“Sawtooth” P waves Classic ECG finding in atrial flutter.

Angina is new, is worsening, or

Definition of unstable angina.
occurs at rest

Antihypertensive for a diabetic

ACEI patient with proteinuria.

Hypotension, distant heart sounds,

Beck’s triad for cardiac tamponade.
and JVD

β-blockers, digoxin, calcium channel Drugs that slow AV node

blockers transmission.

1
 Niacin Hypercholesterolemia treatment that → flushing and
pruritus.

Anticoagulation, rate control,

Treatment for atrial fibrillation.
cardioversion

Immediate Treatment for ventricular

fibrillation.
cardioversion

Dressler’s syndrome: fever, Autoimmune complication

pericarditis, ↑ ESR occurring 2–4 weeks post-MI.

Treat existing heart failure and replace the tricuspid IV drug use with JVD and holosystolic murmur at
valve the left sternal border. Treatment?

2
Echocardiogram (showing thickened left ventricular Diagnostic test for hypertrophic
wall and outflow obstruction) cardiomyopathy.

Pulsus paradoxus (seen in cardiac A fall in systolic BP of > 10 mmHg

tamponade) with inspiration.

Low-voltage, diffuse ST-segment

Classic ECG findings in pericarditis.
elevation

BP > 140/90 on three separate

Definition of hypertension.
occasions two weeks apart

Renal artery stenosis, coarctation of the aorta,

pheochromocytoma, Conn’s syndrome, Cushing’s Eight surgically correctable causes of
syndrome, unilateral renal parenchymal disease, hypertension.
hyperthyroidism, hyperparathyroidism

3
 Evaluation of a pulsatile abdominal
Abdominal ultrasound and CT
mass and bruit.

> 5.5 cm, rapidly enlarging, Indications for surgical repair of abdominal aortic
symptomatic, or ruptured aneurysm.

Morphine, O2, sublingual nitroglycerin, ASA, IV Treatment for acute coronary

β-blockers, heparin syndrome.

Abdominal obesity, high triglycerides, low HDL,

hypertension, insulin resistance, prothrombotic or What is the metabolic syndrome?
proinflammatory states

Appropriate diagnostic test? ■ A 50-year-old male

Exercise stress treadmill with ECG with angina can exercise to 85% of maximum
predicted heart rate.

4
 Pharmacologic stress test (e.g., Appropriate diagnostic test? ■ A 65-year-old woman
with left bundle branch block and severe
dobutamine echo) osteoarthritis has unstable angina.

Angina, ST-segment changes on Signs of active ischemia during

ECG, or ↓ BP stress testing.

ST-segment elevation (depression means ischemia),

flattened T waves, and Q waves ECG findings suggesting MI.

A young patient has angina at rest with ST-segment

Prinzmetal’s angina elevation. Cardiac enzymes are normal.

CHF, shock, and altered mental Common symptoms associated with

status silent MIs.

5
 The diagnostic test for pulmonary
V/Q scan embolism.

An agent that reverses the effects of

Protamine heparin.

The coagulation parameter affected

PT by warfarin.

A young patient with a family history of sudden

Hypertrophic cardiomyopathy death collapses and dies while exercising.

Oral surgery—amoxicillin; GI or GU
procedures—ampicillin and gentamicin before and Endocarditis prophylaxis regimens.
amoxicillin after

6
Pain, pallor, pulselessness, paralysis, paresthesia, The 6 P’s of ischemia due to
poikilothermia peripheral vascular disease.

Stasis, hypercoagulability,
endothelial damage Virchow’s triad.

The most common cause of

OCPs hypertension in young women.

The most common cause of

Excessive EtOH hypertension in young men.

Seborrheic keratosis “Stuck-on” appearance.

7
 Red plaques with silvery-white
Psoriasis scales and sharp margins.

The most common type of skin cancer; the lesion is a

Basal cell carcinoma pearly-colored papule with a translucent surface and
telangiectasias.

Impetigo Honey-crusted lesions.

Cellulitis A febrile patient with a history of diabetes presents

with a red, swollen, painful lower extremity.

Pemphigus vulgaris + Nikolsky’s sign.

8
 Bullous pemphigoid - Nikolsky’s sign.

Acanthosis nigricans. Check fasting blood sugar to A 55-year-old obese patient presents with dirty,
rule out diabetes velvety patches on the back of the neck.

Dermatomal
Varicella zoster
distribution.

Lichen planus Flat-topped papules.

Erythema multiforme Iris-like target lesions.

9
 A lesion characteristically occurring in a linear
Contact dermatitis pattern in areas where skin comes into contact with
clothing or jewelry.

Presents with a herald patch,

Pityriasis rosea Christmas-tree pattern.

Alopecia areata (autoimmune A 16-year-old presents with an annular patch of

process) alopecia with broken-off, stubby hairs.

Pinkish, scaling, flat lesions on the chest and back.

Pityriasis versicolor KOH prep has a “spaghetti-and-meatballs”
appearance.

Asymmetry, border irregularity, color variation, large Four characteristics of a nevus

diameter suggestive of melanoma.

10
 Premalignant lesion from sun exposure that can →
Actinic keratosis squamous cell carcinoma.

Lesions of 1° varicella “Dewdrop on a rose petal.”

Seborrheic dermatitis. Treat with

antifungals “Cradle cap.”

Acne vulgaris Associated with Propionibacterium acnes and

changes in androgen levels.

Herpes simplex A painful, recurrent vesicular eruption of

mucocutaneous surfaces.

11
 Inflammation and epithelial thinning of the
Lichen sclerosus anogenital area, predominantly in postmenopausal
women.

Squamous cell Exophytic nodules on the skin with varying degrees

of scaling or ulceration; the second most common
carcinoma type of skin cancer.

The most common cause of

Hashimoto’s thyroiditis
hypothyroidism.

High TSH, low T4, antimicrosomal Lab findings in Hashimoto’s

antibodies thyroiditis.

Exophthalmos, pretibial myxedema,

Graves’ disease and ↓ TSH.

12
Iatrogenic steroid administration. The second most The most common cause of
common cause is Cushing’s disease Cushing’s syndrome.

A patient presents with signs of hypocalcemia, high

Hypoparathyroidism phosphorus, and low PTH.

Signs and symptoms of “Stones, bones, groans, psychiatric

hypercalcemia overtones.”

A patient complains of headache, weakness, and

1° hyperaldosteronism (due to Conn’s syndrome or polyuria; exam reveals hypertension and tetany. Labs
bilateral adrenal hyperplasia) reveals hypernatremia, hypokalemia, and metabolic
alkalosis.

A patient presents with tachycardia, wild swings in

Pheochromocytoma BP, headache, diaphoresis, altered mental status, and
a sense of panic.

13
 α-antagonists (phentolamine and Should α- or β-antagonists be used first in treating
phenoxybenzamine) pheochromocytoma?

A patient with a history of lithium use presents with

Nephrogenic diabetes insipidus (DI) copious amounts of dilute urine.

Administration of DDAVP ↓ serum osmolality and Treatment of central

free water restriction
DI.

A postoperative patient with significant pain

SIADH due to stress presents with hyponatremia and normal volume
status.

An antidiabetic agent associated

Metformin with lactic acidosis.

14
1° adrenal insufficiency (Addison’s disease). Treat A patient presents with weakness, nausea, vomiting,
with replacement glucocorticoids, weight loss, and new skin pigmentation. Labs show
mineralocorticoids, and IV fluids hyponatremia and hyperkalemia. Treatment?

Goal hemoglobin A1c for a patient

< 7.0 with DM.

Fluids, insulin, and aggressive replacement of

electrolytes (e.g., K+) Treatment of DKA.

They can mask symptoms of Why are β-blockers contraindicated

hypoglycemia in diabetics?

Bias introduced into a study when a clinician is

Observational bias aware of the patient’s treatment type.

15
 Bias introduced when screening detects a disease
Lead-time bias earlier and thus lengthens the time from diagnosis to
death.

If you want to know if race affects infant mortality

rate but most of the variation in infant mortality is
Confounding variable predicted by socioeconomic status, then
socioeconomic status is a _____.

Sensitivity The number of true positives divided by the number

of patients with the disease is _____.

Out Sensitive tests have few false negatives and are used
to rule _____ a disease.

PPD reactivity is used as a screening test because

Highly sensitive for TB most people with TB (except those who are anergic)
will have a +PPD. Highly sensitive or specific?

16
 Chronic diseases such as SLE—higher prevalence or
Higher prevalence incidence?

Epidemics such as influenza—higher prevalence or

Higher incidence incidence?

Cross-sectional survey—incidence or
Prevalence prevalence?

Incidence and Cohort study—incidence or

prevalence?
prevalence

Case-control study—incidence or
Neither prevalence?

17
 Describe a test that consistently gives identical
High reliability, low validity results, but the results are wrong.

Cohort studies can be used to calculate relative risk Difference between a cohort and a
(RR), incidence, and/or odds ratio (OR).
Case-control studies can be used to calculate an OR case-control study.

The incidence rate (IR) of a disease in exposed − the

IR of a disease in unexposed Attributable risk?

The IR of a disease in a population exposed to a

particular factor ÷ the IR of those not exposed Relative risk?

The likelihood of a disease among individuals

exposed to a risk factor compared to those who have
not been exposed Odds ratio?

18
1 ÷ (rate in untreated group − rate in Number needed to
treated group)
treat?

Patients with IBD; those with familial adenomatous

polyposis (FAP)/hereditary nonpolyposis colorectal
In which patients do you initiate colorectal cancer
cancer (HNPCC); and those who have first-degree
screening early?
relatives with adenomatous polyps (< 60 years of
age) or colorectal cancer

Prostate cancer is the most common cancer in men, The most common cancer in men and the most
but lung cancer causes more deaths common cause of death from cancer in men.

The percentage of cases within one SD of the mean?

68%, 95.5%, 99.7% Two SDs? Three SDs?

Number of live births per 1000

population Birth rate?

19
 Number of live births per 1000
women 15–44 years of age Fertility rate?

Number of deaths per 1000

population Mortality rate?

Number of deaths from birth to 28

days per 1000 live births Neonatal mortality?

Number of deaths from 28 days to one year per 1000

live births Postnatal mortality?

Number of deaths from birth to one year of age per

1000 live births (neonatal + postnatal mortality) Infant mortality?

20
Number of deaths from 20 weeks’ gestation to birth
per 1000 total births Fetal mortality?

Number of deaths from 20 weeks’ gestation to one

month of life per 1000 total births Perinatal mortality?

Number of deaths during pregnancy to 90 days

postpartum per 100,000 live births Maternal mortality?

False. Patients may change their minds at any time.

Exceptions to the requirement of informed consent True or false: Once patients sign a statement giving
include emergency situations and patients without consent, they must continue treatment.
decision-making capacity

No. Parental consent is not necessary for the medical A 15-year-old pregnant girl requires hospitalization
treatment of pregnant minors for preeclampsia. Should her parents be informed?

21
 A doctor refers a patient for an MRI at a facility
Conflict of interest he/she owns.

The patient is a danger to self, a danger to others, or Involuntary psychiatric hospitalization can be
gravely disabled (unable to provide for basic needs) undertaken for which three reasons?

False. Withdrawing and withholding life are the True or false: Withdrawing life-sustaining care is
same from an ethical standpoint ethically distinct from withholding sustaining care.

When there is no rationale for treatment, maximal

intervention is failing, a given intervention has When can a physician refuse to continue treating a
already failed, and treatment will not achieve the patient on the grounds of futility?
goals of care

An eight-year-old child is in a serious accident. She

Treat immediately. Consent is implied in emergency
requires emergent transfusion, but her parents are
situations
not present.

22
 Real threat of harm to third parties; suicidal Conditions in which confidentiality
intentions; certain contagious diseases; elder and
child abuse must be overridden.

When treatment noncompliance represents a serious Involuntary commitment or isolation for medical
danger to public health (e.g., active TB) treatment may be undertaken for what reason?

Treat because the disease represents an immediate A 10-year-old child presents in status epilepticus, but
threat to the child’s life. Then seek a court order her parents refuse treatment on religious grounds.

A patient’s family cannot require that a doctor A son asks that his mother not be told about her
withhold information from the patient recently discovered cancer.

Patient presents with sudden onset of severe, diffuse

Emergent laparotomy to repair perforated viscus, abdominal pain. Exam reveals peritoneal signs and
likely stomach AXR reveals free air under the diaphragm.
Management?

23
 Diverticulosis The most likely cause of acute lower GI bleed in
patients > 40 years old.

HIDA scan Diagnostic modality used when ultrasound is

equivocal for cholecystitis.

Acute pancreatitis Sentinel loop on AXR.

Fat, female, fertile, forty, flatulent Risk factors for cholelithiasis.

Murphy’s sign, seen in acute Inspiratory arrest during palpation

cholecystitis of the RUQ.

24
Campylobacter Identify key organisms causing diarrhea: ■ Most
common organism

Identify key organisms causing diarrhea: ■ Recent

Clostridium difficile antibiotic use

Identify key organisms causing

Giardia diarrhea: ■ Camping

ETEC Identify key organisms causing diarrhea: ■ Traveler’s

diarrhea

S. aureus Identify key organisms causing diarrhea: ■ Church

picnics/mayonnaise

25
 Identify key organisms causing diarrhea: ■
E. coli O157:H7 Uncooked hamburgers

Identify key organisms causing

Bacillus cereus diarrhea: ■ Fried rice

Identify key organisms causing

Salmonella diarrhea: ■ Poultry/eggs

Identify key organisms causing

Vibrio, HAV diarrhea: ■ Raw seafood

Isospora, Cryptosporidium, Mycobacterium avium Identify key organisms causing

complex (MAC) diarrhea: ■ AIDS

26
 Yersinia Identify key organisms causing diarrhea: ■
Pseudoappendicitis

A 25-year-old Jewish male presents with pain and

watery diarrhea after meals. Exam shows fistulas
Crohn’s disease between the bowel and skin and nodular lesions on
his tibias.

Inflammatory disease of the colon with ↑ risk of

Ulcerative colitis colon cancer.

Uveitis, ankylosing spondylitis, pyoderma Extraintestinal manifestations of

gangrenosum, erythema nodosum, 1° sclerosing
cholangitis IBD.

5-aminosalicylic acid +/− sulfasalazine and steroids

during acute exacerbations Medical treatment for IBD.

27
 Mallory-Weiss—superficial tear in the esophageal Difference between Mallory-Weiss
mucosa Boerhaave—full-thickness esophageal
rupture and Boerhaave tears.

RUQ pain, jaundice, and fever/chills in the setting of

ascending cholangitis Charcot’s triad.

Charcot’s triad plus shock and mental status

changes, with suppurative ascending cholangitis Reynolds’ pentad.

Medical treatment for hepatic

↓ protein intake, lactulose, neomycin
encephalopathy.

First step in the management of a patient with acute

Establish the ABCs GI bleed.

28
Hemolytic-uremic syndrome (HUS) A four-year-old child presents with oliguria,
petechiae, and jaundice following an illness with
due to E. coli O157:H7 bloody diarrhea. Most likely diagnosis and cause?

HBV immunoglobulin Post-HBV exposure treatment.

TB medications (INH, rifampin, pyrazinamide), Classic causes of drug-induced

acetaminophen, and tetracycline hepatitis.

A 40-year-old obese female with elevated alkaline

Biliary tract obstruction phosphatase, elevated bilirubin, pruritus, dark urine,
and clay-colored stools.

Femoral hernia Hernia with highest risk of incarceration—indirect,

direct, or femoral?

29
 A 50-year-old man with a history of alcohol abuse
Confirm the diagnosis of acute pancreatitis with
presents with boring epigastric pain that radiates to
elevated amylase and lipase. Make patient NPO and
the back and is relieved by sitting forward.
give IV fluids, O2, analgesia, and “tincture of time”
Management?

TICS—Thalassemia, Iron deficiency, anemia of

Chronic disease, and Sideroblastic anemia Four causes of microcytic anemia.

Fecal occult blood test and sigmoidoscopy; suspect An elderly male with hypochromic, microcytic
colorectal cancer anemia is asymptomatic. Diagnostic tests?

Sulfonamides, antimalarial drugs, Precipitants of hemolytic crisis in patients with

fava beans G6PD deficiency.

Factor V Leiden The most common inherited cause

of hypercoagulability.
mutation

30
 Hereditary The most common inherited
hemolytic anemia.
spherocytosis

Diagnostic test for hereditary

Osmotic fragility test spherocytosis.

Diamond-Blackfan
Pure RBC aplasia.
anemia

Anemia associated with absent radii and thumbs,

Fanconi’s anemia diffuse hyperpigmentation, café-au-lait spots,
microcephaly, and pancytopenia.

Chloramphenicol, sulfonamides, radiation, HIV,

chemotherapeutic agents, hepatitis, parvovirus B19,
Medications and viruses that →
EBV aplastic anemia.

31
 Both have ↑ hematocrit and RBC mass, but How to distinguish polycythemia
polycythemia vera should have normal O2 saturation
and low erythropoietin levels vera from 2° polycythemia.

Pentad of TTP—“FAT RN”: Fever, Anemia, Thrombotic thrombocytopenic

Thrombocytopenia, Renal dysfunction, Neurologic
abnormalities purpura (TTP) pentad?

Anemia, thrombocytopenia, and

acute renal failure HUS triad?

Emergent large-volume plasmapheresis,

corticosteroids, antiplatelet drugs Treatment for TTP.

Usually resolves spontaneously; may require IVIG Treatment for idiopathic thrombocytopenic purpura
and/or corticosteroids (ITP) in children.

32
 Which of the following are ↑ in DIC: fibrin split
Fibrin split products and D-dimer are elevated;
products, D-dimer, fibrinogen, platelets, and
platelets, fibrinogen, and hematocrit are ↓.
hematocrit.

An eight-year-old boy presents with hemarthrosis

Hemophilia A or B; consider desmopressin (for
and ↑ PTT with normal PT and bleeding time.
hemophilia A) or factor VIII or IX supplements
Diagnosis? Treatment?

A 14-year-old girl presents with prolonged bleeding

von Willebrand’s disease; treat with desmopressin, after dental surgery and with menses, normal PT,
FFP, or cryoprecipitate normal or ↑ PTT, and ↑ bleeding time. Diagnosis?
Treatment?

Monoclonal gammopathy, Bence Jones proteinuria, A 60-year-old African-American male presents with
“punched-out” lesions on x-ray of the skull and long bone pain. Workup for multiple myeloma might
bones reveal?

Hodgkin’s lymphoma Reed-Sternberg cells

33
 Non-Hodgkin’s A 10-year-old boy presents with fever, weight loss,
and night sweats. Examination shows anterior
lymphoma mediastinal mass. Suspected diagnosis?

Microcytic anemia with ↓ serum iron, ↓ total

Anemia of chronic disease iron-binding capacity (TIBC), and normal or ↑
ferritin.

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑

Iron deficiency anemia TIBC.

An 80-year-old man presents with fatigue,

Chronic lymphocytic leukemia (CLL) lymphadenopathy, splenomegaly, and isolated
lymphocytosis. Suspected diagnosis?

Blast crisis (fever, bone pain, A late, life-threatening complication of chronic

splenomegaly, pancytopenia) myelogenous leukemia (CML).

34
Acute myelogenous leukemia (AML) Auer rods on blood smear.

M3 AML subtype associated with DIC.

↓ Ca2+ , ↑ K− , ↑ phosphate, ↑ uric Electrolyte changes in tumor lysis

acid syndrome.

Treatment for AML

Retinoic acid M3.

A 50-year-old male presents with early satiety,

CML splenomegaly, and bleeding. Cytogenetics show
t(9,22). Diagnosis?

35
Intracellular inclusions seen in thalassemia, G6PD
deficiency, and postsplenectomy Heinz bodies?

An autosomal-recessive disorder with a defect in the

Glanzmann’s thrombasthenia GPIIbIIIa platelet receptor and ↓ platelet
aggregation.

Parvovirus B19 Virus associated with aplastic anemia in patients

with sickle cell anemia.

O2, analgesia, hydration, and, if A 25-year-old African-American male with sickle cell
anemia has sudden onset of bone pain. Management
severe, transfusion of pain crisis?

A significant cause of morbidity in thalassemia

Iron overload; use deferoxamine patients. Treatment?

36
Infection, cancer, and autoimmune The three most common causes of fever of unknown
disease origin (FUO).

Fever, pharyngeal erythema, tonsillar exudate, lack Four signs and symptoms of
of cough streptococcal pharyngitis.

A nonsuppurative complication of streptococcal

Postinfectious glomerulonephritis infection that is not altered by treatment of 1°
infection.

Encapsulated organisms––pneumococcus, Asplenic patients are particularly susceptible to these

meningococcus, Haemophilus influenzae, Klebsiella organisms.

The number of bacterial culture on a clean-catch

105 bacteria/mL specimen to diagnose a UTI.

37
 Pregnant women. Treat this group aggressively Which healthy population is
because of potential complications susceptible to UTIs?

A patient from California or Arizona presents with

Coccidioidomycosis. Amphotericin B fever, malaise, cough, and night sweats. Diagnosis?
Treatment?

1° syphilis Nonpainful chancre.

Rubella A “blueberry muffin” rash is characteristic of what

congenital infection?

Group B strep, E. coli, Listeria. Treat with Meningitis in neonates. Causes?

gentamicin and ampicillin Treatment?

38
Pneumococcus, meningococcus, H. influenzae. Treat Meningitis in infants. Causes?
with cefotaxime and vancomycin Treatment?

Check for ↑ ICP; look for What should always be done prior to
papilledema LP?

CSF findings: ■ Low glucose, PMN

Bacterial meningitis predominance

CSF findings: ■ Normal glucose,

Aseptic (viral) meningitis
lymphocytic predominance

CSF findings: ■ Numerous RBCs in

Subarachnoid hemorrhage (SAH)
serial CSF samples

39
 MS CSF findings: ■ ↑ gamma globulins

Cutaneous anthrax. Treat with Initially presents with a pruritic papule with regional
lymphadenopathy and evolves into a black eschar
penicillin G or ciprofloxacin after 7–10 days. Treatment?

Tabes dorsalis, general paresis, gummas, Argyll

Robertson pupil, aortitis, aortic root aneurysms Findings in 3° syphilis.

Arthralgias, migratory polyarthropathies, Bell’s

palsy, myocarditis Characteristics of 2° Lyme disease.

Mycoplasma Cold agglutinins.

40
 A 24-year-old male presents with soft white plaques
Candidal thrush. Workup should include an HIV
on his tongue and the back of his throat. Diagnosis?
test. Treat with nystatin oral suspension
Workup? Treatment?

Begin Pneumocystis carinii pneumonia (PCP)

≤ 200 for PCP (with TMP); ≤ 50–100 for MAI (with prophylaxis in an HIV-positive patient at what CD4
clarithromycin/azithromycin) count? Mycobacterium avium-intracellulare (MAI)
prophylaxis?

Pregnancy, vesicoureteral reflux, anatomic

anomalies, indwelling catheters, kidney stones Risk factors for pyelonephritis.

Neutropenic nadir
7–10 days postchemotherapy.

Lesion of 1° Lyme disease Erythema migrans.

41
Fever, heart murmur, Osler’s nodes, splinter Classic physical findings for
hemorrhages, Janeway lesions, Roth’s spots endocarditis.

Parvovirus B19 Aplastic crisis in sickle cell disease.

Ring-enhancing brain lesion on CT

Taenia solium (cysticercosis)
with seizures

Name the organism: ■ Branching

Actinomyces israelii rods in oral infection.

Name the organism: ■ Painful

Haemophilus ducreyi chancroid.

42
 Name the organism: ■ Dog or cat
Pasteurella multocida bite.

Sporothrix schenckii Name the organism: ■ Gardener.

Name the organism: ■ Pregnant

Toxoplasma gondii women with pets.

Name the organism: ■ Meningitis in

Neisseria meningitidis adults.

Streptococcus Name the organism: ■ Meningitis in

pneumoniae elderly.

43
 Name the organism: ■ Alcoholic
Klebsiella with pneumonia.

Name the organism: ■ “Currant

Klebsiella jelly” sputum.

Name the organism: ■ Infection in

Pseudomonas burn victims.

Pseudomonas Name the organism: ■ Osteomyelitis from foot

wound puncture.

Salmonella Name the organism: ■ Osteomyelitis in a sickle cell

patient.

44
 A 55-year-old man who is a smoker and a heavy
drinker presents with a new cough and flulike
Legionella pneumonia symptoms. Gram stain shows no organisms; silver
stain of sputum shows gram-negative rods. What is
the diagnosis?

A middle-aged man presents with acute-onset

Lyme disease, Ixodes tick, monoarticular joint pain and bilateral Bell’s palsy.
doxycycline What is the likely diagnosis, and how did he get it?
Treatment?

A patient develops endocarditis three weeks after

S. aureus or S. epidermidis. receiving a prosthetic heart valve. What organism is
suspected?

A patient presents with pain on passive movement,

All-compartment fasciotomy for suspected
pallor, poikilothermia, paresthesias, paralysis, and
compartment syndrome
pulselessness. Treatment?

Back pain that is exacerbated by standing and

Spinal stenosis walking and relieved with sitting and hyperflexion of
the hips.

45
MCP and PIP joints; DIP joints are Joints in the hand affected in
spared rheumatoid arthritis.

Osteoarthritis Joint pain and stiffness that worsen over the course
of the day and are relieved by rest.

Osteogenesis Genetic disorder associated with multiple fractures

and commonly mistaken for child abuse.
imperfecta

Suspect ankylosing spondylitis. Hip and back pain along with stiffness that improves
with activity over the course of the day and worsens
Check HLA-B27 at rest. Diagnostic test?

Reactive (Reiter’s) arthritis. Associated with

Arthritis, conjunctivitis, and urethritis in young men.
Campylobacter, Shigella, Salmonella, Chlamydia,
Associated organisms?
and Ureaplasma

46
Gout. Needle-shaped, negatively birefringent crystals A 55-year-old man has sudden, excruciating first
are seen on joint fluid aspirate. Chronic treatment MTP joint pain after a night of drinking red wine.
with allopurinol or probenecid Diagnosis, workup, and chronic treatment?

Pseudogout Rhomboid-shaped, positively birefringent crystals on

joint fluid aspirate.

Polymyalgia An elderly female presents with pain and stiffness of

the shoulders and hips; she cannot lift her arms
rheumatica above her head. Labs show anemia and ↑ ESR.

Osgood-Schlatter An active 13-year-old boy has anterior knee pain.

Diagnosis?
disease

Bone is fractured in fall on

Distal radius (Colles’ fracture)
outstretched hand.

47
 Avascular necrosis Complication of scaphoid fracture.

Signs suggesting radial nerve

Wrist drop, loss of thumb abduction
damage with humeral fracture.

A young child presents with proximal muscle

Duchenne muscular dystrophy weakness, waddling gait, and pronounced calf
muscles.

A first-born female who was born in breech position

Developmental dysplasia of the hip. If severe,
is found to have asymmetric skin folds on her
consider a Pavlik harness to maintain abduction
newborn exam. Diagnosis? Treatment?

Slipped capital femoral epiphyses. AP and frog-leg An 11-year-old obese, African-American boy presents
lateral view with sudden onset of limp. Diagnosis? Workup?

48
 The most common 1° malignant
Multiple myeloma tumor of bone.

Unilateral, severe periorbital headache with tearing

Cluster headache and conjunctival erythema.

β-blockers, Ca2+ channel blockers,

Prophylactic treatment for migraine.
TCAs

Prolactinoma. Dopamine agonists The most common pituitary tumor.

(e.g., bromocriptine) Treatment?

Broca’s aphasia. Frontal lobe, left A 55-year-old patient presents with acute “broken
speech.” What type of aphasia? What lobe and
MCA distribution vascular distribution?

49
 Trauma; the second most common
The most common cause of SAH.
is berry aneurysm

Subdural hematoma—bridging veins A crescent-shaped hyperdensity on CT that does not

torn cross the midline.

A history significant for initial altered mental status

Epidural hematoma. Middle meningeal artery.
with an intervening lucid interval. Diagnosis? Most
Neurosurgical evacuation
likely etiology? Treatment?

Elevated ICP, RBCs, xanthochromia

CSF findings with
SAH.

Guillain-Barré (↑ protein in CSF with only a modest ↑

in cell count)
Albuminocytologic dissociation.

50
 Cold water is flushed into a patient’s ear, and the fast
Normal phase of the nystagmus is toward the opposite side.
Normal or pathological?

Lung, breast, skin (melanoma), The most common 1° sources of

kidney, GI tract metastases to the brain.

May be seen in children who are accused of

Absence seizures inattention in class and confused with ADHD.

The most frequent presentation of

Headache intracranial neoplasm.

Infection, febrile seizures, trauma, The most common cause of seizures in children
idiopathic (2–10 years).

51
Trauma, alcohol withdrawal, brain The most common cause of seizures in young adults
tumor (18–35 years).

First-line medication for status

IV benzodiazepine epilepticus.

Wernicke’s encephalopathy due to a Confusion, confabulation,

deficiency of thiamine ophthalmoplegia, ataxia.

Seventy percent if the stenosis is What % lesion is an indication for

symptomatic carotid endarterectomy?

The most common causes of

Alzheimer’s and multi-infarct
dementia.

52
 ALS Combined UMN and LMN disorder.

Rigidity and stiffness with resting tremor and

Parkinson’s disease masked facies.

The mainstay of Parkinson’s

Levodopa/carbidopa therapy.

IVIG or Treatment for Guillain-Barré

syndrome.
plasmapheresis

Rigidity and stiffness that progress to choreiform

Huntington’s disease movements, accompanied by moodiness and altered
behavior.

53
 A six-year-old girl presents with a port-wine stain in
Sturge-Weber syndrome. Treat symptomatically.
the V2 distribution as well as with mental
Possible focal cerebral resection of affected lobe
retardation, seizures, and leptomeningeal angioma.

Neurofibromatosis 1 Café-au-lait spots on skin.

Hyperphagia, hypersexuality, hyperorality, and

Klüver-Bucy syndrome (amygdala) hyperdocility.

Edrophonium Administer to a symptomatic patient to diagnose

myasthenia gravis.

Placental abruption and placenta

1° causes of third-trimester bleeding.
previa

54
 Snowstorm on ultrasound. “Cluster-of-grapes” Classic ultrasound and gross appearance of complete
appearance on gross examination hydatidiform mole.

Chromosomal pattern of a complete

46,XX mole.

Molar pregnancy containing fetal

Partial mole tissue.

Continuous, painful vaginal bleeding Symptoms of placental abruption.

Self-limited, painless vaginal

Symptoms of placenta previa.
bleeding

55
 Never When should a vaginal exam be performed with
suspected placenta previa?

Tetracycline, fluoroquinolones, aminoglycosides,

sulfonamides Antibiotics with teratogenic effects.

Obstetric conjugate: between the sacral promontory

and the midpoint of the symphysis pubis Shortest AP diameter of the pelvis.

Betamethasone or dexamethasone × Medication given to accelerate fetal

48 hours lung maturity.

The most common cause of

Uterine atony postpartum hemorrhage.

56
Uterine massage; if that fails, give Treatment for postpartum
oxytocin hemorrhage.

Typical antibiotics for group B streptococcus (GBS)

IV penicillin or ampicillin prophylaxis.

Sheehan’s syndrome (postpartum A patient fails to lactate after an emergency C-section

pituitary necrosis) with marked blood loss.

Uterine bleeding at 18 weeks’ gestation; no products

Inevitable abortion expelled; membranes ruptured; cervical os open.

Uterine bleeding at 18 weeks’ gestation; no products

Threatened abortion expelled; cervical os closed.

57
β-hCG; the most common cause of The first test to perform when a woman presents
amenorrhea is pregnancy with amenorrhea.

Term for heavy bleeding during and between

Menometrorrhagia menstrual periods.

Cause of amenorrhea with normal prolactin, no

Asherman’s syndrome response to estrogen-progesterone challenge, and a
history of D&C.

Therapy for polycystic ovarian

Weight loss and OCPs syndrome.

Medication used to induce

Clomiphene citrate ovulation.

58
 Diagnostic step required in a postmenopausal
Endometrial biopsy woman who presents with vaginal bleeding.

Stable, unruptured ectopic pregnancy of < 3.5 cm at Indications for medical treatment of
< 6 weeks’ gestation ectopic pregnancy.

OCPs, danazol, GnRH agonists Medical options for endometriosis.

Laparoscopic findings in
“Chocolate cysts,” powder burns
endometriosis.

The most common location for an

Ampulla of the oviduct ectopic pregnancy.

59
 How to diagnose and follow a
Ultrasound leiomyoma.

Regresses after menopause Natural history of a leiomyoma.

A patient has ↑ vaginal discharge and petechial

Trichomonas vaginitis patches in the upper vagina and cervix.

Oral or topical metronidazole Treatment for bacterial vaginosis.

The most common cause of bloody

Intraductal papilloma nipple discharge.

60
 Contraceptive methods that protect
OCP and barrier contraception
against PID.

Endometrial or estrogen receptor– Unopposed estrogen is

breast cancer contraindicated in which cancers?

Consider Fitz-Hugh–Curtis A patient presents with recent PID

syndrome with RUQ pain.

Breast malignancy presenting as itching, burning,

Paget’s disease and erosion of the nipple.

Annual screening for women with a strong family

CA-125 and transvaginal ultrasound history of ovarian cancer.

61
 Kegel exercises, estrogen, pessaries for stress A 50-year-old woman leaks urine when laughing or
incontinence coughing. Nonsurgical options?

Anticholinergics (oxybutynin) or β-adrenergics A 30-year-old woman has unpredictable urine loss.

(metaproterenol) for urge incontinence. Examination is normal. Medical options?

↑ serum FSH Lab values suggestive of menopause.

The most common cause of female

Endometriosis infertility.

Colposcopy and endocervical Two consecutive findings of atypical squamous cells

of undetermined significance (ASCUS) on Pap
curettage smear. Follow-up evaluation?

62
 Breast cancer type that ↑ the future risk of invasive
Lobular carcinoma in situ carcinoma in both breasts.

Neuroblastoma Nontender abdominal mass associated with elevated

VMA and HVA.

Esophageal atresia with distal TEF (85%). Unable to The most common type of tracheoesophageal fistula
pass NG tube (TEF). Diagnosis?

Mild illness and/or low-grade fever, current Not contraindications to

antibiotic therapy, and prematurity vaccination.

Tests to rule out shaken baby

Ophthalmologic exam, CT, and MRI
syndrome.

63
 CF or Hirschsprung’s disease A neonate has meconium ileus.

Bilious emesis within hours after the

Duodenal atresia first feeding.

A two-month-old presents with nonbilious projectile

Correct metabolic abnormalities. Then correct
emesis. What are the appropriate steps in
pyloric stenosis with pyloromyotomy
management?

The most common 1°

Selective IgA deficiency immunodeficiency.

An infant has a high fever and onset of rash as fever

Febrile seizures (roseola infantum) breaks. What is he at risk for?

64
High-dose aspirin for inflammation and fever; IVIG Acute-phase treatment for Kawasaki
to prevent coronary artery aneurysms disease.

Phototherapy (mild) or exchange Treatment for mild and severe unconjugated

transfusion (severe) hyperbilirubinemia.

Sudden onset of mental status changes, emesis, and

Reye’s syndrome liver dysfunction after taking aspirin.

A child has loss of red light reflex.

Suspect retinoblastoma Diagnosis?

HBV, DTaP, Hib, IPV, Vaccinations at a six-month

well-child visit.
PCV

65
 Tanner stage 3 in a six-year-old
Precocious puberty female.

Infection of small airways with epidemics in winter

RSV bronchiolitis and spring.

Surfactant deficiency Cause of neonatal RDS.

What is the immunodeficiency? ■ A boy has chronic

Chronic granulomatous disease respiratory infections. Nitroblue tetrazolium test is
+.

Wiskott-Aldrich What is the immunodeficiency? ■ A child has

eczema, thrombocytopenia, and high levels of IgA.
syndrome

66
 Bruton’s X-linked What is the immunodeficiency? ■ A four-month-old
agammaglobulinemia boy has life-threatening Pseudomonas infection.

A condition associated with red

Intussusception “currant-jelly” stools.

Coarctation of the A congenital heart disease that cause

2° hypertension.
aorta

Amoxicillin × 10 days First-line treatment for otitis media.

The most common pathogen causing

Parainfluenza virus type 1
croup.

67
 A homeless child is small for his age and has peeling
Kwashiorkor (protein malnutrition) skin and a swollen belly.

Lesch-Nyhan syndrome (purine Defect in an X-linked syndrome with

salvage problem with mental retardation,

gout, self-mutilation, and

HGPRTase deficiency) choreoathetosis.

A newborn female has continuous

Patent ductus arteriosus (PDA)
“machinery murmur.”

First-line pharmacotherapy for

SSRIs depression.

68
 Antidepressants associated with
MAOIs hypertensive crisis.

Galactorrhea, impotence, menstrual dysfunction,

Patient on dopamine antagonist and ↓ libido.

A 17-year-old female has left arm paralysis after her

Conversion disorder boyfriend dies in a car crash. No medical cause is
found.

Displacement Name the defense mechanism: ■ A mother who is

angry at her husband yells at her child.

Name the defense mechanism: ■ A pedophile enters

Reaction formation a monastery.

69
 Isolation Name the defense mechanism: ■ A woman calmly
describes a grisly murder.

Regression Name the defense mechanism: ■ A hospitalized

10-year-old begins to wet his bed.

Life-threatening muscle rigidity, fever, and

Neuroleptic malignant syndrome rhabdomyolysis.

Anorexia Amenorrhea, bradycardia, and abnormal body image

in a young female.

Panic disorder A 35-year-old male has recurrent episodes of

palpitations, diaphoresis, and fear of going crazy.

70
 The most serious side effect of
Agranulocytosis clozapine.

A 21-year-old male has three months of social

Schizophreniform disorder (diagnosis of
withdrawal, worsening grades, flattened affect, and
schizophrenia requires ≥ 6 months of symptoms)
concrete thinking.

Weight gain, type 2 DM, QT Key side effects of atypical

prolongation antipsychotics.

A young weight lifter receives IV haloperidol and

Acute dystonia (oculogyric crisis). Treat with
complains that his eyes are deviated sideways.
benztropine or diphenhydramine
Diagnosis? Treatment?

Neuroleptics Medication to avoid in patients with a history of

alcohol withdrawal seizures.

71
 A 13-year-old male has a history of theft, vandalism,
Conduct disorder and violence toward family pets.

A five-month-old girl has ↓ head growth, truncal

Rett’s disorder dyscoordination, and ↓ social interaction.

Acute mania. Start a mood stabilizer A patient hasn’t slept for days, lost $20,000
gambling, is agitated, and has pressured speech.
(e.g., lithium) Diagnosis? Treatment?

Malingering After a minor fender bender, a man wears a neck

brace and requests permanent disability.

Factitious disorder (Munchausen A nurse presents with severe hypoglycemia; blood

syndrome) analysis reveals no elevation in C peptide.

72
 A patient continues to use cocaine after being in jail,
Substance abuse losing his job, and not paying child support.

Phencyclidine hydrochloride (PCP) A violent patient has vertical and

intoxication horizontal nystagmus.

A woman who was abused as a child frequently feels

Depersonalization disorder outside of or detached from her body.

A man has repeated, intense urges to rub his body

Frotteurism (a paraphilia) against unsuspecting passengers on a bus.

Tardive dyskinesia. ↓ or discontinue haloperidol and A schizophrenic patient takes haloperidol for one
consider another antipsychotic (e.g., risperidone, year and develops uncontrollable tongue movements.
clozapine) Diagnosis? Treatment?

73
 A man unexpectedly flies across the country, takes a
Dissociative fugue new name, and has no memory of his prior life.

Stasis, endothelial injury and hypercoagulability

(Virchow’s triad) Risk factors for DVT.

Pleural/serum protein > 0.5;

Criteria for exudative effusion.
pleural/serum LDH > 0.6

Think of leaky capillaries. Malignancy, TB, bacterial

or viral infection, pulmonary embolism with infarct, Causes of exudative effusion.
and pancreatitis

Think of intact capillaries. CHF, liver or kidney

disease, and protein-losing enteropathy Causes of transudative effusion.

74
Fatigue and impending respiratory Normalizing PCO2 in a patient having an asthma
failure exacerbation may indicate?

Dyspnea, lateral hilar lymphodenopathy on CXR,

Sarcoidosis noncaseating granulomas, increased ACE, and
hypercalcemia.

Obstructive pulmonary disease (e.g.,

PFT showing ↓ FEV1/FVC.
asthma)

Restrictive pulmonary disease PFT showing ↑ FEV1/FVC.

Diffuse interstitial pulmonary fibrosis. Supportive Honeycomb pattern on CXR.

care. Steroids may help Diagnosis? Treatment?

75
 Radiation Treatment for SVC syndrome.

Inhaled β-agonists and inhaled Treatment for mild, persistent

corticosteroids asthma.

Hypoxia and Acid-base disorder in pulmonary

embolism.
hypocarbia

Squamous cell Non–small cell lung cancer (NSCLC) associated with

hypercalcemia.
carcinoma

Small cell lung cancer (SCLC) Lung cancer associated with SIADH.

76
 Lung cancer highly related to
SCLC cigarette exposure.

Spontaneous pneumothorax. Spontaneous A tall white male presents with acute shortness of
regression. Supplemental O2 may be helpful breath. Diagnosis? Treatment?

Treatment of tension
Immediate needle thoracostomy
pneumothorax.

Age > 45–50 years; lesions new or larger in

Characteristics favoring carcinoma in an isolated
comparison to old films; absence of calcification or
pulmonary nodule.
irregular calcification; size > 2 cm; irregular margins

ARDS Hypoxemia and pulmonary edema with normal

pulmonary capillary wedge pressure.

77
 ↑ risk of what infection with
Mycobacterium tuberculosis
silicosis?

Right-to-left shunt, hypoventilation, low inspired O2

tension, diffusion defect, V/Q mismatch Causes of hypoxemia.

Cardiomegaly, prominent pulmonary vessels, Kerley Classic CXR findings for pulmonary
B lines, “bat’s-wing” appearance of hilar shadows,
and perivascular and peribronchial cuffing edema.

Renal tubular acidosis (RTA) associated with

Type I (distal) RTA abnormal H+ secretion and nephrolithiasis.

RTA associated with abnormal

Type II (proximal) RTA HCO3 − and rickets.

78
 RTA associated with aldosterone
Type IV (distal) RTA defect.

Hypernatremia “Doughy skin.”

Differential of hypervolemic
Cirrhosis, CHF, nephritic syndrome
hyponatremia.

Hypocalcemia Chvostek’s and Trousseau’s signs.

Malignancy and The most common causes of

hyperparathyroidism hypercalcemia.

79
Hypokalemia T-wave flattening and U waves.

Hyperkalemia Peaked T waves and widened QRS.

IV hydration and loop diuretics First-line treatment for moderate

(furosemide) hypercalcemia.

Type of ARF in a patient with FeNa

Prerenal < 1%.

A 49-year-old male presents with acute-onset flank

Nephrolithiasis pain and hematuria.

80
 The most common type of
Calcium oxalate nephrolithiasis.

A 20-year-old man presents with a palpable flank

Cerebral berry aneurysms (AD mass and hematuria. Ultrasound shows bilateral
PCKD) enlarged kidneys with cysts. Associated brain
anomaly?

Hematuria, hypertension, and

Nephritic syndrome oliguria.

Proteinuria, hypoalbuminemia, hyperlipidemia,

Nephrotic syndrome hyperlipiduria, edema.

The most common form of nephritic

Membranous glomerulonephritis
syndrome.

81
 The most common form of
IgA nephropathy (Berger’s disease)
glomerulonephritis.

Alport’s syndrome Glomerulonephritis with deafness.

Wegener’s granulomatosis and Glomerulonephritis with

Goodpasture’s syndrome hemoptysis.

Glomerulonephritis/nephritic Presence of red cell casts in urine

syndrome sediment.

Allergic interstitial nephritis Eosinophils in urine sediment.

82
 Waxy casts in urine sediment and Maltese crosses
Nephrotic syndrome (seen with lipiduria).

Uremic syndrome seen in patients Drowsiness, asterixis, nausea, and a pericardial

with renal failure friction rub.

Wait, surgical resection, radiation and/or androgen A 55-year-old man is diagnosed with prostate cancer.
suppression Treatment options?

DI Low urine specific gravity in the presence of high

serum osmolality.

Fluid restriction, demeclocycline Treatment of SIADH?

83
 Hematuria, flank pain, and palpable
Renal cell carcinoma (RCC)
flank mass.

Testicular cancer associated with

Choriocarcinoma β-hCG, AFP.

Seminoma—a type of germ cell The most common type of testicular

tumor cancer.

The most common histology of

Transitional cell carcinoma
bladder cancer.

Complication of overly rapid

Central pontine myelinolysis
correction of hyponatremia.

84
Anion gap acidosis and 1° respiratory alkalosis due to Salicylate ingestion → in what type of acid-base
central respiratory stimulation disorder?

Acid-base disturbance commonly

Respiratory alkalosis seen in pregnant women.

DM, SLE, and Three systemic diseases → nephrotic

syndrome.
amyloidosis

RCC or other erythropoietin-producing tumor; Elevated erythropoietin level, elevated hematocrit,

evaluate with CT scan and normal O2 saturation suggest?

Likely BPH. Options include no treatment, terazosin, A 55-year-old man presents with irritative and
finasteride, or surgical intervention (TURP) obstructive urinary symptoms. Treatment options?

85
 Antipsychotics (neuroleptic Class of drugs that may cause syndrome of muscle
rigidity, hyperthermia, autonomic instability, and
malignant syndrome) extrapyramidal symptoms.

Acute mania, immunosuppression, thin skin,

osteoporosis, easy bruising, myopathies Side effects of corticosteroids.

Benzodiazepines Treatment for DTs.

Treatment for acetaminophen

N-acetylcysteine overdose.

Naloxone Treatment for opioid overdose.

86
 Treatment for benzodiazepine
Flumazenil overdose.

Treatment for neuroleptic malignant

Dantrolene or bromocriptine
syndrome.

Treatment for malignant

Nitroprusside hypertension.

Rate control, rhythm conversion,

and anticoagulation Treatment of AF.

Rate control with carotid massasge or other vagal Treatment of supraventricular

stimulation tachycardia (SVT).

87
 INH, penicillamine, hydralazine,
Causes of drug-induced SLE.
procainamide

Macrocytic, megaloblastic anemia

B12 deficiency with neurologic symptoms.

Macrocytic, megaloblastic anemia without

Folate deficiency neurologic symptoms.

A burn patient presents with cherry-red flushed skin

Treat CO poisoning with 100% O2 or with hyperbaric
and coma. SaO2 is normal, but carboxyhemoglobin is
O2 if severe poisoning or pregnant
elevated. Treatment?

Blood in the urethral meatus or

Bladder rupture or urethral injury
high-riding prostate.

88
 Retrograde cystourethrogram Test to rule out urethral injury.

Widened mediastinum (> 8 cm), loss of aortic knob, Radiographic evidence of aortic
pleural cap, tracheal deviation to the right,
depression of left main stem bronchus disruption or dissection.

Free air under the diaphragm, extravasation of

Radiographic indications for surgery in patients with
contrast, severe bowl distention, space-occupying
acute abdomen.
lesion (CT), mesenteric occlusion (angiography)

The most common organism in

Pseudomonas burn-related infections.

Method of calculating fluid repletion

Parkland formula in burn patients.

89
 Acceptable urine output in a trauma
50 cc/hour patient.

Acceptable urine output in a stable

30 cc/hour patient.

Third-degree heart
Cannon “a” waves.
block

Hypotension and bradycardia Signs of neurogenic shock.

Hypertension, bradycardia, and

Signs of ↑ ICP (Cushing’s triad).
abnormal respirations

90
 ↓ CO, ↓ pulmonary capillary wedge pressure (PCWP),
Hypovolemic shock ↑ peripheral vascular resistance (PVR).

Cardiogenic shock ↓ CO, ↑ PCWP, ↑ PVR.

Septic or anaphylactic shock ↑ CO, ↓ PCWP, ↓ PVR.

Fluids and antibiotics Treatment of septic shock.

Identify cause; pressors (e.g.,

Treatment of cardiogenic shock.
dobutamine)

91
 Identify cause; fluid and blood
Treatment of hypovolemic shock.
repletion

Diphenhydramine or epinephrine
Treatment of anaphylactic shock.
1:1000

Continuous positive airway pressure Supportive treatment for ARDS.

A patient with chest trauma who was previously

stable suddenly dies Signs of air embolism.

AP chest, AP/lateral C-spine, AP

pelvis Trauma series.

92