| What is the cause of hypertension in a patient with high blood pressure in the arms and normal blood pressure in the legs? |
Coarctation of the aorta |
| What is the cause of secondary hypertension characterized by elevated systolic blood pressure without diastolic hypertension? |
Hyperthyroidism |
| In patients with renal failure or renal artery stenosis, what antihypertensives should be used with caution? |
ACE-inhibitors |
| What are the classic ECG findings that indicate an acute myocardial infarction? |
ST-segment elevation and Q waves |
| What are the auscultatory characteristics of a ventricular septal defect? |
Harsh holosystolic murmur at the lower left sternal border with a thrill (palpable turbulence) |
| What type of pleural effusion is characterized by a pleural LDH/serum LDH ratio >0.6? |
Exudate |
| What are the signs of pulmonary embolism? |
Sinus tachycardia, fever, pleuritic chest pain, cough, dyspnea/tachycardia, swollen calf, anxiety |
| What serologic test can assist in ruling out pulmonary embolism when negative? |
D-dimer |
| What drug may be used in massive PE causing instability? |
Tissue plasminogen activator |
| What are the signs of spontaneous pneumothorax? |
Tachypnea, unilateral diminished breath sounds, hyperresonance to percussion |
| What is the most common cause of cancer death for both males and females? |
Lung cancer |
| What is the most common malignant lung tumor? |
Metastatic lesions |
| 65 year old 40 pack-year smoker with cough, thick yellow sputum for 4 months; cyanosis, crackles, wheezes; increased hematocrit, WBC 12,500; CXR shows no infiltrates. What is the diagnosis? |
Chronic bronchitis |
| How does acute sinusitis usually present? |
Purulent rhinorrhea, facial pain, maxillary tooth pain |
| What sexually transmitted disease is caused by a flagellated, motile protozoan? |
Trichomoniasis. Treat with metronidazole. |
| What is primary syphilis? |
Firm, painless, indurated ulcer (chancre) |
| Osteomyelitis is characterized by what finding on x-ray? |
Periosteal elevation |
| What food poising bacteria is associated with reheated rice? |
Bacillus cereus |
| 19 year old female with anxiety, abdominal discomfort, irregular bowel habits; stool cultures negative for pathogens. What is the diagnosis? |
Irritable bowel syndrome |
| What is the formula for anion gap? |
Na+- (Cl-+HCO3-) |
| How is syndrome of inappropriate antidiuretic hormone diagnosed? |
Urine osmolality >50-100 mOsm/kg, hyponatremia, urinary sodium >20 mEq/L |
| What skeletal muscle disease causes variable muscle weakness, most noticeable in the ocular and facial muscles initially? |
Myasthenia gravis |
| What is the leading cause of mortality in persons 25-64 years old? |
Cancer: #1 lung, #2 breast/prostate, #3 colon |
| List the four types of shock |
Cardiogenic, septic, hypovolemic, neurogenic |
| What type of shock is characterized by hypotension, increased PCWP, and decreased CO? |
Cardiogenic caused by left ventricular failure. Treatment is inotropic agents, afterload reduction |
| What type of shock is characterized by tachycardia, decreased systolic BP, and decreased pulse pressure? |
Hypovolemic shock caused by hemorrhage. Treatment is IV fluids, blood, control of hemorrhage. |
| What is the clinical picture of perforated peptic ulcer? |
Sudden, severe abdominal pain radiating to back and shoulders, nausea, vomiting, rebound tenderness, guarding |
| What is the management of perforated peptic ulcer when free air is present under the diaphragm? |
Surgery |
| What is the treatment of gastrointestinal bleeding that does not respond to endoscopic treatment? |
Surgery |
| What are the causes of upper GI bleeding? |
Duodenal ulcer (40%), gastric ulcer (20%), gastritis (20%), varices (10%), Mallory-Weiss tear (10%) |
| What is Murphy’s sign? |
Inspiratory arrest upon deep palpation of RUQ in cholecystitis |
| What are five common causes of chronic pancreatis? |
Alcoholism, biliary tract disease, cystic fibrosis, hypercalcemia, pancreas divisum |
| What is an indirect inguinal hernia? |
Inguinal hernia that protrudes from the peritoneal cavity lateral to the epigastric vessels |
| What are the three most common causes of large bowel obstruction |
Colon cancer, diverticulitis, volvulus |
| How should diverticulitis be treated initially? |
NPO, IV fluids, antibiotics |
| What autosomal dominant syndrome is associated with colonic polyps, osteomas, soft tissue tumors, abnormal dentition? |
Gardner’s syndrome |
| 19 year old female complains of paralysis of her arm. Physical examination is normal. Her father recently died. What is the diagnosis? |
Conversion disorder |
| What are the unique toxicities of chlorpromazine? |
Corneal and lenticular deposits, neuroleptic malignant syndrome |
| What is the drug of choice for overdose with benzodiazepines? |
Flumazenil (Romazicon) |
| What is the mechanism of action of selective-serotonin reuptake inhibitors, such as fluoxetine? |
Block reuptake of 5-HT. Two to three weeks required for effect. |
| What is somatization disorder? |
Multiple, unrelated physical complaints, leading to excessive medical attention seeking |
| What is body dysmorphic disorder? |
Preoccupation with an imagined physical defect, causing significant impairment of social and occupational functioning |
| List the key features of schizophrenia |
Two or more psychotic symptoms for more than 1 month; impairment of social or occupational functioning |
| What are the positive symptoms of schizophrenia |
Hallucinations, delusions, disorganized thought processes (loosening of associations) |
| Positive symptoms of schizophrenia respond best to what type of drugs? |
Traditional antipsychotics, such as haloperidol |
| What is hypomania? |
Less severe manic symptoms for several days that are not impairing; no psychotic features |
| 53 year old male with lower extremity weakness, muscle atrophy; positive Babinski’s sign, fasciculations, hyperreflexia and spasticity in the arms. What is the diagnosis? |
Amyotrophic lateral sclerosis |
| What are the signs of angle closure glaucoma? |
Sudden onset of blurred vision, eye pain; hard, red, painful eye; nonreactive pupil and increased intraocular pressure |
| What is the most common cause of permanent bilateral visual loss in the US? |
Macular degeneration |
| What medications can be used to prolong periods of remission in multiple sclerosis? |
Immunosuppressants, such as cyclophosphamide, azathioprine, methotrexate, and immunomodulators, such as beta interferon and copaxone |
| What demyelinating disorder is associated with ascending paralysis, facial diplegia, and autonomic dysfunction? |
Guillain-Barre syndrome |
| What treatment improves outcome in embolic stroke patients when they receive treatment within 3 hours? |
Tissue plasminogen activator |
| What surgical procedure is indicated in patients with carotid atherosclerosis compromising >70% of the carotid lumen |
Carotid endarterectomy |
| Occlusion of which artery results in vertigo, cranial nerve palsies, impaired consciousness, dysarthria? |
Basilar artery |
| What is the most common source of emboli that cause stroke? |
Carotid atheroma |
| What is the antidote for anticholinergic/antimuscarinic overdose? |
Physostigmine |
| What is the clinical result of tricyclic antidepressant overdose? |
Cardiac arrhythmias, convulsions, coma |
| Describe how body surface area burned is calculated |
Rule of nines: Head = 9%, chest and abdomen = 18%, upper/mid/low back and buttocks = 18%, each arm = 9%, groin = 1%, each leg = 18% |
| Newborn with tachypnea, cyanotic episodes, right ventricular heave, systolic ejection murmur, CXR: boot-shaped heart. What is the diagnosis? |
Tetralogy of Fallot |
| 4 week old male with projectile, nonbilious vomiting; first-born child; mobile, nontender, olive-shaped epigastric mass. What is the diagnosis? |
Pyloric stenosis |
| 13 year old with episodes of palpitations with exercise; ECG reveals "delta waves." What is the diagnosis? |
Wolff-Parkinson-White syndrome |
| What disorder can occur if a baby is fed only cow’s milk? |
Iron deficiency anemia because breast milk has better iron bioavailability |
| What is Hemophilia B? |
X-linked coagulation disorder caused by deficiency of factor IX |
| What congenital hormonal deficiency causes severe mental retardation? |
Congenital hypothyroidism |
| Ambiguous genitalia in females, hyponatremia, hyperkalemia, and hypoglycemia are caused by what type of congenital adrenal hyperplasia? |
21-hydroxylase deficiency |
| How does cystic fibrosis usually present in infants and children? |
Failure to thrive |
| What are the four defects of tetralogy of Fallot? |
Pulmonic stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect |
| What is the most common congenital heart defect? |
Ventricular septal defect |
| What is the mode of inheritance associated with hypertrophic cardiomyopathy? |
Autosomal dominant |
| Name the clinical triad of hypertrophic cardiomyopathy? |
Chest pain, dyspnea on exertion, syncope |
| What is the fatal complication of neonatal hyperbilirubinemia? |
Kernicterus caused by bilirubin staining of the basal ganglia, pons, and cerebellum |
| What are the two treatments for severe neonatal jaundice? |
Phototherapy and exchange transfusion |
| How is HIV status determined in the infant of a HIV positive mother? |
HIV DNA level |
| What are the causes of tachypnea in the newborn? |
Respiratory distress syndrome, meconium aspiration, transient tachypnea of the newborn, pneumonia, heart disease |
| At what age is the average child expected to be able to sit without support? |
6 months |
| What are the clinical findings in Down syndrome (Trisomy 21)? |
Endocardial cushion defects, duodenal atresia, Hirschsprung’s disease, hypothyroidism, mental retardation, leukemia, Alzheimer’s-like dementia |
| What is the most common chromosomal abnormality? |
Trisomy 21 |
| What is the karyotype in Turner’s syndrome? |
45 XO |
| What are the dysmorphic features of Turner’s syndrome? |
Lymphedema of hands and feet, shield-shaped chest, widely spaced nipples, webbed neck, low hair line |
| Name the clinical features of Klinefelter’s syndrome |
Small phallus, small testes, gynecomastia |
| 20 year old G1P1 female pregnant with twins at 36 weeks gestation, complains of headaches, blurred vision; BP 145/101, facial edema; 2+ protein on urine dipstick. What is the diagnosis? |
Mild preeclampsia |
| What is Asherman syndrome? |
Secondary amenorrhea caused by uterine scarring, adhesions from dilation and curettage or myomectomy. |
| What is Sheehan’s syndrome? |
Secondary amenorrhea caused by pan-hypopituitarism resulting from pituitary infarction related to postpartum hemorrhage |
| Polycystic ovarian syndrome may cause what problems? |
Infertility, diabetes, endometrial hyperplasia, uterine cancer |
| Absence of menses by age 16 is known as? |
Primary amenorrhea |
| What are the clinical signs of preterm labor? |
Uterine contractions, positive fetal fibronectin, cervical dilation >3 cm or effacement >80%, vaginal bleeding, ruptured membranes. |
| How is placenta previa diagnosed? |
Ultrasound examination |
| When can ultrasound detect a fetal gestational sac? |
Ultrasound can detect a gestational sac at 5 weeks |
| When can fetal ultrasound detect fetal cardiac activity? |
At 6 weeks |
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