Missed Qs Practice Test

1. Dyshidrotic eczema - dermatitis involving palms and soles.
   Cutaneous T-cell lymphoma "mycosis fungoides" - variety of appearances, usu scaly, pruritic patches/plaques.
   Psoriasis - well-defined plaques w/silvery scales on extensor surfaces of arms or legs.
2. Painless jaundice should be considered pancreatic cancer until proven otherwise. ↑ bilirubin and ↑alk phos implies cholestatic jaundice (d/t blockage of common bile duct by pancreatic mass).
3. Iron poisoning causes GI hemorrhage, bloody diarrhea, hematemesis. Severe poisoning → metabolic acidosis, hepatotoxicity, bowel obstruction, death.
4. Rituximab - CD20 monoclonal Ab for CLL
   Imatinib - BCR-ABL tyrosine kinase Ab for CML
   Cetuximab - EGFR Ab for various cancers (colorectal)
5. Pts. w/mitral valve prolapse have slightly higher risk of developing infective endocarditis after certain invasive procedures than those with normal mitral valves. Antimicrobial prophylaxis in pts w/MVP or mitral regurgitation is not recommended.
6. Ovarian cancer should be in differential diagnosis in any middle-aged woman w/vague pelvic complaints, particularly if an adnexal mass is palpated. Intraperitoneal spread is common in advanced cases → pleural effusion.
7. In most cases of metastatic pancreatic cancer, Tx is palliative. If a metastatic pancreatic head carcinoma causes extrahepatic cholestasis d/t common bile duct obstruction, then immediate Tx should include endoscopic placement of a common bile duct stent.
8. Anticoagulation and rate/rhythm control are accepted Txs for atrial fibrillation in presence of tachycardia, β-adrenergic antagonists, or non-dihydropyridine calcium channel blockers can be used to rapidly control the heart rate.
9. Clostridium difficile is the MCC of antibiotic-associated colitis. Pts present w/low-grade fever, diarrhea, abd pain, and leukocytes in stool. Tx: oral metronidazole or oral vancomycin.
10. Renal Failure, hypercalcemia, and anemia - eval for multiple myeloma. MCC of renal failure in multiple myeloma is toxic effect of light chain casts on the renal tubules, then amyloidosis, monoclonal Ig deposition. Rouleaux formation is common in MM.
11. Pts w/chronic dementia are predisposed to delirium d/t acute infections or other medical stressors. If pt endangers themselves, antipsychotic meds (haloperidol) are useful as 1st-line treatment
12. Hemiparalysis w/abn fxn of contralateral cranial nerve "crossed paralysis" localizes lesion to brainstem.
13. Catheter tip infection is one of the MC problems in pts w/parenteral nutrition. Meticulous aseptic technique when placing and using catheter minimizes infection.
14. HSV encephalitis CSF: ↓WBC, 60% neutorphil, ↑glucose, ↓RBC, ↑protein.
    Bacterial meningitis CSF: ↓glucose, ↑protein, neutrophilic pleocytosis.
15. Pseudoclaudication is LE pain w/walking not improved w/standing or rest (vs true claudication). MCCof pseudoclaudication is spinal stenosis usu d/t spinal esteoarthritis.
16. ACTH is a polypeptide hormone.
    Paraneoplastic Cushing's syn is MCC by ectopic ACTH from small cell lung carcinoma. ACTH is not suppressed by dexamethasone and the clinical features of Cushing's Syndrome. Hyperpigmentation d/t ↑MSH (cleavage product of ACTH).
17. TB: exudative pleural effusion w/protein >4 g/dL, lymphocytic leukocytosis, no gross purulence, ↓glucose.
    Empyema: exudative effusion w/frank pus, ↓↓glucose, predominance of PMNs.
18. SBP (Spontaneous bacterial peritonitis) is common complication of ascites d/t enteric organism translocating across intestinal wall. >250 neutrophils/µL is diagnostic.
19. SLE can → inflammatory arthritis, usu migratory, polyarticular, and symmetric.
    Knees and Hands are MC involved.
    Presence of other signs of SLE (renal disease, photosensitivity) help diagnosis of lupus.
20. Wide-complex tachycardia should be considered ventricular unless definitively interpreted as supraventricular tachy w/aberrancy. Tx of Vtach: loading dose of amiodarone.
21. Esophageal rupture is possible complication of esophageal dilation. Sx: CP, hematemesis, SOB.
    CXR: left-sided pleural effusion or pneumomediastinum.
    Esophageal rupture usu → mediastinitis → severe sepsis/death.
22. HTN & hypokalemia is consistent w/Primary Hyperaldosteronism (Conn's Syn) MCC is adrenal hyperplasia.
    Tx: aldosterone blocking (spironolactone)
23. MCC of hypercalcemia (hyperparathyroidism or malignancy)
    Severe, symptomatic hypercalcemia usu d/t malignancy.
24. ↑Phosphate, ↓Ca²⁺, & Renal dysfxn ← Renal Osteodystrophy → parathyroid hyperplasia, 2⁰ hyperparathyroidism.
25. Somatic Abd pain: well-localized and usu d/t peritoneal irritation.
    Visceral Abd pain: vague localization and usu d/t mechanical stretching of viscera.
26. Pts w/diabetes on insulin may need to adjust dosage w/intense exercise to prevent hypoglycemia.
27. SIADH: kidneys unable to excrete excess water d/t ↑ADH
    Hyponatremia, ↓serum osmolality, ↑urine osmolality, ↑urine Na⁺
28. SBP (spontaneous bacterial periotonitis):
    Ascities, AMS (altered mental status), >250 neutrophils/mL
    Tx: broad-spectrum antibiotics
29. Non-selective β-blockers (propanolol or nadolol) are often used to ↓risk of esophageal variceal hemorrhage.
    Nitrates, endoscopic band ligation, and TIPS are other option is β-blockers alone are ineffective.
30. Septic arthritis should be suspected in any pt w/fever and monarticular joint symptoms even in the presence of preexisting joint disease (rheumatoid arthritis - an abn joint has ↑risk of infection)
    Arthrocentesis should quickly be performed if diagnosis is suspected so appropriate abx Tx can be started.
    Synovial Fluid: >50k leukocytes/mL, >90% neutrophils, +synovial cxs.
    MCC of septic arthritis is Staphylococcus aureus.
31. Cushing's syn: central obesity, proximal muscle weakness, androgen excess, menstrual irregularities, HTN, easy bruising.
    In absence of exogenous glucocorticoid administration MCC of Cushing's syn: ↑pituitary secretion of ACTH (Cushing's Disease), Adrenal Tumor, ectopic ACTH production.
32. Parkinson Disease: dementia, falls, festinating gait, slowed speech, resting hand tremor, cogwheel rigidity on PROM. Characterized by loss of dopaminergic neurons in substantia nigra.
33. Apical lung tumor "Pancoast" in thoracic inlet → compress cervical/thoracic nerve roots → pain, numbness, and weakness in ipsilateral arm, Horner syndrome . Smoking is strongest riskF for lung cancer.
34. Guillain-Barre Syn (GBS): symmetric, ascending weakness, loss of reflexes w/relative preservation of sensory fxn.
    A/w respiratory or GI infection.
    LP: ↑protein, normal WBC "albuminocytologic dissociation"
35. Factitious disorder: A patient consciously making himself sick to assume the sick role, without mention of secondary gain "malingering".
    Multiple organisms growing in blood cultures is most likely d/t injxn of feces into the vein.
36. Pts w/spinal epidural abscesses typically present w/acute-onset fever, back pain, neurologic symptoms.
    Staph aureus is MCC.
    Tx: broad-spectrum antibiotics to cover MRSA, Surgical drainage.
37. Most cases of pharyngitis in children are self-limiting viral infections - absence of sx/signs suggestive of bacterial infection - No Tx or further work-up is indicated.
38. MDS (myelodysplastic syn) is a hematologic disorder mc in pts>65 usu presents w/macrocytic anemai, leukopenia, thrombocytopenia.
    Ovalo-macrocytes on peripheral smear w/neutrophils ↓segmentation. Vs. megaloblastic, hypersegmented neutrophils in B12/folate deficiency anemias.
    Schilling's test - used to distinguish lack of intrinsic factor secretion from other etiologies of B12 deficiency.
39. 2⁰ causes of HTN should be considered in pts w/new-onset, severe HTN refractory to med treatment
    Episodic HTN a/w sweating, palpitations, HA, tachycardia ←pheochromocytoma (Adrenal medulla hypertrophy - ↑catecholamine secretion).
40. Tumor Lysis Syn: hypocalcemia, hyperphosphatemia, hyperkalemia, ↑uric acid → N/V, bowel disturbances, ↓urine output, acute renal insufficiency, seizures, tetany, arrhythmias.
41. Foot ulcers are very common in DM d/t peripheral neuropathy and peripheral vascular disease.
    Eval: depth of involvement, presence of infection. If no infection or bone involvement - debridement of necrotic tissue is Treatment
42. Bipolar Tx: Lithium, valproic acid, and carbamazepine.
43. Borderline personality disorder reflects a lifelong pattern of behavior characterized by unstable relationships, labile mood, and poor sense of self. These pts are often impulsive, and will go to great lengths to avoid abandonment, including attempting suicide or making suicidal gestures. They can also become paranoid or feel dissociated in times of stress.
44. Smudge cells: CML
    Hypersegmented neutrophils: B12/Folate deficiency Anemia
    Auer Rods: AML 3
    Heinz Bodies: G6PD deficiency or thalassemia
    Teardrop: myelofibrosis or metastatic Cancer
45. Pts w/blunt chest trauma-related injury to great vessels while hemodynamically stable and CXR with widened mediastinum require further workup with TEE or CT.
46. Hyperthyroidism → unintentional weight loss, HTN, palpitations, and diaphoresis.
47. Kawasaki Disease "mucocutaneous lymph node syn": fever ≥5days, +4/5: oral mucous membrane Δs(strawberry tongue, cracked lips), bilateral bulbar conjunctival injxn, cervical lymphadenopathy, polymorphous rash, erythema/edema of hands & feet.
    A/w significant cardiovascular complications (coronary artery aneurysms)
    Tx: single dose IVIG, ASA (helps ↓coronary risks)
48. Splenectomy is a/w thrombocytosis (loss of spleen removal of old platelets from circulation).
49. Pts w/familial dysbetalipoproteinemia (Federickson Type III Hyperlipidemia) develop hypertriglyceridemia. Sx: striate palmar xanthomas.
    Tx: initial - fibric acid derivative.
50. All women at risk for preterm delivery between 24-34 wks gestation are candidates for corticosteroid therapy (betamethasone injxn) to enhance fetal lung maturity and ↓neonatal morbidity.
51. Roseola infantum "exanthem subitum or sixth disease" d/t HHV 6 or 7. Sx: very high fevers, a/w febrile seizures, exanthem appears once fever subsides(pink macules and papules over face and trunk).
52. Severe hypercalcemia → altered mental status, can be d/t squamous cell carcinoma of lung (PTHrP)
    Severe hypercalcemia often a/w volume depletion. Initial Tx: fluid resuscitation w/isotonic saline.
53. Arrhythmia should be suspected w/rapid-onset LOC Ø preceding prodrome. Usage of antiarrhythmic drugs, structural heart dz, and Hypokalemia/ Hypomagnesemia are all potential predisposing factors for torsades de pointes.
54. Amaurosis fugax is sudden, painless, transient monocular vision loss usu d/t artery emboli originating from a carotid artery atherosclerotic plaque.
    Temporal arteritis monocular vision loss is usu permanent.