Sodium channels on
the neuron's membrane (both)
203. Which autoimmune diseases are associated with EPISCLERITIS?

Rheumatoid arthritis & Inflammatory bowel disease

204. Pap Smear => ASCUS => age 21-24: Repeat cytology in 1 year
What to do next? age >25: HPV DNA test
if positive => COLPOSCOPY
if negative => Pap smear + HPV test in 3 years
205. Palpable breast mass, <30 yrs. => USG
what to do next? if Simple cyst - Needle aspiration
if Complex cyst or solid mass - image guided core biopsy

>30 yrs. => MAMMOGRAM & USG

if suspicious for malignancy - Core Biopsy
206. Herpes simplex keratitis

Most common cause of corneal blindness in the US

Sx: pain, photophobia, blurred vision, tearing and redness

May be RECURRENT
Florescent staining = DENDRITIC pattern

Tx: Antivirals (oral or topical)

!!! Corticosteroids are CONTRAindicated
207. Herpes Zoster
Ophthalmicus

A prodrome of TINGLING of the forehead may occur.

Sx: severe ocular pain; pain AROUND EYE (along Trigeminal Ophthalmic area); marked EYELID
EDEMA; HUTCHINSON sign (shingles on nose), and photophobia.
Dendriform (Pseudodendritic) ulcers

Tx: high dose ACYCLOVIR

208. Tumor lysis syndrome: K/P/Ca
levels?

Potassium and PHOSPHATE are intracellular ions.

Phosphate binds Ca => serum Ca
Prevented by increasing hydration 24-48 hours before treatment until 74 hours after.
Untreated, can cause renal failure. Usually resolves within 7 days with treatment.
209. Warm agglutinin AIHA

IgG that agglutinate RBC in warm temps

Ex: drugs, viruses (EBV), autoimmune (SLE), immunodeficiency, lymphoproliferative (CLL

Dx: Direct Coombs'; anti-IgG, anti-C3
Tx: High-dose Corticosteroids (Prednisone), if refractory Splenectomy
210. What is the difference between a
warm agglutinin and cold
agglutinin?

211. Pathognomic rash with

glucagonoma

Necrolytic Migratory Erythema

Erythematous papules/plaques on face, perineum and extremities that enlarge and

coalesce over 1-2 weeks with central clearing, blistering, crusting and scalings at borders.
Painful
212. Serum Glucagon levels more
than ___ pg/mL confirms
diagnosis of Glucagonoma.

500 pg/mL

ALPHA cell tumor that causes Hyperglycemia with high glucagon levels and migratory necrotizing
skin erythema
4 D's: DERMATITIS, DIABETES, DVT, DEPRESSION
213. Man stepped on rusty nail. Pseudomonas Aeruginosa
Osteomyelitis developed on the Tx: Surgical debridement + Quinolones
heel. Which organism?
214. Quinolones MOA: Block DNA topoisomerases
ciprofloxacin(Cipro), ofloxacin(Floxin)
215. HER2 oncogene

Overexpression in 20% of primary breast cancers.

Determined by FISH or Immunohistochemistry (IHC).

Trastuzumab (HERceptin) is used to treat breast cancer that is HER2 positive. An ECHOcardiogram
is recommended before beginning treatment as there is a risk of developing CARDIOtoxicity,
particularly in patients with baseline low ejection fractions.
216. Bullous pemphigoid is
triggered by culprit
medications like ____

Furosemide, NSAIDs, Captopril, Penicillamine, and various Antibiotics.

IgG and C3 deposits at the DERMAL-Epidermal junction.
IgGs target HEMIDESMOSOME and BASEMENT membrane zone.
217. What is Mentzer index? Mentzer index is MCV/RBC
<13 - thalassemia (normal RBC count)
>13 - iron deficiency anemia (low RBC count)
218. The presence of Thrombocytopenia idicates a poor prognosis in ___. CLL
Stage Clinical feature Prognosis
0 Lymphocytosis Good
I Lymphocytosis+LAP Fair
II Splenomegaly Fair
III Anemia Intermediate
IV Thrombocytopenia Poor
219. What cells are pathognomonic for CLL (chronic lymphocytic leukemia)?

Smudge cells
220. TransAbdominal USG shows gestational sacs when b-hCG levels are higher than Abdominal >6500 IU/L
____, however TransVAGINAL USG can show it with levels of ____ or higher. Vaginal >1500 IU/L
221. Trachoma

Ex: Chlamydia trachomatis

The MCC single cause of blindness in the
world is
Sx:
222. Non traumatic causes of the avascular (aseptic) necrosis are ___, ____ & ____. Chronic corticosteroid use
Alcoholism
Hemoglobinopathies
223. _____ in TCA overdose is an indication for Sodium Bicarbonate therapy. QRS interval >100 msec
224. What is the effect of Glucocorticoids on the Thyroid hormones? Glucocorticoids (eg. Prednisone) decrease
the peripheral CONVERSION of T4 to T3
225. Screening for ___ , ____ & ____ is recommended in all pregnant women regardless of Syphilis, HIV, & Hepatitis B
their risk factors for sexually transmitted infections.
226. Duchenne vs Becker: age & severance

Age: 2-3 vs 5-15

Duchenne more severe and earlier onset
227. Modified Well's criteria

228. IgA anti-endomysial and anti-tissue transglutaminase Abs are Selective IgA Deficiency
highly predictive of celiac disease but may be ABSENT if there is
concurrent ______, which is common in celiac disease.
229. inflammatory carcinoma

orange peel appearance; lymphatics blocked by tumor

(lymphedema)
230. Which diuretic and which antibiotic are OTOTOXIC?

Furesemide and Aminoglycosides

231. Common findings in Anorexic patiens OSTEOPOROSIS*
Elevated CHOLESTEROL and Carotene levels
Arrhythmias (prolonged QT )
Euthyroid SICK Syndrome
HPA dysfunction resulting in ANOVULATION, amenorrhea
HYPONatremia secondary to EXCESS WATER DRINKING is
often the only electrolyte abnormality, but the presence of
other electrolyte abnormalities indicates purging behavior

Miscarriage
IUGR
Hyperemesis gravidarum
Premature birth
C/S delivery
Postpartum DEPRESSION
232. Triphalangeal thumb

Diamond-blackfan disease
233. Daptomycin Daptomycin has activity against the following:
- Gram(+) bacteria (broad-spectrum activity)
- Multidrug-resistant gram-positive bacteria

Used mainly for:

Vancomycin- and Methicillin-resistant Staph. aureus
Vancomycin-resistant enterococci
Pneumococci with reduced penicillin sensitivity
234. Dapsone used to treat:
Leprosy
Hydradenitis Suppurativa
Dermatitis Herpetiformis
235. Pyrazinamide Which TB drug can cause hyperuricemia and exacerbate the gouty arthritis?
Observe for hepatotoxicity
236. Marcus Gunn pupil

Afferent pupillary defect (e.g., due to optic nerve damage or retinal detachment). Decreased
bilateral pupillary constriction when light is shone in affected eye
237. Tangentiality inability to get to the point of communication due to introduction of many new topics.
Loose associations are more severe form of tangentiality.
238. Circumstantiality Speech that is delayed in reaching the point and contains excessive or irrelevant details
239. Perseveration The continuation or repetition of a motor act or task
240. List 3 causes of increased Prerenal renal failure
BUN/creatinine ratio GI Bleeding (secondary to reabsorption of blood)
Steroid administration
241. Bipolar lifetime risks for: General population - 1%
General population, affected 1st-degree relative - 5-10%
1st-degree relative Child with both parents - 60%
Monozygotic twin - 70%
242. Visual acuity testing should begin at age ___ with the tumbling E or Snellen chart. 3
243. Universal screening for dyslipidemia is recommended at age ___ and again at age ___. 9-11, 17-21
244. Rotavirus vaccination is recommended at age ___ 2-8 months
245. Quadrivalent meningococcal vaccination should be administered at age ___ followed by 11-12
booster dose at age ___. Children with asplenia, HIV and complement deficiency may 16
be vaccinated as early as age ___. 2
246. Black Widow vs Brown recluse Black widow Brown Recluse
Garden, Garage Dark areas of home
Abdominal pain, Sweating Skin Necrosis
Antivenom Dapsone + Debridement
247. Histiocyte a stationary phagocytic cell present in
connective tissue.
248. CD1a positive and Birbeck granules

Langerhans cell histiocytosis

249. _____ _____ is the infiltration of neoplastic leukocytes into the epidermis, the dermis, or
the subcutis, resulting in clinically identifiable cutaneous lesions.

Leukemia cutis
250. MCC diarrhea in AIDS, acid-fast oocytes in stool

Cryptosporidium parvum
251. Guaifenesin (do NOT confuse with Guanfacine)

expectorant - thins respiratory secretions

252. Guanfacine alpha 2 agonist, centrally acting antiadrenergics
can be used in Tourette syndrome and ADHD
253. ____ is typically used in younger patients where tremor is the Trihexyphenidyl
predominant symptom. anti muscarinic
centrally-acting anticholinergic for tremor
254. The classic triad of ___________ consists of:
nongonococcal urethritis,
asymmetric oligo-arthritis, &
conjunctivitis.
The arthritis often involves the KNEE & SACROILIAC spine.
Mucocutaneous lesions (such as MOUTH ulcers) and ENTHESITIS
(Achilles tendon pain) are common.
Tx is ___________

Reactive arthritis
Dx of arthritis which manifests within 2 month of a bacterial
gastroenteritis or nongonococcal urethritis/cervicitis (most
commonly C. trachomatis)
255. ____ is the arrhythmia mos specific for DIGITALIS toxicity. Atrial tachycardia with AV block
256. Cyclosporine side effects

1-Nephrotoxicity:the mc and serious side effect. It manifest as

acute azothemia or irreversible progressive renal disease
2. Gingival hypertrophy
3. HyperKalemia
4. Tremor
257. All sexually active women age <24 should be screened for ____ Chlamydia trachomatis and Neisseria gonorrhoeae
and ___ with Nucleic acid amplification.
258. Although Gd-dependent (central) Precocious puberty is MRI with contrast
IDIOPATHIC in MOST (80%) of patients, all patients with elevated
LH levels should undergo ____.
259. Traveler's Cryptosporirium
diarrhea most common travel-related illness. bacteria causes 80% of TD. E.coli, campylobacter jejuni, shigella, salmonella.
Protoza includes giardia, entamoeba, cryptosporidum and cyclospora. Primary source of infection is ingestion of
fecally contaminated food and water.
260. Respiratory
Quotient
use

= CO2 produced/O2 consumed

c6h12o6 +6O2=6CO2+6H20 => 6CO2/6O2=1.0
C16H32O2 (Palmitic acid) - 16CO2/23O2=0.7
Normal=0.8

Underfeeding, which promotes use of endogenous fat stores, should cause decreases in the RQ, whereas overfeeding,
which results in lipogenesis, should cause increases in the RQ.
261. Ehrlichiosis

vs
Tick Bite disease, sustained fever, chills, head ache, muscle pain but no rash. Treat with tetracycline
262. Babesiosis

Babesia microti
carried by Ixodes tick; in IMCD and asplenics
HEMOLYTIC ANEMIA - JAUNDICE (in contrast to Erhlichiosis)
NE of the USA.
Parasite enters RBCs and causes hemolysis. Jaundice, hemolytic anemia, thrombocytopenia, high ESR, NO rash.
Dx- Giemsa thin and thick smear.
Tx- Quinin+Clinda or Atovaquone+Azithromycin
263. Keratoderma blenorrhagicum

palms and soles lesions

skin lesion (looks like psoriasis) characteristic of reactive
arthritis/reiter's syndrome
264. Balanitis circinata

dermatologic manifestation of reactive arthritis

(sometimes also referred to as Reiter Syndrome)
foreskin with papulosquamous lesions with a rolled up
appearance
Ringlike inflammation of the glans penis.
265. 2 dermatologic manifestations of Reactive arthritis (urethritis, Balanitis circinata, Keratoderma blenorrhagicum
conjuctivitis/uveitis, arthritis):
266. Alpha 1 blockers such as _____ act on the distal ureter, lowering muscle Tamsulosin (Flomax) is used to improve urination in men
tone and reducing ureteral spasm secondary to stone impaction. with BPH. Relaxing the muscles in the prostate and
These agents facilitate stone passage. bladder so that urine can flow easily
267. TAMSULOSIN

268. Actinomyces treatment Prolonged (12 week) High dose Penicillin

269. SNAP stands for: ___ for Nocardia, Actinomyces - ____ Sulfa, Penicillin
270. Antimalarial drug in pregnancy Mefloquine
271. ____, ____ and ____ are recommended chemoprophylaxis for travelers to Mefloquine, atovaquone-proguanil, doxycycline
endemic regions of chloroquine-resistant malaria.
272. Trimetoprim causes Hyper____ Hyperkalemia. blocks epithelial sodium channel in the
collecting tubule.
Also competitively inhibits renal tubular creatinine
secretion and may cause an artificial increase in serum
creatinine without affecting the GFR.
273. ____ analogs and ____ have been shown to increase appetite and weight Progesterone analogs: Megestrol acetate &
gain in patients with cancer-related anorexia/cachexia syndrome. medroxyprogesterone acetate

Corticosteroids
274. Salvage therapy This type of chemotherapy is used after relapse after
radiation
275. Indications for drainage of the parapneumonic effusion Low pH (<7.2) is almost always indicative of empyema
Gluclose of less than 60 MG/DL is also an indication for
tube thoracostomy.
276. Children age more than ____ and adults should have a cardiothoracic 1 year
ratio of less than 50%.
277. What's the treatment of contact dermatitis? Topical glucocorticoids for example betamethasone,
flucinonide
278. Treatment of Torsades de Pointes Stable pt: IV Magnesium

Unstable pt: Defibrillation

279. Nerves of the Lower extremity

280. The DOC for Pulmonary Nocardiosis is TMP-SMX. When BRAIN is

involved, the _____ are added for better coverage.

Carbapenems

(Nocardia can disseminate from lungs to affect other organs,

with BRAIN or SKIN being the Most common.)
281. Marfan syndrome vs Homocystinuria

Homocystinuria:
Fair complexion
Thromboembolic events
Intellectual disability
DOWNward dislocation of lens
282. Arachnodactyly

Marfan syndrome
283. Conjunctivitis

The conjunctiva is the mucous membrane that lines the inside surface of the lids and covers the surface of the
globe up to the limbus (the junction of the sclera and the cornea). The portion covering the globe is the "bulbar
conjunctiva," and the portion lining the lids is the "tarsal conjunctiva."
284. Keratitis inflammation of the cornea
285. Uveitis

inflammation of the vascular layer of the eye (Uvea)

286. Schizoaffective
disorder

Manifested by schizophrenic behaviors, PLUS mood disorders (depression or mania).

287. Hemochromatosis

Autosomal Recessive
increased GI iron absorption
HFE mutation
288. Treatment of Clubfoot

Talipes Equinovarus
Rx: Stretching, followed by serial casting. If results are unsatisfactory, then do surgery before 12 months.
289. Metatarsus Adductus

290. Leukocytoclastic vasculitis henoch-schonlein purpura ( HSP) - 1/2 of time it is triggered by an URI
291. Galactokinase def vs Gal-1-Uridyl
transferase def

Galactokinase def
MILDER symptoms
Catarrhact ONLY

Gal-1-Uridyl transferase def

Bilateral Cattarhact
Jaundice, Hepatomegaly, Hypoglycemia
SEIZURES
Mental retardation
risk for E.Coli neonatal sepsis
292. Long term sequela of the bacterial Hearing loss
MENINGITIS Loss of cognitive functions (due to neuronal loss in dentate gyrus of the hyppocampus)
Seizures
Mental retardation
Spasticity or paresis
293. Montevideo unit

montevideo unit= # of uterine ctx in 10 mins X ctx strengt, OR

the sum of the amplitudes (in mm Hg) above baseline of the uterine contractions within
a 10min window.
Normal=200 Montevideo units
294. Mixed
cryoglobulinemia

Mixed cryoglobunemia is most commonly due to hepatitis C and presents with immune complex deposition in
small blood vessels, leading to endothelial injury, inflammation, and end-organ damage. The immune
complexes are IgM antibodies (similar to rheumatoid factor) that form complexes with IgG anti-hepatitis C virus
antibodies, hepatitis C virus RNA, and complement.
Patients can be asymptomatic or develop findings in the skin (e.g., palpable purpura, Raynaud's phenomenon),
kidney (e.g., MPGN), nervous system (e.g., motor sensory axonopathy), and musculoskeletal system (e.g.,
arthralgias).
Diagnosis can be confirmed serologically (serum cryoglobulins, low complement levels) or with kidney/skin
biopsy.
Treatment options in addition to addressing the underlying hepatitis C infection include plasmapheresis to
remove cryoglobulins and immunosuppressants (e.g. glucocorticoids, cyclophosphamide)
295. Folic acid vs Vit elevated Homocystein (in both)
B12(Cobalamin) elevated Methylmalonic acid (in Vit B12 def)
def: which amino
acids increased?
296. Behcet's disease May progress to Dementia and Blindness
complications
297. Absolute
contraindications
to OCPs

Migraine with aura

Smokers >35
BP >160/100 mmHg
298. De Quervain
tenosynovitis

abductor pollicis longus and extensor pollicis brevis tendons

Dx: Finkelstein test diagnoses
Tx: Steroids
299. Antiretroviral drugs SEs: Didanosine - Pancreatitis
"..." - Pancreatitis Abacavir - Hypersensitivity syndrome
"..." - Hypersensitivity syndrome NRTs - Lactic Acidosis
"..." - Lactic Acidosis NNRTIs - Stevens-Johnson syndrome
"..." - Stevens-Johnson syndrome Nevirapine - Liver Failure
"..." - Liver Failure Indinavir - Crystal-nduced nephropathy
"..." - Crystal-nduced nephropathy
300. Nonsense vs Missense mutation

Nonsense - STOP, NONcontinuing

Missense
301. Intrauterine growth restriction, Maternal HTN, and Chronic The most important risk factor for RDS is prematurity; other
intrauterine stress from prolonged rupture of membranes decrease factor that increase RDS risk include male sex, perinatal
the risk of RDS. Intrauterine stress is thought stimulate early fetal asphyxia, maternal diabetes, and cesarean section without
lung maturity. labor.
302. Leser-Trelat sign

Sudden appearance of multiple seborrheic keratoses,

indicating an underlying malignancy (e.g., GI, lymphoid).
303. Strongyloidiasis: Sx & Tx

Ppx: infects via eggs laid in upper GI, hatch, move to

bowel, get excreted, and can infect via skin penetration
and then travel to the lungs.
Sx: Urticaria, Abdominal pain, and Respiratory problems
(eg dry cough, dyspnea, wheezing)
Tx: Ivermectin
304. Onchocerciasis

River Blindness
S: Ocular lesions and Dermatitis
Tx: Ivermectin
305. Efavirenz NNRTI
insomnia with vivid, bizarre dreams
AVOID IN PREGNANCY.
306. Tocolytics

Magnesium
NIFEDIPINE (CCBs)
INDOMETHACIN
TERBUTALINE (b-Blocker)
307. Intracranial calcification Congeital toxoplasmosis
Chorioretinitis
Hydrocephalus
Intracranial calcifications
308. Periventricular calcifications

Congenital CMV syndrome

309. Congenital Rubella

Deafness
Cataract
Cardiac defects
310. Howel-Jolly bodies

nuclear remnants seen in asplenics

311. Heinz bodies

derived from denatured hemoglobin

G6PD deficiency
312. Rosacea treatment

A chronic condition of unknown cause that produces redness, tiny pimples, and broken blood
vessels mostly on the nose and cheeks

Tx: avoid triggers, metronidazole, oral abx (tetracycline, minocycline, oral metronidazole)
313. The aldosterone-to-renin ratio >20 - Hyperaldosteronism
314. What is the antidote for Methylene blue
methemoglobin toxicity?
315. Cyanide poisoning

Sx: Bitter almonds (scent)

Ex: Hydrogen cyanide produced from the combustion of nitrogen-containing synthetic polymer (eg,
foam, cotton, paint, silk). That's why it is crucial to treat empirically in victims of smoke inhalation.
Tx: Sodium Thiosulfate, Hydroxycobalamin
316. Methemoglobinemia Ex: occurs after exposure to oxidizing agents (eg. Dapsone, Nitrates, Nitric oxide, topical/local
anesthetics)
Px: Results from oxidation of ferrous iron (Fe2+) to ferric iron (Fe3+) leading to a reduced affinity for
oxygen.
Sx: Chocolate brown blood
Tx: Rarely, Methylene blue or exchange transfusion is needed
317. ARDS severity PaO2/FiO2 < 300
- Mild (P/F 200-300)
- Moderate (P/F 100-200)
- Severe (P/F <100)
318. Patient taking
Hydroxychloroquine should
be screened for:

Eye screening every 6 month for Retinopathy

- used in SLE
319. Metabolic Alkalosis

320. Essential Tremor Shaking hands, increased when using hands/writing/volitional activities. Stress worsens, wine
improves. Is familial.
Propranolol
321. Hyperemesis gravidarum
treatment

Ginger
Vit B6 (Pyridoxine) +/- Doxylamine
Ondansetron
Metoclopramide
322. Scabies treatment:

Permethrin 5% cream (Remember you have 5 fingers)

323. Shy-Drager syndrome

Parkinsonism with predominant orthostasis (autonomic dysfunction)

324. Normal Pressure
Hydrocephalus

Sx:
Dementia
Gait disturbance
Urinary incontinence.

Ex: due to incomplete subarachnoid CSF block. Commonly results from prior subarachnoid
hemorrhage or meningitis.
325. Kwashiorkor

PROTEIN malnutrition resulting in skin lesions, edema, liver malfxn (fatty change). Clinical picture is small child w/
swollen belly. "Kwashiorkor results from a protein-deficient MEAL: Malnutrition, Edema, Anemia, Liver (fatty)"
326. Marasmus

Decreased CALORIC intake results in loss of muscle mass during

Energy malnutrition resulting in tissue and muscle wasting, loss of subcutaneous fat, and variable edema. "M arasmus
results in M uscle wasting"
327. Q Fever

Ex: Coxiella burnetti(rickettsial-like), from Cattle, Goat, Sheep

Sx: Flu-like syndrome, HEPATITIS, Pneumonia
Rx: Doxycycline
328. Raccoon

Rabies
Raccoons are the most prevalent rabid animal in the USA, especially on the east coast.
329. Koplik spots

330. Cardiac enzymes

CK-MB - returns to normal within 1-2 days

Troponin T - 10 days
331. Torsades de Pointes Life threatening cardiac event that prolong QT
Tx: Magnesium
332. Porphyria Cutanea Tarda

Most COMMON porphyri

Ex: Deficiency uroporphyrinogen decarboxylase
Sx: painless blisters (on dorsum of hands), hyperpigmentation. Associated with Hep C, ethanol, OCPs.
Dx: elevated urinary porphyrins
333. Bruton's 1. X linked BTK tyrosine kinase deficiency --> no development of mature B cells --> encapsulated
agammaglobulinemia infections, chronic enteroviral infections, no tonsil
334. Common Variable - B cells normal amount but do not make effective immunoglobulins==> Decrease in all subtypes: IgG,
Immunodeficiency IgM, IgA
335. Bruton vs CVID Both have decreased Igs
Bruton - No B cells, Severe, INFANT
CVID - B cells present but defective, Les Severe, Later age (15-35 years)
336. Asthma treatment

337. CURB-65

1) Confusion
2) BUN>19
3) RR>30
4) BP<90/60
5) 65yo
One or less indicates patient can be treated outpatient, >1 =hospitalization
338. Inpatient CAP treatment

Outpatient: Macrolide (azithromycin or clarithromycins)

Inpatient: Fluoroquinolone
339. Macrovesicular vs Microvesicular hepatitis

Macro: Alcoholic and Nonalcoholic fatty liver disease

Micro: Reye syndrome
340. Phenytoin cause which vitamin deficiency? Folic acid
It impairs absorbtion of Folic acid
341. Etiology of the Erysipelas GAS (Strep. Pyogenes)
342. Shock liver, aka Ischemic Liver Disease septic shock then huge increase in LFTs one day later
AST & ALT high s/p hemorrhage surgery ( cardiovascular ) or sepsis
343. Hepatic Encephalopathy Px & Px: HE is a CNS complication of cirrhosis due to inability of the liver to convert AMMONIA to
Tx UREA.

TX: decreasing blood levels of AMMONIA

- Lactulose (Nonabsorbabli disaccharide)
- Rifaximin (Antibiotic)
- Laxatives
344. Erythema Marginatum

MARGINS of the lesions are SHARP

Acute Rheumatic Fever
345. Erythema Multiforme

Target-like lesion
No BULLA (vs Steven-Johnson syndrome)
346. Clostridium Difficile colitis Px: Intestinal overgrowth leads to toxin production:
Enterotoxin A: Watery diarrhea
Cytotoxin B: Colonic epithelial cell necrosis & fibrin deposition
347. Vesicle vs Bulla vs Pustule

348. Pustule
349. Non-bullous vs Bullous Impetigo tx Non-bullous: S.Aureus &/or Strep. Pyogenes
TOPICAL Mupirocin
Bullous: S.Aureus
ORAL Ab(Cephalexin, Dicloxacillin)
350. Tx for Histoplasmosis Itraconazole
351. Erythema Migrans is sufficent to make diagnosis of Lyme ...
disease.
352. Sildenafil contraindications nitrates or nitroprusside (Both decrease blood pressure)
While combining with alpha-blocker, it is important to give the
drugs with at least 4-hour interval to reduce the risk of
hypotension
353. Homocystinuria Treatment

dose Vit. B6 (pyridoxine) + methionine diet

354. Niacin Hypercholesterolemia treatment that flushing and pruritus.
355. Hyperparathyroidism

Hypertension
Depression, Psychosis, Confusion
356. Tourette syndrome treatment 1. Antipsychotics (2nd gen antipsyichotics preferred) Risperidone
2. alpha agonists (sympatholytics)- clonidine, guanfacine are also
popular
3. Behavioral therapy.
357. Fever, Cough, Diarrhea PLUS SPlenomegaly PLUS Elevated Disseminated Mycobacterium Avium Complex
ALP in HIV patient with CD4<50 should raise suspicion of ... Elevated ALP shows Hepatosplenic involvement
Patients with CD4<50 should receive AZITHROMYCIN for
prophylaxis
358. Levothyroxine does not cross the placenta. Endogenous ...
thyroid hormone also doesn't cross.
359. Neonatal thyrotoxicosis

Methimazole PLUS Beta-blocker

360. Paroxysmal Nocturnal
Hemoglobinuria

Sx: Sudden onset of SOB after a period of sleep

Cx: Hepatic vein thrombosis
Tx: Eculizumab
361. Vertebrobasilar
insufficiency

Reduced blood flow in the posterior circulation of the brain

Vertigo, Dysarthria, diplopia, and numbness
brainstem, cerebellum, inner ear labyrinth
362. Brain Death

Absent cortical and Brain stem functions

NO pupil light reflex and Oculovestibular reax
Heart rate fails to accelerate after ATROPINE injection because vagal control of the heart is lodt,
and the heart rate becomes INVARIANT
flat EEG reading
An Apnea test shows no spontatneous respiration at PCO2 values of 50 mmHg and more
Spinal cord MAY still be functioning
363. Abnormal Nitroblue tetrazolium Slide Test

chronic granulomatous disease (NADPH complex dysfunction), infx with catalase +

organisms (aspergillus, serratia, burkholderia)
364. Partial Albinism + Recurrent URIs + Chediak Higashi Syndrome
Neurological disorders
365. Poor smooth pursuit of the eye + elevated Ataxia-telangiectasia
AFP after 8 months
366. Pneumonitis vs Pneumonia

Pneumonitis:
Px: Lung inflammation (without infx)
Ex: Aspiration of GASTRIC contents with subsequent acid injury
Px: Present HOURS after aspiration event
Sx: Ranges from No symptoms -> nonproductive Cough
Tx: Supportive (NO ABs) Resolves spontaneously
367. Hepatic Hydrothorax

Sx: transudative pleural effusions, cirrhosis, usually Right-sided

Tx: salt restriction and diuretics and if resistant, TIPS placement
368. Tea and Toast type of diet Folic acid deficiency
Folic acid is heat sensitive
369. Urea breath test Dx of H. pylori
370. Hydrogen Breath test Dx of Lactose intolerance
371. Meningitis long-term complications 1. Hearing loss.
2. Loss of cognitive functions (due to neuronal loss in dental gyrus)
3. Seizures
4. Mental retardation
5. Spasticity or paresis
372. Aspirin Sx: Asthma, chronic rhinosinusitis with NASAL POLYPs, bronchospasm or nasal congestion following the
Exacerbated ingestion of Aspirin or NSAIDs.
Respiratory
Disease
373. Systolic-diastolic Renal artery stenosis
abdominal bruit
374. Scleroderma renal SRC is characterized by Malignant HTN and oligo-anuric Acute Renal Failure.
crisis It occurs in 5% of patients with systemic sclerosis (SSc), particularly in patients with diffuse disease during the
first years. SRC is more common in patients receiving CORTICOSTEROIDs, the risk increasing with increasing
dose.
Thrombotic microangiopathy is detected in 43% of cases.
The prognosis of SRC has greatly improved with the introduction of angiotensin-converting enzyme (ACE)
inhibitors.
Tx: aggressive BP control (ACE inhibitor). Dialysis
375. Pyoderma
Gangrenosum

PG causes rapidly progressive painful ulcer with a purulent base and violaceous borders. More than 50% of
patients have associated systemic disease (eg IBD).
Tx: local or systemic CORTICOSTEROIDs
376. Autoimmune
hemolytic anemia

AHA is a group of disorders characterized by a malfunction of the immune system that produces
autoantibodies, which attack RBCs.
377. Chlordiazepoxide long acting benzodiazepine
Commonly used for Alcohol withdrawal
378. Cauda Equina Spinal ROOT compression
syndrome Causes RADICULAR pain, SADDLE (vs Conus medullaris - PERIANAL) anesthesia,
379. Erythema Toxicum Neonatorum

Benign neonatal rash characterized by blanching erythematous papules

and/or PUSTULEs.
Small pustules (whitish yellow color) that are 1 to 3 mm in size and
surrounded by a red base. Erupts during the 2nd-3rd day of life.
Tx: It resolves spontaneously in 2 weeks after birth.
380. Antiphospholipid syndrome Tx in pregnancy Low dose Aspirin and LMWH are recommended to avoid pregnancy loss.
381. All patients should receive Vaccines either 2 weeks ...
before or 2 weeks after splenectomy.
382. Primaquine vs Chloroquine vs Mefloquine Primaquine does not kill P. Falciparum schizonts. Does kill P. Ovale and
P.Vivax.
Chloroquine used in susceptible areas.
Mefloquine used in Chloroquine-resistant P. Falciparum. Drug of Choice in
Pregnancy.
383. Antimalarial DOC in Pregnancy Mefloquine
384. Anti mitochondrial antibodies Primary biliary cirrhosis
Autoimmune destruction of intrahepatic bile ducts
385. Anti smooth muscle antibodies (ASMA) Autoimmune hepatitis
Tx: Oral glucocorticoids
386. Quantitative Pilocarpine Iontophoresis Cystic fibrosis
Up to 40% of patients have NASAL POLYPs
387. Tinea corporis Tx: Topical 2% antifungal lotions (Terbinafine)
Systemic treatment with Griseofulvin for extensive
388. Aortoiliac occlusion

aka Leriche syndrome

Triad of:
Bilateral hip, thigh and buttock claudication
Impotense
Symmetric ATROPHY of the bilateral lower extremities due to chronic
ischemia
389. Broca and Wernicke
areas: which lobes?

Broca - frontal lobe

Wernicke - Temporal lobe
390. Serotonin release What is the best diagnostic test of HIT(Heparin Induced Thrombocytopenia)?
assay
391. Sialadenosis

benign, noninflammatory enlargement of the SUBMANDIBULAR salivary glands. It is seen in patients with
advanced liver disease as as a variety of dietary and nutritional disorders (diabetes, malnutrition, bulimia)
392. Zinc deficiency

Impaired wound healing

Tad alamaz (Dysgeusia)
Koku alamaz (Anosmia)
Alopecia
Periooral rash
393. HIV retinopathy

benign cotton wool spots in retina that remit spontaneously

394. Syphilis treatment Primary and Secondary:
Single dose IM Penicillin.
if allergic, Oral Doxycycline

Tertiary:
IV Penicillin, if allergic, then Desensitize.
395. Tertiary Syphilis

Treponema pallidum

Neurosyphilis:
Stoke from Vasculitis
Tabes dorsalis
General paresis (Memory and Personality changes)
Argyll Robertson pupil

Gummas (a non-cancerous growth, a form of granuloma, skin and bone)

Aortitis (aortic regurgitation and anurysm)

396. False positive VDRL/RPR causes VDRL is false positive in "Missed Positive VDRL"
Malaria
Pregnancy
Viral diseases - Hepatitis, AIDS
Drug IV use
Rheumatic fever, Rheumatoid arthritis
Leprosy, Lupus
397. Pediculosis vs Scabies

Bit vs Pire
Lice vs Scabies
Tx: both Permethrin
398. Chronic
Granulomatous
Disease

inherited deficiency in NADPH oxidase, in which the individual is likely to develop infections with catalase-
positive organisms?

Chronic granulomatous disease is so-named for the macrophage-rich granulomas formed by the immune
system to wall-off microbial infection when NEUTROPHILE DEFENSE is INADEQUATE. Recurrent infections may
lead to other manifestations including:
Lymphadenopathy
Hypergammaglobulinemia
Increase in WBC count
Hepatosplenomegaly (secondary to granuloma formation).
399. CGD diagnosis

Chronic granulomatous disease can be diagnosed by:

A negative nitroblue tetrazolium (NBT) dye reduction test
An abnormal dihydrorhodamine 123 (DHR) test.
400. Indications for Age 40-75 with Diabetes
Statin: Estimated 10-year ASCVD risk >7.5%
LDL > 190 mg/dL
Atherosclerotic Disease (ACS, MI, Stable or Unstable Angina, Stroke, TIA, PAD)
401. COPD'de Home oxygen therapy
mortalitenin Smoking cessation
azaltan 2
modalities:
402. Myxedema coma Coma & extreme hypothermia (24-32)
403. Pigmented
granular casts

Pathognomonic findings of acute tubular necrosis (ATN)

aka as Muddy Brown Granular sediments/casts
404. Riluzole

Used to slow the progression of ALS

405. Oxybutynin Oxybutynin is an anticholinergic medication used to relieve urinary and
bladder difficulties, including frequent urination and inability to control
urination
406. Ergonovine Ergot alkaloid: uterine effect prototype, causes prolonged uterine
contraction. Used in postpartum bleeding
407. Disseminated Histoplasmosis treatment ITRAconazole
Pt, HIV, CD4<100, in SE or SC USA, with
fever, fatigue, and weight loss. Symptoms and signs may point to
involvement of specific sites, such as the skin, oropharynx,
gastrointestinal tract, central nervous system (CNS), and adrenal
glandsinated Histoplasmosis
408. Fever, Hives, Joint pain 1 week after penicillin therapy Serum Sickness
Sx: Fever, arthralgia and rash started after Beta-Lactams or
Sulfonamides administration
Px: type III hypersensitivity, Drug-Ab complexes & Complement
activation
409. Patients comes with Generalized RASH-EDEMA-LAP,
Increased ALT/AST, Facial swelling. Lab findings:
EOSINOPHILIA. Weeks ago he recently diagnosed for
with epilepsy. Dx?

DRESS

Drug Rash with Eosinophilia and Systemic Symptoms

Hepatitis, Exanthema, Facial swelling, Generalized edema, and LAP

410. Patients with endocarditis. Blood cultured turn out to be Coxiella is the MCC of culture-negative Endocarditis
Negative. MCC?
411. Amoxicillin substitutes (vzedici) in penicillin allergic Clindamycin
patients Macrolides (Azithromycin, Clarithromycin)
412. HACEK endocarditis treatment Ceftriaxone
413. HIV patient HLA B5701 is positive: Avoid Abacavir
414. Baby just born to HIV-positive
mother. Baby should receive what?
415. Which antiretroviral should be
avoided during pregnancy?
416. Pregnant diagnosed with HIV.
CD4 = 650
PCR-RNA Viral load = 300.
Next step?
417. When to do C/Section in HIV positive
patient?
418. Patient with facial edema, lips and
eyes swollen, stridor, NO rash. Tx:
419. Dermatographism
420. 17 y/o girl with history of Giardiasis
has chronic diarrhea, flatulence. All
Ig levels are low.
What is the diagnosis?
What cancer likely to develop?
421. 4 y/o male with history of frequent
sinusitis, otitis, pneumonia. No
adenoid tonsils seen. No LAP. Dx?
Zidovudine during delivery and for 6 weeks afterward to help prevent transmission.
Zidovudine may cause ANEMIA
Efavirenz, teratogen in animals.
Asymptomatic pregnant women with High CD4 and Low Viral load should STILL BE
TREATED with Antiretroviral UNTIL DELIVERY just to PREVENT TRANSMISSION. Treatment
can be Stopped after delivery if CD4 and Viral load is fine. !!!!!
Virus > 1000l
CD4 <350
Angioedema
Px: C1 ESTERASE INHIBITOR deficiency, low C2 & C4
Tx: Fresh Frozen Plasma or ECALLANTIDE (Specific treatment)
Type of urticaria that is trigerred by PRESSURE
Common Variable ImmunoDeficiency (teenager)
Low IG levels
Normal levels of NONfunctionings B cells
Lymphoid tissue present
GIARDIASIS and LYMPHOMA
Bruton's X-linked Agammaglobulinemia (kids)
NO Cell
NO IGs
NO Lymphoid tissue
422. 2 y/o kid with recurrent infections. PE: fair skin, sensitivity to Chdiak-Higashi is a rare, autosomal recessive syndrome
light. Increased Ig levels, giant inclusions inside the characterized by impaired lysis of phagocytized bacteria,
neutrophils. How to confirm diagnosis? resulting in recurrent bacterial respiratory and other infections
and oculocutaneous ALBINISM.

Dx: can be confirmed with genetic testing for LYST mutations.

Giant lysosomal granules develop in neutrophils.
423. 50 yo female develops chest pain after hearing her brothers
death. ECG shows ST elevations. Angiography shows normal
Coronary arteries and apical balooning. Echo shows apical
hypokinesis. Dx?

Takotsubo
Beta blockers and ACEIs
424. 45 yo male has chest pain after exertion. He had leg Echo with Dobutamine
amputation last year. He also has left-bundle branch block.
How to diagnose his condition? CAD diagnosis:
1. Stress (Exercise tolerance) test
2. if cannot read EKG due to abnormalities (bundle block, a-fib, v-
tach etc.), then either Nuclear isotope (Thallium or Sestamibi) or
Echo
3. if cannot read EKG and pt cannot Exercise, then:
Dipyridamole, or Adenosine + Thallium or Sestamibi
Dobutamine + Echo
425. When Clopidogrel used? Aspirin intolerance such as allergy
Recent angioplasty with stenting

Clopidogrel rarely causes TTP

426. If patient intolerant to both Aspirin and Clopidogrel? Ticlopidine
Can cause Neutropenia and TTP
427. Prasugrel ADP receptor inhibitor
indicated in patients w/ ACS who are going to be managed w/
PCI
428. Side effects of Niacin? Elevations in Glucose and Uric acid level
Pruritus
429. Patient develops Thrombocytopenia after using heparin. Serotonin release assay is the gold standard confirmation test for
What's the best way to confirm his condition? heparin induced thrombocytopenia
430. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated
with Streptococcal infections)
is group of tic and OCDs linked to GAS infection and subsequent
autoimmune damage. Classically, a patient would present with tics
that are worse in winter and spring.
431. Patient comes with dyspnea. He has history of recurrent Osler-Weber-Rendu syndrome (Hereditary telangiectasia)
epistaxis. Purple papule is noted in his oral mucosa. ABG an AD disorder characterized by diffuse telangiectasia, recurrent
shows low PO2. What is the cause of his Hypoxia? epistaxis, and widespread AV malformations(mucosa, skin, GIS,
Lungs etc)
AVMs in the lung can shunt the blood from right to left causing
chronic Hypoxemia which results in Polycythemia.
432. 25-year-old female comes to the clinic with severe flushing and palpitation. Disulfiram like reaction
Recently she has been diagnosed with trichomonas vaginitis. Yesterday she Is characterized by severe flashing and maybe
attended a party in her friends house. What's the cause of her symptom? accompanied buy tachycardia and
hypertension. Drowsiness it Is common
symptoms.
Patients should be advised to avoid alcohol
for 24 hours after Metronidazole, and 72 hours
after Bactrim and Tinidazole.
433. One year old infant present with multiple petechial lesions throughout the body
he also has purple rash on his flanks. He develops hypotension while in the ER.
What's the most likely diagnosis?

Waterhouse-Friederichsen syndrome is
characterized by sudden vasomotor collapse
and large purpuric rashes in the flanks.
434. Patient comes chest pain any EKG shows ST segment depression. Aspirin has Low molecular weight heparin
been given. What's the most appropriate next step in the management of this
patient?
435. Cannon A waves

3rd degree AV block

atrial contraction against closed tricuspid

valve
436. What's the most common cause of death congested heart failure? arrhythmia/ sudden death
437. Nesiritide IV form of Atrial Natriuretic Peptide
can be used in Acute pulmonary edema, but
there is NO mortality benefit.
438. Patient jugular vein bulges when he get a breath. What sign is this?

Kussmaul sign
439. Combustion of nitrate-containing synthetic materials (foam, Cyanide toxicity
cotton, silk, paint). Treatment? Tx: Hydroxycobalamine or Na Thiosulfate antidotes
They directly bind cyanide molecules.
440. Which of the following is the most dangerous to pregnant Peripartum CM is worst, followed by Eisenmenger syndrome
woman?
a. Mitral stenosis
b. Peripartum Cardiomyopathy
c. Eisenmenger phenomenon
441. Treatment options of acromegaly Surgery: transsphenoidal resection
Medications:
- Cabergoline: dopamine agonist will inhibit GH release
- Octreotide or lanreotide: somatostatin inhibits GH release
- Pegvisomant: A GH receptor antagonist, it inhibits IGF release
from the liver.
442. Pegvisomant

A GH rec antagonist, it inhibits IGF release from the liver.

used in Acromegaly
443. 46-year-old woman incidentally found to have 7 mm thyroid USG in a year
nodule. What is the next step?
444. Six -year-old woman incidentally found to have 1.5 cm thyroid Check TSH/T4
nodule. What's the best next? - if normal - Fine needle aspiration
- if TSH is low do Radio Active I uptake
- if low RAIU - Fine needle Aspiration

Cold nodules bigger than 1 cm - FNA

445. 44 y/o male with hypercalcemia has parathyroid nodule. He is Cinacalcet - inhibitor of PTH release
poor candidate for Surgery. What's next?
446. Perioral numbness and Early cataract. Which metabolic Hypocalcemia can present with perioral numbness and early
disorder? cataracts
447. Cosyntropin COSyntropin stimulates COrtiSole.
ACTH analog used fordiagnosis of Addison's disease
448. Fludrocortisone Synthetic corticosteroid: high mineralocorticoid and moderate
glucocorticoid activity; long duration of action
449. Adrenal crisis. Tx? Hydrocortisone
450. 35 yo female comes to cleaning confusion, Altered mental status and - Intravenous T4
unresponsiveness. Her palms appear to be yellow in color. Temperature is 28C. her - Corticosteroids
blood pressure is 90/65, heartrate is 55. She has had an upper respiratory illness - The patient should not be re-warmed
recently. What's the most likely diagnosis? What's the next in management? rapidly which may precipitate her
hypotension or arrhythmias.
451. Treatment of Schizoaffective disorder? Manic type: antipsychotics PLUS Li,
Manic type vs depressive type Carbamazepine, or Valproate

Depressive type:
1. 2nd-generation antipsychotics should
be given first.
2. Once positive symptoms are
stabilized, anti-depressant should be
introduced.
452. Churg-strauss syndrome What variant of polyarteritis nodosa is
associated with bronchial asthma,
granulomas, and eosinophilia?
453. Plethysmography

Pulmonary plethysmographs are

commonly used to measure the
functional residual capacity (FRC) of the
lungs and total lung capacity.
454. Pilocarpine Muscarinic cholinergic receptor agonist
Pilocarpine is used to treat dry mouth
and glaucoma.
Also used in skin chloride test for
diagnosing cystic fibrosis.
455. 32 y/o women has been treated for Tuberculosis for 1 months with RIPE regimens. Her Continue current treatment.
current lab show AST=105, ALT=95. What is the next step? All TB medications cause
Hepatotoxicity, but do not stop them
unless the transaminases rise to 3-5
times the upper limit of normal.
456. 28 y/o pregnant woman diagnosed with Tuberculosis. How should he be treated? - treatment extended to 9 mo for:
- Osteomyelitis, Miliary tbc, Meningitis,
Pregnancy

Avoid Pyrazinamide and Streptomycin

during pregnancy.
457. Treatment options of Idiopathic Pulmonary HTN Idiopathic Pulmonary HTN

- Prostacyclin analogues (Pulm Artery

vasodilators): Epoprostenol, Treprostinil,
Iloprost, Beraprost
- Endothelin antagonist: Bosentan
- PDE inhibitors: Sildenafil
458. Pseudogout: Dx and Tx Pseudogout (Wrists and Knees) treatment is the same as gout.
Dx: positive rhomboid
- Tx:
- First give NSAIDs, if C/I or no response to NSAIDs, then give
intraarticular Steroids such as Triamcinolone or Colchicine.
459. Busulfan MOA: alkylates DNA (all phases of cell cycle susceptible
460. 45 yo male with chronic disease is diagnosed with Hypertension. Losartan (ARB) lowers uric acid. Losartan is the best drug for
What is the best treatment for his HTN? HTN in Gout patients.
461. What GnRH analog is used as a repository form of treatment in Leuprolide
prostatic cancer?
462. Pannus

- inflamed hyperplastic synovial tissue destroys articular

cartilage; joint fusion
Rheumatoid arthritis
- a vascular tissue that initially develops at the junction
between the articular cartilage, synovial membrane, and joint
capsule as a result of an autoimmune response.
463. Ostephyte Osteophytes, commonly referred to as bone spurs or parrot
beak, are bony projections that form along joint margins.
464. The patient with long-standing rheumatoid arthritis is to have Cervical spine x-ray
coronary bypass surgery. Which of the following is most
important prior to surgery? RA a is associated with C-1/C2 subluxation. Cervical spine
imaging to detect possible instability of the vertebra is
Cervical spine x-ray essential prior to hyper extension of the neck that typically
Rheumatoid factor occurs with endotracheal intubation.
Extra dose of methotrexate
ESR
Pneumococcal vaccination
465. 42-year-old Woman has URI. On physical examination her spleen Felty syndrome
is enlarged. Low neutrophile numbers is found on lab test. She's
being using methotrexate for her rheumatoid arthritis. What's the - Rheumatoid arthritis
most likely diagnosis? - Splenomegaly
- Neutropenia
466. 51-year-old male comes to the clinic with dyspnea.
He's been working as a coal miner for 20 years.
Chest x-ray shows multiple lung nodules. He has
long history of multiple joint pains. What's the most
likely diagnosis?

Caplan syndrome

pneumoconiosis + rheumatoid nodules in lungs.

Thick walled cavitating lung nodules. Rheumatoid arthritis patients with

hypersensitivity to inhaled dust particles (coal, silica, asbestos).
467. 11-year-old lady comes to the clinic complaining Still diease (systemic juvenile rheumatoid arthritis) where quotidian high-
multiple joint pains and fever. She has salmon spiking fevers occur, patients get a macular, salmon-colored eruption rash
colored rash all over her chest and abdomen. on the trunk and extremities, and have arthritis that is progressive and
Physical examination shows probable spleen and destructive; may also see weight loss, sore throat, lymphadenopathy,
chest x-ray shows pericardial effusion hepatosplenomegaly, pleurisy, or abdominal pain.
468. 31-year-old female comes to the clinic with the Hypokalemia
complain of generalized muscle weakness. She was
diagnosed week vitamin B12 deficiency a week ago
and has been taking vitamin B12 since then. What's
the most likely diagnosis?
469. Pelger-Huet cells

hyposegmented neutrophil (Pelger-Huet cells)

most distinct lab finding in Myelodysplastic syndrome (5q del, Pancytopenia

with Hyperplastic marrow, elderly, asymptomatic pancytopenia)
470. 67-year-old man complains of fatigue. physical Richter phenomenon (conversion of CLL into high-grade lymphoma) occurs
examination shows MULTIPLE LAP, enlarged spleen in 5% of patients.
and liver. High WBCs. What is Richter phenomenon?
471. Electronic manufacturer Berylliosis (Granuloma)
- respond to steroids(prednisone)
472. Sandblasting, Rock mining, Tunneling Silicosis
473. Shipyard workers, pipe fitting, insulators Asbestosis
474. Cotton Byssinosis
475. Coal Coal miners pneumoconiosis
476. 65 yo man complains of episodes of hand pain, warmth, redness that last couple Hydroxyurea (lower cell count)
of minutes. PLT=800,000. Patient has hx of 2 episodes of painless vision loss that Essential thrombocythemia patient with
resolved spontaneously. What is the treatment? Erythromelalgia.
Treatment criteria:
- > 60 and with Previous thrombosis and TIAs
should be treated with Hydroxyurea.
477. Somatostatin receptor scintigraphy Gastrinoma is associated with massive increase
in the number of somatostatin receptors in the
abdomen.

Somatostatin is a hormone secreted in the

pancreas and pituitary gland that inhibits
gastric secretion and somatotropin release.
478. High Formic Acid in the blood. Dx & Tx?

Dx:Methanol toxicity
Exam: Inflamed Retina
Tx: Fomepizole, Dialysis
479. High Oxalic Acid in the blood. Dx & Tx? Dx: Ethylene Glycol toxicity
Exam: Crystals on Urinalysis
Tx: Fomepizole, Dialysis
480. Kidney stone tx < 5 mm pass spontaneousl
5-7 mm - Nifedipine or Tamsulosin
<2 cm = Lithotripsy

Thiazides decrease Ca levels in urine

481. Pregnancy save hypertension drugs: Beta blockers - use first
CCB
Hydralazine
Alpha methydopa
482. Central acting alpha agonists Alpha methyldopa
Clonidine
483. Peripheral acting alpha antagonists Pr azosin
Ter azosin
Dox azosin
484. Which antihypertensive should be used in patients with osteoporosis Thiazide
485. Hypertensive crisis diagnosis and treatment Hypertensive crisis is a high blood pressure in
association with confusion, blurry vision,
dyspnea, and chest pain.
The best initial therapy for hypertensive crisis is
labetalol or nitroprusside.
486. Do not lower blood pressure in hypertensive crisis to normal, or you may Because nitroprusside needs monitoring with
provoke a stroke. an arterial line, this is not usually the first
choice. Labetalol is the first choice.
487. Modified Wells criteria

488. 35 year old woman comes to the symptoms of depression. She Antidepressant monotherapy should be avoided in Bipolar I
has a history of bipolar I disorder. PE is remarkable for disorder due to risk of precipitating mania.
psychomotor retardation, and suicidal ideation. Which
medication is appropriate for this patient? Medication commonly used in the treatment of bipolar
depression include the 2nd-generation antipsychotics Quetiapine
& Lurasidone and the anticonvulsant Lamotrigine
489. Malignant Hyperthermia Malignant hyperthermia (HALOTHANE, SUCCINYLCHOLINE,
abnormal rhyanodine rec. in muscle, release of Ca from SR,
>40(Very RAPID), muscle rigidity, hypermetabolism,
hyperkalemia, multiple organ failure, Rx: Dantrolene)
490. Neuroleptic Malignant Syndrome Neuroleptic Malignant Syndrome (ANTIPSYCHOTIC use, muscle
rigidity, fever, LEUCOCYTOSIS, Rx: Dantrolene)
491. Serotonin syndrome Serotonin syndrome (MYOCLONUS&HYPERREFLEXIA, rigidity,
nausea, vomiting, and diarrhea, fever, Rx: BZ, if fails,
Cyproheptadine,)
492. Patient with asthma develops productive cough. Which fungal Allergic bronchopulmonary aspergillosis
infection should be tested for? What's the pathophysiology? Hypersensitivity reaction to Aspergillus species
What's the treatment? Dx: Aspergillus Skin test, Aspergillus ab
Rx: corticosteroids, if refractory - itraconazole
493. Patient had seizure. Now she's holding her arm adducted an Posterior dislocation should be suspected after tonic clonic
internally rotated. What's the diagnosis? seizure
No sensory loss
494. 27-year-old female. BP 155/95. Low-dose hydrochlorothiazide The easily induced hypokalemia after starting a thiazide diuretic
started. 1 week later patient develops hypokalemia. BP: 150/90. suggests primary hyperaldosteronism.
What's the most likely diagnosis?
495. Pt dx with brain abscess and sinusitis. What is the pathogen Viridans streptococci (&anaerobs) are the most common
causing abscess? pathogens when brain abscess results from sinusitis.

If hematogenously, trauma, or neurosurgery - Staph. Aureus

496. 22 month old boy has easy fatigability. PE: 2/4 holosystolic VSD
murmur, Diastolic rumble. Dx?
Diastolic rumble is due to relatively increased blood flow to the
left side.
497. Wide, bounding pulse Water-Hammer
498. Pulsations in the nail bed Quincke pulse
499. BP in legs as much as 40 mm Hg above arm BP Hill sign
500. Head bobbing de Musset sign
501. Left ventricular hypertrophy EKG criteria S wave in V1
+
R way in V5
> 35mm
502. Pathologic jaundice in the newborn Hyperbilirubinemia is considered pathological when:
It appears on the 1st day of life
Bilirubin rises more than 5 per day
Bilirubin rises above 19.5 in term child
Direct bilirubin rises above 2 at any time
Hyperbilirubinemia persists after the 2nd week of Life
503. What is the radiographic finding of pyloric stenosis? String sign
504. Steeple sign

Croup
505. Infant with choanal atresia. What other anomalies to look for?

CHARGE syndrome
C oloboma
H eart defects
A tresia of Choanae
R etardation of growth
G enitourinary defects (hypogonadism)
E ar anomalies &/or deafness
506. Ristocetin cofactor assay

abnormal vWD.
Best test for vWF diasese?
507. First trimester Signs of Pregnancy (4 signs) Softening of the cervix (GOODELL sign)
Softening of the midline of the uterus (LADIN sign)
Blue discoloration of vagina and cervix (CHADWICK sign)
Small blood vessels/ reddening off the palms (Telangiectasia/Palmar
Erythema)
508. Second trimester signs of pregnancy (2 signs) The "mask of pregnancy" - hyperpigmentation of the face (MCly forehead,
cheeks, nose); worsen with sun exposure (CHLOASMA)

Hyperpigmentation from xiphoid to pubic symphysis (LINEA NIGRA)

509. 27-year-old female in her 30th week of pregnancy Betamethazone, Tocolytics
was diagnosed week PROM. There is no signs of AMPICILLIN (if rash, then Cefazolin; if anaphylaxis, then Clindamycin)
chorioamnionitis. What's the next step managing the 1 dose AZITHROMYCIN
patient?

PRETERM fetuses WITHOUT Chorioamnionitis should be treated with

Betamethazone, Tocolytics, AMPICILLIN and 1 dose AZITHROMYCIN (to
decrease risk of developing chorioamnionitis while waiting for steroids to
begin working)
510. 27-year-old female in her 36th week of pregnancy - If the fetus is the TERM and there is NO chorioamnionitis = wait 6 to 12
was diagnosed week PROM. There is no signs of hours for a spontaneous delivery.
chorioamnionitis. What's the next step managing the - If there is no spontaneous delivery, then induce labor.
patient?
511. IUGR

<10 % for their gestational age

intrauterine growth restriction
512. Gestatinal Diabetes Rx Gestational Diabetes Rx:
- Diet&exercise, if fails:
- NPH before bed, and Aspart before meals, if refuse insulin:
- both Metformin and Glyburide are safe and effective
513. Sensitized Rh negative pregnant female. Rh Ab titer - Ab screening - Rh Ab (+)
is 1:64. What to do next? - Ab titer test - >1:16
- Amniocentesis - High Bilirubin
- Percutaneous Umbilical Blood sample - Low Fetal Hg
- Intrauterine blood transfusion
514. Normal Fetal HR in NST Normal Fetal HR: 110-160 bpm
515. Early decelerations

SAFE head compression.

No need for intervention if variability is within normal range (6-10) and the FHR is within normal range.
516. Late decelerations

Placental insufficiency
517. Variable decelerations

Common; occurs in 40% of all labors

Cord compression but could also indicate rapid fetal descent
518. Stages of Labor Stage 1
- Latent phase (onset - 4cm) (Primi:7h; Multi:5h)
- Active phase (4cm - full dilation) (1-1.2 cm/h)

Stage 2 (Full dilation - delivery of neonate) (Primi: 30min-3h; Multi:5-30min)

Stage 3 (dDelivery of neonate - Delivery of placenta) (30min)

519. Induction of labor
520. Prolonged latent stage
521. Protracted cervical dilation
522. Arrest of Descent
Arrest of Cervical dilation
Prostaglandin E2(not for Asthmatics) is used for cervical ripening(yetismek, olgunlasma)
Oxytocin
Latent phase:
20 hours for Primi;
14 hours for Multi.
Rx: rest and hydration. Most will convert to spontaneous delivery in 6 to 12 hours.
Slow dilation during active phase of stage 1 labor
Primi: <1.2cm/h;
Multi: <1.5cm/h
Ex: 3P's:
Power, Passenger, Passage
No Fetal descent 1 hour
No Cervical dilation for 2 hours
523. Breech
presentation

524. Treatment of
shoulder dystocia

1. McRoberts maneuver (1st-line; flexion of knees into abdomen with suprapubic pressure)
2. Rubin maneuver (rotation of the fetus's shoulders by pushing the posterior shoulder towards fetal head)
3. Woods maneuver (rotation of the fetus's shoulders by pushing the posterior shoulder towards fetal back)
4. Delivery of posterior arm
5. Deliberate fracture of clavicle
6. Zavanelli maneuver (push fetal head back into the uterus and perform cesarean delivery; high rate of both
maternal & fetal mortality; last maneuver to try)
525. Zavanelli maneuver Zavanelli maneuver (push fetal head back into the uterus and perform cesarean delivery; high rate of both
maternal & fetal mortality; last maneuver to try)
526. Rubin maneuver

Rubin maneuver (rotation of the fetus's shoulders by pushing the posterior shoulder towards fetal head)
527. Premenstrual PMS (headache, breast tenderness, pelvic pain, bloating, irritability, lack of energy; Rx: decrease caffeine,
Syndrome alcohol, cigarettes, chocolate, should exercise; if Sx severe:SSRI)
528. Lichen Planus

Pruritic, purple, polygonal planar papules and plaques (6 P's).

Rx: Topical Steroids
529. Lichen Sclerosus

Inflammation and epithelial thinning of the anogenital area, predominantly in

postmenopausal women.
Rx: Topical Steroids
530. Endometriosis treatment

1. NSAIDs
2. Progesterone or OCP
3. Testosterone (Danocine, Danazol(acne, oily skin))
4. GnRH analogs (Lupron, Leuprolide (hot flashes, osteoporosis))
531. Pleural effusion in X-Ray: PA: 200-300 ml
PA vs Lateral Lateral: as little as 50-75 ml
532. Contrast vs Non-contrast Head CT Contrast: Infection & Cancer (enhance)
Non-contrast: Bleeding
533. Neovascular macular degeneration VEGF inhibitors (Ranibizumab, Bevizumab, Aflibercept)
treatment
534. Autistic disorder Autistic disorder (boys; No peer relationship, no eye contact/social smile;
repetitive behaviors such as spinning or banging head as well as self injurious
behavior)

Autistic disorder
Rett disorder
Childhood disintegrative disorder
Asperger disorder
535. Rett disorder Rett disorder (girls; progress encephalopathy, microcephaly, hand wringing,
Loss of speech, ataxia, Psychomotor retardation)

Autistic disorder
Rett disorder
Childhood disintegrative disorder
Asperger disorder
536. Childhood disintegrative disorder Childhood disintegrative disorder (boys; normal development for 2 years, then
Marked regression in functioning (loss of language, social interaction, Motor
function, bladder function))

Autistic disorder
Rett disorder
Childhood disintegrative disorder
Asperger disorder
537. Asperger disorder Asperger disorder (boys; problems in social interaction and behaviors, but with
no language or intellectual deficits. Preoccupied with rules)

Autistic disorder
Rett disorder
Childhood disintegrative disorder
Asperger disorder
538. ADHD Rx & Side effects 1. Methylphenidate & Dextroamphetamine: SE: insomnia, decreased appetite,
headache (caffein gibi)
2. Atomoxetine(NE reuptake inhibitor) - on the USMLE, Atomoxetine is usually
chosen over the 1st-line treatment, given the side effect profile of those
treatments.
539. Oppositional defiant disorder vs Conduct ODD (problems with authority figures, argue with others, blame others for their
disorder mistakes)

Conduct disorder (breaks rules. Aggression to others such as bullying, cruelty,

fighting, using weapons)
540. Which medication should be used in patients with Duloxetine (SNRI)
depression and neuropathic pain?
541. Which medication should be used in patients with Bupropion
depression who is fearful of weight gain or
sexual side effects?
542. Bipolar I vs II Bipolar I - Mania (1 word)
Bipoarl II - Hypomania (2 words)
543. MAO inhibitors Phenelzine
Isocarboxazid
Tranylcypromine
544. Which antipsychotics don't cause weight gain? Aripiprazole & Ziprasidone (QT long)
(Clozapine&Olanzapine have highest risk)
545. Schozophrenia types (4 tane) Paranoid (MC type; delusion or hallucinations; persecutory or grandiose; Later age of onset)

Catatonic (stupor, rigidity, MUTISM)

Disorganized (disheveled, bizarre emotional responses; WORST prognosis; ESRLIEST age of

onset)

Residual (ONLY NEGATIVE Sx (flat affect, social withdrawal, poor grooming); positive sx
ABSENT)
546. Risperidone Risperidone (Long-acting antipsychotic; greater incidence of Movement disorders(vs Quetiapine
lowest incidence))
547. IntraMuscular Antipsychotics Ziprasidone (QT prolongation; low risk of DM&weight gain)
used in emergency state Olanzapine (high risk of DM&weight gain)
548. Antipsychotic Side effects Acute distonia (Rx: Benztropine, Trihexyphenidyl, Diphenhydramine)

Akathisia (Betablockers)

Parkinsonism

Tardive dyskinesia (Clozapine has least risk)

Neuroleptic Malignant syndrome (ANTIPSYCHOTIC use, muscle rigidity, fever, LEUCOCYTOSIS,

Rx: Dantrolene)
549. Panic attack vs Panic disorder Panic attack = BZ
(treatment) Panic disorder = SSRI
550. Social phobia vs social anxiety Social anxiety disorder (aka social phobia), is an ANXIETY disorder
(fear of situation such as public restrooms, eating in public, public speaking. These involve
situations where something potentially embarrassing may happen;)
551. BZ used in emergency LoraZEPam (IntraMuscular)

(IM Antipsychotic = Ziprasidone&Olanzapine)

552. When Flumazenil should be Flumazenil (BZ antagonist) use only when:
used? The overdose is acute
AND
You are certain that there is NO CHRONIC dependence.

Flumazenil can cause seizures in benzodiazepine-dependent patients.

It causes acute withdrawal, which can be Tremor or seizures similar to Delirium Tremens.
553. Disinhibition in psychiatry Disinhibition (lack of restraint; Hypersexuality, hyperphagia, and aggressive outbursts are
indicative of disinhibited instinctual drives.)
554. Alcohol withdrawal Sx Alcohol withdrawal (Tremors, Hallucinations, Seizures, Delirium tremens)
555. Amphetamine & Cocaine Amphetamine&Cocaine withdrawal (Tremor, Headache, Increased appetite, DEPRESSION,
withdrawal Sx & Rx increased risk of SUICIDE; Rx: BUPROPION &/or BROMOCRIPTINE)
556. Opiate intoxication vs withdrawal Opiate Intoxication (Miosis, Drowsiness, Slurred speech, coma, death; Rx: Naloxone)
(Sx&Rx)
Opiate Withdrawal (Fever, Chills, Cholinergic Sx (LACRIMATION, Abd. CRAMPs, Muscle SPASMs,
DIARRHEA))
557. Arteriovenous nicking

Arteriovenous nicking (Compression of venule by arteriole causing vein to bulging

in either side; seen in Hypertensive retinopathy)
558. Poorly treated HTN increases risk of: Hypertension increases risk of:
Coronary artery disease (CAD)
Stroke
Aortic dissection
Congestive heart failure
Kidney disease
Vision impairment
559. Incontinence briefs(kulot) ...
560. Lymphangitis

Lymphangitis (MCC: S. Pyogenes (GAS))

561. ECG in Pulmonary Embolism
562. Which enzyme is deficient in Angioedema
and what is the treatment?
RED, irregular, warm, tender STREAKs develop on an extremity and EXTEND
PROXIMALLY toward regional lymph nodes
On ECG, PE causes non-specific ST and T wave changes:
- T-wave inversion in the anterior lead
- S1Q3T3 (a large S wave in lead 1 and a Q wave and an inverted T wave in lead III)

Angioedema (C1 esterase inhibitor; Swelling, NO PRURITUS/URTICARIA; NOT

responding to Glucocorticoids; Low C2&C4)
Rx:
Acute: FFP or Ecallantide
Long-term: Androgens, Danazol, Stanazol
563. Low Complement: SLE, HEP SLE - C3 (3 letter)
C, PSGN, Angioedema HEP C - C4 (4 letter)
PSGN - C3
Angioedema - C2&C4
564. Treatment of Angioedema? Angioedema (C1 esterase inhibitor; Swelling, NO PRURITUS/URTICARIA; NOT responding to
Glucocorticoids; Low C2&C4)
Rx:
Acute: FFP or Ecallantide
Long-term: Androgens, Danazol, Stanazol
565. Intussusception Dx & Rx Intussusception
The meniscus sign (X-ray; crescent of gas within the colonic lumen)
Dx: USG(preferred) or Contrast Enema
Rx: Contrast (hydrostatic) or air (pneumatic) enema
Contrast enema is both diagnostic and therapeutic
566. Urge incontinence Urge incontinence (overactivity of the detrusor muscle; sudden and urgent feeling of needing to
urinate followed by complete emptying of the bladder)

Rx: ANTICHOLINERGICS (Oxybutynin, Tolterodine; do NOT use in GLAUCOMA), to reduce

parasympathetic stimulation of detrusor muscle contraction.
567. Overflow incontinence

Overflow incontinence (poor bladder contractions, resulting in an over-distended bladder that

leaks or dribbles constantly; increased post-void residual volume (>50mL))

Overflow incontinence is treated with

- medication (-1 blockers, striated muscle relaxants, and cholinergic agents)
- Self-catheterization
- Surgery (Prostatectomy)

-1 blockers reduce urethral closing pressures (ie. prazosin, terazosin)

Striated muscle relaxants reduce outflow resistance (ie. diazepam, dantrolene)
Cholinergic agents increase detrusor contractility (ie. Bethanecol)
568. Pessary

Pessary (similar to the outer ring of a diaphragm)

used to support the uterus, vagina, bladder, or rectum.

used to treat PROLAPSE of the uterus, STRESS INCONTINENCE, a retroverted

uterus, CYSTOCELE and RECTOCELE.
569. Hydatidiform mole Gestational Trophoblastic Disease (aka Hydatidiform mole; Benign; "snowstorm"
in USG; Complete mole (empty ovum(x)2sperms)(80%); Rx: Suction&Curettage)
Complications:
malignant transformation (20% of cases)
choriocarcinoma (5%)
hyperthyroidism (2%) (hCG is similar to TSH)
570. Tinea versicolor Treatment Tinea versicolor (aka pityriasis versicolor; Malassezia furfur; salmon-colored,
light brown, or hypopigmented macules. The lesions do not tan with the
surrounding skin and may scale when they are scraped; in chest & back;
"spaghetti and meatball" appearance in KOH; Rx: topical antifungal
(ketoconazole), topical SELENIUM SULFIDE SHAMPOO, or oral itraconazole in
more severe cases.
571. Epididimitis Ex Epididimitis
<35 yr: due to STD (Neisseria or Chlamydia) Infection may begin as urethritis.
>35 yr: due to Gr(-) coliform bacilli (E.coli) and typically occur in patients with
urologic abnormalities, indwelling catheters, or recent urologic procedures.
572. The best test to diagnose Malaria is: The best test to diagnose malaria is a peripheral blood smear with Giemsa-
staining (NOT serology; NMBE Qx***).
573. Passive smoking Passive smoking children (higher risk of CROUP, BRONCHITIS, & PNEUMONIA;
MIDDLE EAR infections; ASTHMA attacks; OBESITY; SHORT stature
574. 37-year-old woman undergoes SPLENECTOMY Subphrenic abscess
for ITP seven days ago. She has had LEFT
SHOULDER PAIN and abdominal pain 2 days. The
Temperature is 39. leukocytosis. CXR LEFT
PLEURAL EFFUSION. What's the most likely
diagnosis?
575. Vitamin C deficiency Vitamin C deficiency (aka SCURVY; Fatigue, Depression, Connective tissue
defects: GINGIVITIS, PETECHIAE, rash, internal bleeding, IMPAIRED WOUND
healing)
576. Croup vs Epiglottitis Croup = STEROID or EPINEPHRINE
Epiglottitis = INTUBATE in the OR

Croup (MCC=Parainfluenza 1&2, 2nd MCC=RSV; MC in

3-mo to 5-year; in winter; Steeple sign; X-ray is rarely
done, wrong answer; Rx: Mild: STEROID, Severe:
Racemic EPINEPHRINE)

Epiglottitis (Hot potato voice, Drooling, Tipod; X-

ray:Thumbprint sign;)
Rx: INTUBATE,
Ceftriaxone (7-10 days),
Rifampin to close contacts
577. Conn syndrome (Hyperaldosteronism) Rx Hyperaldosteronism is treated with high-dose
SPIRONOLACTONE or EPLERENONE (NOT ARBs)
578. Anticholinergic delirium

Anticholinergic syndrome
flushing, dry skin and mucous membranes, mydriasis
with loss of accommodation, ALTERED MENTAL
STATUS, FEVER, and urinary retention

Sinus tachycardia, Decreased bowel sounds,

Functional ileus, Urinary retention, Hypertension,
Tremulousness, Myoclonic jerking
Patients with central anticholinergic syndrome may
present with the following:

Ataxia, Disorientation, Short-term memory loss,

Confusion, Hallucinations (visual, auditory), Psychosis,
Agitated delirium
579. 47-year-old man has 2-year history of increasing left knee pain. 30 years Posttraumatic arthritis
ago he had fracture of left proximal tibia and underwent Open reduction
and internal fixation. His current pain wakes him up at nights. What's the
most but the diagnosis?
580. Differential loss to follow up. Bias that occurs when you lose follow up long term.
Affects Validity
581. Long term poorly controlled hypertension puts a patient at highest risk MI
for which complication?
582. Old football player who had surgery on his tibia back in the day. Now he Post trauma arthritis.
has pain in his knee, and has a varus deformity. Most likely diagnosis?
583. What is used in the treatment of tinea versicolor? Selenium Sulfide
Patient is going to have hypopigmented patches that you do not tan upon sun
exposure.
584. Sexually active male with scrotal pain and full ness of his testicle. Some urinary Chlamydia Trachomitis
symptoms. WBC has WBC. Most common cause?
585. Fatigue cold intolerance in a man that has low TSH levels. Also he has small testes. Non-functioning adenoma. Pituitary.
Most likely etiology?
586. Patient that has non-trauma/non-lesion warmth, erythema and swelling and streaking Lymphangitis.
on the forearm. Due to Beta-hemolytic streptococcus.
Lymph nodes epitrochlear are swollen. Diagnosis? Also known as Group A streptococcus.
587. Patient who is a smoker with productive cough for 2 years. Has low oxygen saturation
on pulse ox. What is the diagnosis?

Bronchitis (Blue Bloater)

Emphysema (Pink Puffer). Increased A/P

diameter with associated with a low
FEV1/FVC ratio.
588. boy with a rash over arms and legs for 7 sdays and has blood in urine PSGN; Low C3
589. Recurrent candidial infections are due to what? impaired cell mediated immunity
590. 10 mo old boy is brought to the ER by his parents because he vomited twice. has Intussception - contrast enema
unconsolible crying and and has passed on bloody stool . no masses. difficult to
around. What is the next step
591. tx for oral esophageal candidiases in HIV FLUCONAZOLE!! ( NOT amphotericin)
592. tx for febrile neutopenia with anemia and thrombocytopenia abx for febrile neutropenia
593. cohort study between OCP and risk of breast cancer. - 20 yrs later only 40% of the Differential follow- up
participants remained. what is most likely to affect the studies validity?
594. Pt has sub arachnoid hemorrhage and Hypernatremia? what caused hypernatremia/ DI - SAH can lead to Diabetes Insipidus
595. What vitamin supplementation is recommended for all breast fed infants? Vit D
596. preg woman has nausea and vomiting. Ct shows multiple echolucent cysts in the uterus Hydatidiform mole -Suction currettage
but no viable fetus. next step?
597. X cray shows dilated loops of small bowel and air fluid leevls. gas in ascenidng colon Nasogastric decompression - GI
and rectum. next step? obstruction
598. O2 sat - 90%. pink puffer or blue boater? blue boater - COPD
599. Red edematous leg form knee to ankle. sharp demarcation separating erythematous Erysipelas - Group A strep - pyogenes
areas. Painful and hyperesthetci to touch. Swollen lympnodes
600. 23 y/o wmean comes to office with abdominal discomfort, nausea, diffuse abominal DKA
tenderness to deep palpitation. K is 6 and Na is 132 Bicarb is 10 glucose is 450
601. What are some nsaids ibuprofen and asprin can cause edema
602. Pt has high BP and peripheral artery disease. What is the cause of HTN? Atheroscleorsis - PVD
603. pooly controlled hypertension increases risk of what MI.
604. Weight loss, severe jaundice dilated gallbladder and dilated intrahepatic and Cancer head of pancreas - CT of
extrahepatic ducts. No stones next step? abdomen

605. 14 yr old girl with swelling of her right knee after playing soccer. knee Stap A
appears warm erythema, range of motion is limited. WHich organism
606. What is a better alternative for urinary incontinence for ALZ pt than use of incontinence briefs instead of catheter
catheter?
607. 37 yr old immigrant from pakistan, RUQ pain, fever, cyst in liver E. Hystolitica
608. pt has painful varicose veins, whats teh next step? WARM COMPRESS (use of compression stocking wont
help immediately with the pain)
609. What is the most common cause of lymphangitis in humans strep pyogenes. - beta hyemolytic strep
610. prussian blue stain Sideroblastic anemia
611. how can tinea capitis be transmistted sharing hats, combs, clothing , and direct contact
612. >pale mucosa, cobble stoning pharynx < Allergic rhinitis
613. What environmental exposure increases incidence of ear and throat Passive smoke exposure
infections in children?
614. HTCZ causing fatigue. what electrolyte abnormality? Hypokalemia
615. what does being african american do to your risk of osteoporosis decrease chance of Osteoporosis
616. 4 yr old wih bulging tympanic membrane, small amount of mucopurulent possible Mastoiditis? - get CT of temporal bone
discharge, moderate tenderness behind ear. 1 cm mass in neck .
617. pain, tenderness, and swelling in the mastoid region. There may be ear mastoiditis - MRI or CT of temporal bone
pain (otalgia), and the ear or mastoid region may be red (erythematous).
Fever or headaches may also be present. Infants usually show
nonspecific symptoms, including anorexia, diarrhea, or irritability.
Drainage from the ear occurs in more serious cases, often manifest as
brown discharge on the pillowcase upon waking. How is dx made?
618. cause of croup parainfluenza virus
619. vegetarian pregnant lady. What vitamin should you give her udirng B12
pregnancy and lactation?
620. Any time there is a myxoma on an embolus. what do you do? Echocardiograophy
621. pregnant lady with sicle cell. What do you give her? Folic acid.
People who have sickle cell anemia typically have
increased needs for folic acid. abnormally shaped red
blood cells are broken down more quickly, -->body to
make new red blood cells more frequently. need
larger amounts of folic acid, so people with sickle cell
anemia may need to increase their folic acid intake.
622. 80 yo woman has SOB, malaise, generalized weakens, DEPRESSED
MOOD for 6 weeks. Easily bruises, Bleeding and inflammation of GUMs.
Had minor skin abrasion that has NOT HEALED completely. PE:
PETECHIA, ECHYMOSES and hypertrophic, lichenified patches.
Diagnosis?

Scurvy
623. ACEIs Cough, Rash, Proteinuria, angioedema, taste changes,
teratogenic effects.
624. Amantadine Ataxia, livedo reticularis
625. Aminoglycosides Ototoxicity, nephrotoxicity (atn)

626. amiodarone pulmonary fibrosis, peripheral deposition -> bluish discoloration, arrhythmias, hypo/hyperthyroidism,
corneal deposition
627. amphotericin fever/chills, nephrotoxicity, bone marrow suppresion, anemia
628. antipsychotics sedation, acute dystonic reaction, akathisia, parkinsonism, tardive dyskinesia, nms
629. Azoles (fluconazole) p-450 inhibition
630. azt thrombocytopenia, megaloblastic anemia
631. b-blockers asthma exacerbation, masking of hypoglycemia, impotence, bradycardia, av block, chf
632. benzos sedation, dependence, respiratory depression
633. bile acid resins gi upset, malabsorption of vitamins and medications
634. calcium channel blockers peripheral edema, constipation, cardiac depression
635. carbemazepine p-450 inducer, agranulocytosis, aplastic anemia, liver tox
636. chloramphenicol gray baby syndrome, aplastic anemia
637. cisplatin nephro, acoustic nerve damage
638. clonidine dry mouth, sever rebound headache and hypertension
639. clozapine agranulocytosis
640. corticosteroids mania, immunosuppression, bone mineral loss, thinning of skin, easy bruising, myopathy, cataracts
641. cyclophosphamide myelosuppresion, hemorrhagic cystitis
642. digoxin gi disturbance, yellow visual changes, arrhythmias (svt)
643. doxorubicin cardiomyopathy
644. ethyl alcohol renal dysfunction
645. gemfibrozil myositis, reversible LFT increase
646. halothane hepatotox, malignant hyperthermia
647. HCTZ hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, hypercalcemia
648. HMG-Coa reductase myositis, reversible LFT increase
inhibitors
649. hydralazine drug induced sle
650. hydroxychloroquine retinopathy
651. inh peripheral neuropathy (prevent with pyridoxine/B6), hepatotox, seizure with overdose, hemolysis if
g6pd def.
652. MAOIs hypertensive tyramine reaction, serotonin syndrome (with meperidine)
653. methanol blindness
654. methotrexate hepatic fibrosis, pneumonitis, anemia
655. methyldopa +coombs test, drug induced sle
656. metronidazole (disulfiram-like reax, vestibular dysfunction, metallic tase)
657. niacin cutaneous flushing
658. nitroglycerin hypotension, tachy, headache, tolerance
659. penicillamine SLE
660. PCN hypersensitivity
661. phenytoin nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, teratogenic effects
662. prazosin (a1 blocker) first dose hypotension
663. procainamide SLE

664. propothyouracil agranulocytosis, aplastic anemia

665. quinidine cinchonism (headache, tinnitus),
thrombocytopenia, arrhythmias (torsades)
666. reserpine depression
667. rifampin p-450 induction, orange-red body secretions
668. salicylates fever, hypervent with resp alk and met acid,
dehydration, diaphoresis, hemorrhagic gastritis
669. SSRIs anxiety, sexual dysfunction, serotonin syndrome
(with MAOI)
670. succinylcholine malignant hyperthermia, hyperkalemia
671. TCAs sedation, coma, anticholinergic effects, seizures
and arrhythmias (QRS increase), hypotension
672. tetracyclines tooth discoloration, photosensitivity, fanconis
syndrome, GI distress
673. trimethoprim megaloblastic anemia, leukopenia,
granulocytosis
674. valproic acid teratogenicity (neural tube defects), rare fatal
hepatotox
675. vancomycin nephro, oto, redman syndrome (histamine
release)
676. vinblastine severe myelosuppression
677. vincristine peripheral neuropathy, paralytic ileus
678. 82 year old with decreased vision. Dilated veins, widespread retinal Central retinal VEIN occlusion.
hemorrhages intermixed with white plaques on fundoscopic exam. Diagnosis?
679. Patient with flank pain with radiation to the groin. He has normal vital signs. Increase fluid discharge and send him home.
Pain relieved with morphine. Next best step?
680. Terminal cancer patient that comes in with acute onset lower back pain. She is Make the morphine Q3 so she has adequate
taking morphine Q4 which works for a bit but then subsides. What should you pain control.
do to her regimen?
681. A young infant that has BILATERAL RETINAL HEMORRHAGES and TENSE Child abuse
FONTANELLE. What is the most likely cause?
682. What is the treatment for an acute gout attack? 1. NSAIDs: Indomethacin
2. Steroids
3. Colchicine
683. 4 year old boy. Suddenly develops a pancytopenia, has hepatosplenomegaly Bone marrow biopsy. This kid has ALL.
and adenopathy. Some mild gingival bleeding. Next best step?
684. Patient has a first time positive PPD and a negative chest X-ray. What is the next This patient has latent TB. This means that he
best step? needs to be treated with INH for 9 months.
Furthermore, if he had a negative PPD. B/c this is
his first time, he would come back in two weeks.
685. Patient that is mute. Has bilateral nystagmus, hypertonia, decreased sensation Intoxication with PCP. Remember he does not
to skin prick. What is the most likely overdose? always have to be aggressive.
686. Patient has a family history of ovarian cancer. What is the best thing to do if she Put her on OCP. They prevent risk of ovarian
is worried that she may get an ovarian malignancy? and endometrial cancer.
687. Elderly patient with increased ESR. Decreased hip motion, and a 20 degree hip Osteoarthritis. Decrease in flexion of 115
flexion contracture. What is the most likely cause? degrees is diagnostic criteria. X-ray may show
joint space narrowing.
688. COPD patient that is post operative day 4
complains of serosang discharge. PE shows
abdominal distension, mild tenderness to the
incision, and no erythema. What is the most likely
diagnosis?
689. A patient comes in with upper motor neuron signs
along with atrophy fasiculations and LMN signs.
What will the EMG show?
690. Patient feels as if something is crawling on his skin.
He has visual hallucinations, and multiple
excoriations on his face. What is the urinary tox
screen going to show?
691. Patient with urinary dripping. Found to have a
midline cystic mass in the middle third of the
vagina. What is the likely diagnosis?
692. A baby that just was born. Is pale, edematous and
jaundiced. Non-complicated pregnancy. Has super
low Hb, high indirect billi, hepatosplenomegaly.
What is the most likely diagnosis?
693. Patient that has a pituitary lesion. Bilateral breast
discharge. Prolactin level is 40. What is the most
appropriate next step in management?
694. Progressive difficulty swallowing solids AND
liquids. The barium X-ray shows some contrast in
the stomach, and subtle tapering at the end of the
esophagus. What are the manometric findings?
695. Patient who jumps a lot. Has tenderness to
palpation of the tibial tubercle. What is the
pathophysiologic mechanism behind this?
696. Patient who has had bloody stools relieved by
stool softeners. He also has external hemorrhoids,
and FOBT positive. Low hematocrit. What is the
next best step?
697. A 3 cm flutuant (could be tender or non-tender)
mass involving the left posterior vulva underlying
the vestibule outside of the hymen. Diagnosis?
698. Of these symptoms in an elderly person, which is
most concerning: reduction in upward gaze, brief
rotatory nystagmus, high frequency hearing loss.
699. Rotatory nystagmus
700. Patient who has aching in the calves, and
decreased pedal pulses has atherosclerosis at
which vessel?
701. Patient has a schizoaffective disorder. Has
hyponatremia, and also has low urine osmolality.
Urine Na is 20. What is the most likely cause?
702. Patient doing a self breast exam and gets clear
yellow fluid out. Not spontaneous, and negative
mammogram. Characterize the discharge.
Wound dehiscence. Pestana says a salmon colored discharge that SOAKS the
dressing on post-op day four.
Fibrillation potentials in multiple sites of the muscle. UpToDate: Fibrillation
potentials occur when an individual muscle fiber is denervated (eg, it is no
longer innervated by its nerve terminal). The denervated muscle fiber
spontaneously produces a muscle action potential, or fibrillation potential.
Amphetamines or cocaine. Remember this might be an opiate withdrawal,
however the question asks the urinary toxicology screen.
Urethral diverticulum. Google images has a nice picture.
This is going to be Rh incompatibility. Even though this pregnancy was
uncomplicated, do not assume that there was Rh given (or in adequate
amounts). Furthermore, realize that ABO compatibility is a much more self-
limited cause of jaundice.
Medical therapy: start with a dopamine agonist. Even though a prolactin
greater than 200 is diagnostic. This is a microadenoma.
This is achalasia. Birds-beak sign. You have decreased peristaltic activity and
increased LES tone.
This is Osgood Schlatter. Repeated microfracture to the tendon insertion. This
is not avulsion of the tibial tubercle rather, a fragmentation. Also, it is
AVULSION of the INSERTION of the muscle not origin.
Colonscopy.
If he has a severe active bleed. First do NG tube. Then if that is negative, you
go to colonscopy. If colonscopy sucks, then you will do a TAGGED RBC scan.
Bartholin duct cyst. Bartholin gland and vestibular gland are the same thing.
However it is the duct inside that will get plugged.
Brief rotatory nystagmus.
Pathognomonic for PCP intoxication
Femoropopliteal artery
Psychogenic polydipsia. UW question ID 2657 gives you a good algorithm.
Hyponatremia? Serum Osm (use 300 as your reference). Urine Osm (use 200
as your reference point). Urine sodium (use 25 as your reference point).
Psy Poly: low serum Osm, low urine Osm, and low sodium osm.
Physiologic discharge.
703. Patient with anaroumix fugax and a TIA.
What artery is involved?
704. Newborn with clubfoot, lack of moving
his lower extremities, no pain in his
lower extremities. Had a uncomplicated
pregnancy.
705. Patient has acute SOB after subclavian
line. 10% apical pneumothorax. Stable
vital signs. O2 saturation 94%. Catheter
in good position. Next best step?
706. What are the treatments for mixed
cryoglobulinemia?
707. Patient 20 yo with auditory
hallucinations, flat affect, seems very
anxious. Has Hepatitis A history. PE
shows hyperreflexia and a mild resting
tremor. Diagnosis?
708. 4 year old boy goes to visit newborn
sister. He gets chicken pox 8 hours later.
What is the postexposure prophylaxis in
the nursery?
All mothers have a history of varicella.
709. 27 yo patient with HGSIL. Next step?
710. Patient who intermittently uses
condoms. Has CMT, and fever. RLQ pain
and left sided adnexal tenderness. ESR
Elevated. Diagnosis?
711. Asymptomatic man found to have a
sliding hiatal hernia. Management for
type 1 sliding hiatal hernia.
712. Pericarditis ECG changes
713. Pericardial knock
714. PAD - Treatment:
715. Peripartum cardiomyopathy
Internal carotid artery.
Remember that innominate artery is actually the brachiocephalic.
Opthalmic artery branches from the internal carotid
Spinal Dysraphism
This is also called spina bifida.
Wait and watch.
Treat Hep C:
-interferon alpha
-ribavarin
Schizophrenia.
It looks like Parkinsons, and that with neurological symptoms sometimes can look like
Wilson's disease. No family history in the scenario so answer is not psychosis due to
medical condition.
Reassurance. UW question 4186 for post exposure varicella.
Mothers have IgG they can give to neonates?
Remember: that you are infectious two days before rash, and until vesicles are crusted.
UpToDate: Hospitalized premature infants born at 28 weeks of gestation or more whose
mothers do not have signs of immunity. Need to have post-exposure prophylaxis. If mom
is immune you are fine.
The US Advisory Committee on Immunization Practices recommends VariZIG, a varicella
zoster immune globulin preparation, in all nonimmune pregnant women who have been
exposed to persons with VZV (five months later, give the vaccine). Postexposure
prophylaxis is not needed among women who were immunized with varicella vaccine in
the past.
Colposcopy. UW question: 4758. If you are above 24, you will go to COLPOSCOPY.
PID.
Repair of an isolated, asymptomatic sliding hiatus hernia is not indicated.
Management of patients with a symptomatic sliding hiatus hernia consists of management
of GERD.
PeRicarDitis: PRDepression
Constricted pericarditis
- Pericardial knock: is due to filling heart hits the rigid pericardium with a knock.
PAD - Treatment:
- Aspirin
- Cizostazol - PDE3 inhibitor, antiplatelet aggregation.
Peripartum cardiomyopathy (Heart failure; develops last month of pregnancy and 5 mo
postpartum in patients without a previous heart disorder. Autoantibodies against the
myocardium; The 5-yr mortality rate is 50%; future pregnancies are not recommended.
Repeat pregnancy will provoke enormous amount of antibodies against myocardium.)
716. Kallmann Syndrome

Kallmann's syndrome (Anosmia; Delayed puberty (No GnRH, No Neurons); Short 4th
Metacarpal; RENAL AGENESIS (50%))

Neuron Migration Failure;

The patients lack secondary sexual characteristics.
AD
decrease in GnRH(HPOTHALAMUS), FSH&LH(Pituitary), testosterone, and sperm count.

Tall; Slightly feminized phenotype; Impared IQ; Femal-type Pubic hair; Small testes;
Osteoporosis; Gynecomastia; Poor beard growth; Absent Frontal baldness
717. Low GH; how to confirm? Low GH
ARGININE or GHRH stimulation test
- GH will not rise
Insulin stimulation (less common)
718. 2 metabolic disorders that cause Hypercalcemia and Hypokalemia are 2 metabolic disorders that cause Nephrogenic
Nephrogenic Diabetes Insipidus: Diabetes Insipidus.
719. Acromegaly Acromegaly
Best initial test:
Most accurate test: - Is almost always caused by the pituitary adenoma. Prolactin levels should be tested in
Treatment: acromegaly because of cosecretion with growth hormone.
Medications: - Diagnosis:
- Best initial test: IGF1 level
- Most accurate test: Glucose suppression test
- MRI should be done only after the lab identification of acromegaly
- Treatment:
- Surgery: Acromegaly responds to transsphenoidal resection in 70% of cases.
- Medications:
- Cabergoline: dopamine agonist will inhibit GH release
- Octreotide or lanreotide: somatostatin inhibits GH release
- Pegvisomant: A GH receptor antagonist, it inhibits IGF release from the liver.
720. - T4 normal, and TSH high - T4 normal, and TSH high (Subclinical Hypothyroidism)
(Subclinical Hypothyroidism) - TSH is double normal => treatment (Thyroxine(Synthroid))
What to do next? - TSH is less than double the normal, get Antithyroidperoxidase/Antithyroglobulin
antibodies
- if positive => treatment
721. Cinacalcet Cinacalcet - inhibitor of PTH release (used in Hyperparathyroidism)
722. Hypocalcemia ECG HypOcalcemia - Long QT syndrome (tOrsades syndrome)
723. Adrenoleukodystrophy

Adrenoleukodystrophy
accumulation of very LCFAs in tissues (Myelin of CNS, Adrenal cortex (Hypoadrenalism),
Leydig cells (testes))

12y/o w/ decreased school performance, behavior changes, ataxia, spasticity,

hyperpigmentation, K, Na, acidosis.
Ages 4-8
X-linked (Males only)
724. Which test used fo rDx of Addison COSyntropin stimulates COrtiSole.
disease? - ACTH analog
- COSYNTROPIN STIMULATION TEST is the Most Specific test for adrenal function.
- used for diagnosis of Addison's disease
725. Which 2 diseases are immune to - Immunity
Malaria: - HbS HETEROzygote (sickle cell TRAIT) - protection against P. falciparum
P. FALCIPARUM: ??? - absence of Duffy (Fy) antigen on RBC - protect against P. vivax, most common in blacks
P. VIVAX: ???
726. Treatment of Severe Malaria IV Quinidine
727. Absent Duffy antigen on RBC. Ne onemi - Immunity to Malaria
var? - HbS HETEROzygote (sickle cell TRAIT) - protection against P. FALCIPARUM
- absence of Duffy (Fy) antigen on RBC - protect against P. VIVAX, most common in
blacks
728. Live vaccines are contraindicated in a Live vaccines are contraindicated in a CD4 count <200 cells/mm^3.
CD4 count UNDER _____ .
729. CD4<50: Which 3 diseases? MAC
CMV Retinitis&Esophagitis
Cryptococcal MeningoEncephalitis
730. Metformin Metformin (block Gluconeogenesis, agranulocytosis, AVOID in Kidney Failure)
731. Acarbose, Miglitol Acarbose, Miglitol - alpha glucosidase inhibitors, they block glucose absorption in the
bowel
732. NateGLINIDINE, RepaGLINIDINE Nateglinide, Repaglinide - are stimulates his insulin release in a similar manner to
sulfonylureas, but do not contain sulfa.
733. Phenoxybenzamine Phenoxybenzamine is an alpha blocker that is given first to patients with
Pheochromocytoma. CCBs and Beta blockers are used afterwards.
734. Zafirlukast Zafirlukast (hepatotoxic; ass. with Churg-Straus syndrome)

Eosinophilic granulomatosis with polyangiitis (aka Churg-Strauss syndrome)

adult-onset asthma, allergic rhinitis, nasal polyposis;
eosinophilic pneumonia and gastroenteritis, and life-threatening vasculitis.
Renal, cardiac, or neurologic involvement can occur and indicate a poor prognosis
735. Acute asthma exacerbation Acute asthma exacerbation Treatment:
Rx? - Oxygen
- Albuterol
- Bolus of Steroid
- Ipratropium should be used.
- Magnesium helps relieve bronchospasm. Magnesium is used only in an severe astham
exacerbation not responsive to several rounds of a while albuterol waiting for steroid to take effect
736. Indications for Long-Term O2 Indications for Long-Term O2 Therapy in COPD
Therapy in COPD
55mmHG - 88% - normal or sleeping
60-90 in Cor Pulmonale, CMP, Erythrocytosis
737. Opiate withdrawal and
treatment

Opiate withdrawal:
Muscle CRAMPS and joing pains
RHINORRHEA, LACRIMATION
Abdominal pain
Nausea/Vomiting

Rx: METHADONE
738. 3 day old kid. SO2 in right
arm=95%, in right foot=85%
Dx?

PREDUCTAL Coarctation of the Aorta

Blood comes from right ventricle-pulmonary aa-ductus arteriosus.
739. Wegener's vs Churg Strauss Wegener - Granulomatosis with Polyangitis

Churg-Strauss - EOSINOPHILIC Granulomatosis with Polyangiitis

Wegener: Caucasian, 30-50 age; c-ANCA

Upper Resp. Sx: bloody/purulent nasal discharge, oral ulcers, sinusitis
Lower Resp. Sx: hemoptysis
Renal Sx: failure, hematuria

Churg-Strauss: adult-onset ASTHMA, allergic rhinitis, nasal polyposis;

eosinophilic pneumonia and gastroenteritis, and life-threatening vasculitis.
Renal, cardiac, or neurologic involvement can occur and indicate a poor prognosis
740. Tropical Sprue Chronic diarrhea; malabsorption of Vit B12, Folate.
Probably infectious, can affect entire small bowel
WBCs in the stool. Blunting of the villi
741. Recurrent Giardiasis infx. No B-Cells:
Ear, Nose, Pharynx infx,. and GIARDIASIS (no IgA)
742. recurrent Neisseria Complement deficiency
743. Cold ABcess Hyper-IgE (Job's) syndrome
Cold (noninflamed) staphylococcal abcess
Eczema
Retained Teeth
744. Premature Atrial beats/complexes Usually benign.
Do ECHO to see if there is underlying structural heart disease.
Then Reassurance
745. Pituitary apoplexy Sudden HEMORRHAGE of pituitary gland often in presence of an existing pituitary
ADENOMA.
746. Abnormal Uterine Bleeding: When to Endometrial biopsy is indicated:
do Endometrial biopsy? - Women >45
- Unopposed Estrogen Exposure (Obesity, PCOS)
- Prolonged amenorrhea with anovulation
- Persistent Sx
747. Patient with WPW has atrial fibrillation. Cardioversion or Antiarrhythmic(Procainamide)
HR 160. What is the Rx?
Do NOT use AV nodal blockers (BB, CCB, Adenosin, Digoxin)
748. Waldenstrom's Macroglobulinemia Waldenstrom's Macroglobulinemia
IgM (IgG or IgA in MM)
Hyperviscosity (absent in MM)
749. beta-hCG: sorce & function? hCG is a hormone secreted by the syncytiotrophoblast and is mainly reponsible for the
preservation of the corpus luteum in early pregnancy.
750. Arteriogram

an x-ray of a particular artery (e.g., coronary arteriogram, renal arteriogram)

751. Flu-like Sx, Elevated
AST/ALT. Contact with
farm animals while giving
birth. Dx/Rx

Q Fever
Ex: Coxiella burnetti(rickettsial-like), from Cattle, Goat, Sheep
Sx: Flu-like syndrome, HEPATITIS(may show granulomas), Pneumonia
Rx: Doxycycline
752. CommunityAP vs Hospital-acquired pneumonia (HAP): VENTILATOR-ASS.PNEUM., POSTOP-, and pneumonia that
HospitalAP/HealthCareAP develops in unventilated patients who have been hospitalized for at least 48 h.
vs VentilatorAPneumonia
Rx Health care-associated pneumonia (HCAP) occurs in non-hospitalized patients that reside in a nursing
home or other long-term care facility; have undergone IV therapy (including chemotherapy) or wound
care within the previous 30 days; have been hospitalized in an acute care hospital for 2 days within
the previous 90 days; or have attended a hospital or hemodialysis center within the previous 30 days. In
addition to the usual community-acquired pathogens, HCAP pathogens include gram-negative bacilli
(including Pseudomonas aeruginosa) and Staphylococcus aureus and.

Community-acquired Pneumonia: Macrolides or Fluoroquinolones

HAP or HCAP: Antipseudomonals (Cefepime or Ceftazidiem, Piperacillin/Tazobactam, Imipenem
(excreted from kidney, can cause Seizure), Meropenem)

Ventilator-associated pneumonia is treated by 2 Antipseudomonals + AntiMRSA

- Antipseudomonal
- Cephalosporins (Cefepime or Ceftazidime) or Penicilin (Piperacillin/Tazo) or Carbapenem (Imipenem
(Seizure), Meropenem)
- Antipseudomonal
- Aminogycoside (Gentamicin, Tobramycin, Amikacin) or Fluoroquinolone (Cipro, Levofloxacin)
- Anti-MRSA
- Vancomycin or Linezolid
753. An HIV positive African-American man is admitted with Switch TMP/SMX to IV pentamidine
dyspnea, dry cough, high LDH, and a PO2 of 63. He
started on TMP/SMX and prednisone. On the 3rd hospital Rash is the most common adverse effect of TMP/SMX and bone
day he develops severe neutropenia and a rash. marrow suppression is the 2nd most common adverse effect.
What's the most appropriate next step in the
management of this patient?
754. Lfgren syndrome Lfgren syndrome

- Lfgren syndrome manifests as a triad of acute polyarthritis, erythema

nodosum, and hilar adenopathy. It often causes fever, malaise, and
uveitis, and sometimes parotitis. It is more common among
Scandinavian and Irish women.
- Lfgren syndrome is often self-limited. Patients usually respond to
NSAIDs.
755. Blau syndrome Blau syndrome

- Blau syndrome is sarcoidosis inherited in a autosomal dominant

fashion that manifests in children. In Blau syndrome, children present
before the age of 4 yr with arthritis, rash, and uveitis. Blau syndrome is
often self-limited Symptoms usually are relieved with NSAIDs.
756. LDH levels are always elevated in PCP. PCP Dx? Bronchoalveolar lavage
757. Suspected Pulmonary Emboli in Pregnant. How to - Ventilation/perfusion scan: only in pregnancy
diagnose? - has False positivity in 15%, and false negativity in 15%.
758. Fibromyalgia Rx Treatment includes exercise, local heat, stress management, improve
sleep, and analgesics.
- Amitryptiline
- MILNACIPRAN (SNRI that is approved for only Fibromyalgia
treatment)
- Pregabalin
759. SCL-70 (Anti topoisomerase) Scleroderma.
760. Anticentromere

Limited scleroderma (CREST syndrome)

761. SLE Rx Skin & Joint only: HYDROXYCHLOROQUINE(retinopathy), BELIMUMAB

Lupus Nephritis: Steroids +/- CYCLOPHOSPHAMIDE or

MYCOPHENOLATE

- Acute Lupus flare - high-dose STEROIDs

762. Scleroderma Rx CREST synd. - METHOTREXATE (liver toxicity, pulmonary toxicity, bone
marrow suppression)

Pulmonary Fibrosis - CYCLOPHOSPHAMIDE

763. Anti-Jo Anti-Jo: Lung Fibrosis (Dermatomyositis)

764. AS vs PA vs RA Rx: NSAIDs for all; if no response:

Ankylosing S: TNF inh

Psoriatic A: METHOTREXATE (then TNF inh)
Reactive A: SULFASALAZINE

(Steroids are NOT that good treatment for seronegative

spondyloarthropathies.)
765. Brain abscess empirical treatment: Brain abscess empirical treatment:
Penicillin + Metronidazole + Ceftriaxone
766. Spontaneous bacterial peritonitis (E. coli) Spontaneous bacterial peritonitis (E. coli) - empiric CEFOTAXIME (1st-line)
or CEFTRIAXONE (2nd-line)

- Albumin given with antibiotics to prevent renal injury.

- Norfloxacin) prophylaxis after the first episode

767. Eculizumab vs Ecallantide Eculizumab(PNH)
Ecallantide(Angioedema)
768. Belimumab vs Bevacizumab Belimumad(SLE)
Bevacizumab (VEGF inh: CRC & RCC)
769. "drunk without the typical smell of alcohol" Think antifreeze(ethylene glycol) when ingested substance is said to be
sweet and individual appears "drunk without the typical smell of alcohol"
770. Methanol poisoning

Methanol poisoning presents with CNS depression, visual changes (blurry

vision progressing to blindness), anion gap metabolic acidosis, and an
elevated OSMOLAR gap.
Formic acid is toxic to the optic nerve, leading to visual changes and
blindness with as little as 30 mL ingested
771. Granulomatosis with polyangiitis (GPA), formerly Granulomatosis with polyangiitis (GPA), formerly known as Wegener's, for
known as Wegener's, for which a first-line treatment which a first-line treatment option is CORTICOSTEROIDs and
option is _____ and ______. CYCLOPHOSPHAMIDE.
772. SE of: Cyclosporine and Tacrolimus (both calcineruin inhibitors) with
Cyclosporine nephrotoxicty;
Tacrolimus Cyclosporine with hyperkalemia, tremor, headache, visual disturbances,
Azathioprine gingival hypertrophy, and hirsutism;
Mycophenolate Azathioprine - dose-related Diarrhea, Leukopenia, and Hepatotoxicity;
Mycophenolate - bone Marrow suppression.
773. C-ANCA is a strong marker for _____ C-ANCA - Wegener Granulomatosis (bloody nasal discharge, hemoptysis,
hematuria)

focal necrotizing vasculitis

necrotizing granulomas in the lung and upper airway
necrotizing glomerulonephritis
774. A 45-year-old man is brought to the emergency room by his wife who reported C-ANCA - Wegener Granulomatosis (bloody
that he coughed up blood earlier that morning. He has had a chronic fever, nasal discharge, hemoptysis, hematuria)
weight loss, and blood in his urine over the past couple of weeks, but refused to
see a doctor until now. focal necrotizing vasculitis
necrotizing granulomas in the lung and upper
airway
necrotizing glomerulonephritis
775. Treatment of: Wegener's: Corticosteroid +
Wegener Cyclophosphamide
Goodpasture
Churg-Strauss Goodpasture: Plasmapheresis (remove Anti-
GBM)

Churg-Strauss: Corticosteroid
776. Mycosis Fungoides / Sezary Syndrome Neoplastic proliferation of mature CD4+ T cells
Classification
mycosis fungoides: CD4+ cells infiltrate only
the skin
Sezary syndrome: CD4+ cells spread from the
skin into the blood
777. Myelofibrosis Rx Myelofibrosis - Thalidomide & Lenalidomide
(TNF inhibitors that increase bone marrow
production)
778. Essential Thrombocytosis Rx - Treatment is controversial but may include
aspirin.
- Asymptomatic and <60 yr - no treatment
- Patients > 60 yr and those with previous
thromboses and transient ischemic attacks
require cytotoxic drugs (Hydroxyurea) to
decrease risk of thromboses.
779. Add Intrathecal chemo (Methotrexate (liver toxicity, bone marrow suppression, ALL
and pulmonary toxicity)) to ____ treatment. This prevent relapse of ___ in the CNS.