Question Main

Id
Division

Sub Division

Notes

2157

Internal
Medicine

Cardiology

Murmur radiating to axils with soft s1 -> MR

2161

Internal
Medicine

Dermatology

impressive cellulitis -> anceph (cefazolin) which is IV vs. cellulitis + pus or in area of high MRSA ->
add Vanco

2164

Internal
Medicine

Cardiology

loop diuretics -> hypo-k and -mg -> Vtach -> get electrolytes and check digoxin level

2165

Internal
Medicine

Endocrinology

hyper-ca with unsuppressed pth and no urinary increase in calcium excretion -> receptor sensing
problem in parathyroid and kidney -> familial hypocalciuric hypercalcemia vs. hyper-ca with
unsupressed pth and increased urinary excretion -> primary hyperparathyroidism

2176

Internal
Medicine

Endocrinology

Very high calcium, low PTH -> malignancy vs. High calcium, high PTH -> primary
hyperparathyroidism

2178

Internal
Medicine

Endocrinology

sore throat and fever on PTU? -> check WBC for agranulocytosis!!

2180

Internal
Medicine

Endocrinology

dilute blood + concentrated urine -> EUVOLEMIC hyponatremia 2/2 SIADH (NSAIDS potentiate
ADH) vs. renal failure/ kidney problem -> HYPERVOLEMIC hyponatremia

2184

Internal
Medicine

Endocrinology

DKA diagnosis: blood glucose >250, blood ketones, acidosis (decreased pH or bicarb)

2190

Internal
Medicine

Endocrinology

diabetic nephropathy -> control your BP to maintain GFR !!! 140/90 OK. Ace-i best (when starting,
monitor decline in GFR and hyper-K)

2191

Internal
Medicine

Endocrinology

hormone OD, iodine OD, subacute painless lymophocytic, post-delivery -> thyrotoxicosis
(inflammed follicles leak thyroid hormones) -> decreased radioactive iodine uptake

2203

Internal
Medicine

GIT

PRESSURE during vomiting -> ruptures submucosal ARTERIES in distal eso -> MALLORY WEISS
TEARS vs. eso varices-> submucosal VEINS from portal hypertension

2221

Internal
Medicine

Genitourinary

left sided scrotal varicocele + blood in urine + polycythemia -> RCC???? -> CT that.

2228

Internal
Medicine

Genitourinary

kidney stone? -> probs Calcium oxalate!! especially if fat malabsorption problem

2229

Internal
Medicine

Genitourinary

Blood in UA but no cells -> rhabdo?

2236

Internal
Medicine

Genitourinary

culture negative urethritis -> chlamydia (is cloaked!!)

2256

Internal
Medicine

Hem&Onc

+ VDRL -> confirm with ABs. lots of false postivies with SLE antiphospholipid AB syndrome

2269

Internal
Medicine

ID

ALL SORTS OF THINGS can give you diarrhea in HIV-> send your stool for analysis before
picking an antibx...

2270

Internal
Medicine

ID

CMV = Can't See Me on Monospot test. Also, usually no sore throat/lymphadenopathy.

2282

Internal
Medicine

Neurology

LEWY body dementia -> see LIONS. FLUCTUATING cognitive impairment, parkinsonism motor
sx..

2287

Internal
Medicine

Neurology

tremor that increases in intensity while reaching for object -> ESSENTIAL TREMOR, AD ->
Propranolol

2292

Internal
Medicine

Respiratory

gram negative -> CIPRO vs. anaerobe -> CLINDA (anaerobes above the diaphragm). CAP ->
z-pack vs. levo (less healthy pt) vs. HCAP-> vanc (+) + zosyn (broad, pseudo) + cipro(-, pseudo)
vs. ICU -> add gentamicin or imipenem?

2295

Internal
Medicine

Respiratory

very sick alcoholic coughing -> aspiration pneumonia -> right lower lobe (can be upper if lying
down)

2305

Internal
Medicine

Rheumatology

air or cartilage erosion -> crepitus. *osteoarthritis -> tylenol!

2582

Internal
Medicine

Hem&Onc

UC -> surveillance colonoscopy every year after 8th year!!

2589

Internal
Medicine

Hem&Onc

testicular cancer -> KILL FIRST AND INVESTIGATE LATER (surgery + chemo)-> high cure rate!!
:) **(NO BIOPSY OR NEEDLE ASPIRATION OR CANCER CELLS/SPERM WILL SPILL OUT)

2599

Internal
Medicine

Hem&Onc

if calcium >12 -> BAD hypercalcemia -> calcitonin, bisphosphonates, NS. *cancer -> parathyroid
hormone related protein -> makes your bones break down -> hypercalcemia CALCIUM BREAKS
YOUR BONES.

2602

Internal
Medicine

Respiratory

ptosis -> eyelid droop (myasthenia, horner's) vs. proptosis/exopthalmous-> eye props out (grave's)

2608

Internal
Medicine

Hem&Onc

Do you TRUST HER??? TRASTuzumab for HER2+ breast cancer. *cardiotoxic so echo before
starting. chemo/radiation after surgery = adjuvant.

2613

Internal
Medicine

Hem&Onc

ONLY If positive for BRCA -> screen for Ovarian cancer with U/S +/- CA125

2615

Internal
Medicine

Hem&Onc

most common type of lung cancer- > ADENOcarcinoma (solitary and in periphery), & remarkable
has NO ASSOCIATION WITH SMOKING!!

2616

Internal
Medicine

Hem&Onc

febrile neutropenia -> PIPTAZ empirically after blood culture to get pseudo, or meropenem or
cefepime

2630

Internal
Medicine

Hem&Onc

kidney stones + ulcers -> AD MEN 1 (hyperparathyroidism, pancreatic tumor/gastrinoma/

zollinger-ellison syndrome, pit tumor)

2632

Internal
Medicine

Hem&Onc

constipation + thirsty -> HYPERcalcemia -> PTHrP???

2641

Internal
Medicine

Hem&Onc

PO43- binds Ca2+, so tumor lysis syndrome -> increased everything except calcium.

2645

Internal
Medicine

Hem&Onc

DM + DERMATITIS (NECROLYTIC MIGRATORY ERYTHEMA) + DIARRHEA -> GLUCAGONOMA

(PANCREATIC NEUROENDOCRINE TUMOR)

2645

Internal
Medicine

Hem&Onc

mild DM + nec rash/diarrhea/anemia/weight loss -> glucagonoma!

2646

Internal
Medicine

Hem&Onc

Progesterone before Pot for anorexia....does the pill make you fat?!?!

2649

Internal
Medicine

GIT

tumor with diarrhea in small intest -> carcinoid syndrome vs. tumor with diarrhea in pancreas ->
VIPoma

2659

Internal
Medicine

Cardiology

GET MAD (MAG) FOR TORSADES. if unstable-> defrilltate instead.

2662

Internal
Medicine

Poisoning

dry as a bone, full as a flask, blind as a bat, mad as a hatter -> anticholineric tox -> give
physostigmine (cholinesterase inhibitor)

2663

Internal
Medicine

Cardiology

brady + wheezing + hypotension -> BB overdose -> 1. atropine + fluids 2. glucagon 3. epinephrine

2695

Internal
Medicine

Cardiology

systolic mumur radiation going to axilla + S3 + palpitations -> most likely Afib from MR from MVP

2731

Internal
Medicine

Cardiology

month after MI -> LV aneurysm or pericarditis

2737

Internal
Medicine

Cardiology

Troponin T Takes TEN days to return to normal. so use CK-MB (returns to normal within 1-2 days)
for recurrent heart attack.

2741

Internal
Medicine

Cardiology

CHF in young person -> myocarditis 2/2 coxsackie B virus???

2745

Internal
Medicine

Cardiology

STEMI: PTCA (door to ballon time < 90 min) better outcomes than fibrinolytics (door to needle
time <30 min).

2745

Internal
Medicine

Cardiology

door to balloon time < 90 minutes (Percut transluminal coronary angioplasty PTCA)

2747

Internal
Medicine

Dermatology

URI then herald patch-> xmas tree pattern -> pityriasis rosea

2760

Internal
Medicine

Dermatology

elaine's painful stye from local process -> Hordeolum -> Hot compresses, I&Dvs. painless
granuloma rxn from obstructed gland-> chalazion -> if recurrent, biopsy to R/O gland cancer

2775

Internal
Medicine

Dermatology

IgG against desmoglein in epidermis -> flacci blistering bullae -> pemphigus VULGARIS vs. IgG
and C3 at dermal epidermal junction (DEEPER) -> HARD blisters -> bullous pemphiGOLD

2775

Internal
Medicine

Dermatology

Dig deeper for gold ( igG in dermal-epidermal layer for tense bulbous pemphigoid) Vs. Vulgaris
(vulgar, flaccid, superficial)

2786

Internal
Medicine

Electrolytes

pneumonia -> hypoxia -> tachypnea, respiratory alkalosis -> renal compensation by decreasing
bicarb

2790

Internal
Medicine

Electrolytes

pneumonia -> respiratory acidosis ( if COPD exacerbation) & metabolic acidosis (production of
lactate). are the lungs compensating for a metabolic acidosis? arterial pCo2= 1.5xbicarb +8

2796

Internal
Medicine

Electrolytes

Winter's formula for respiratory compensation for DKA or metabolic acidosis: PaCO2 = 1.5xbicarb
+8

2812

Internal
Medicine

Electrolytes

hypotension from septic shock (acidosis, low urine output, fever, tachypnea): 1. NS bolus 2.
Pressors only if NS fails

2813

Internal
Medicine

Electrolytes

vomiting: 1. lose gastric juice (HCl, NaCl)-> pancreas doesn't release bicarb -> bicarb increases in
blood. 2. lose blood volume -> kidneys sense decreased Q -> aldosterone -> lose H+ and K+. ->
hypokalemic, hypochloremic metabolic alkalosis

2817

Internal
Medicine

Electrolytes

NON-AG metabolic acidosis with hyperkalemia and hyponatremia -> aldosterone deficiency->
addison's disease -> autoimmune vs. TB vs. hemorrhage vs. met cancer?

2821

Internal
Medicine

Electrolytes

seizure -> chem panel 2 hours after. has lactic acidosis resolved?????

2821

Internal
Medicine

Electrolytes

seizures -> muscles release lactic acid -> Anion Gap METABOLIC ACIDOSIS -> repeat labs in 2
hours

2837

Internal
Medicine

ID

MYYYY AMINOGLYCOSIDE (GENTAMICIN, TOBRAMYCIN..........) -> MY EAR HAIR CELLS

A-DYING

2842

Internal
Medicine

ENT

AERD (aspirin exacerbated respiratory disease) after NSAIDS is associated with nasal polyps.

2858

Internal
Medicine

Ophthalmology

chalazion just chills there. vs. hordeolum hurts. vs. dacryocystitis (infected lacrimal sac) needs
antibiotics.

2877

Internal
Medicine

Hem&Onc

iINCREASED TIBC microcytic anemia -> IRON DEF

2880

Internal
Medicine

Hem&Onc

cirrhosis, bronze diabetes, dilated heart failure -> AR hemochromatosis -> genetic testing dx;
serial phelbotomy trx

2885

Internal
Medicine

Hem&Onc

low leukocyte alkaline phosphatase (cells fucked up and not making enzyme)-> CML vs. high w/
PV or leukemoid reaction/ infection

2888

Internal
Medicine

Hem&Onc

Smudge the CLLs

2889

Internal
Medicine

Hem&Onc

back pain with anemia-> multiple myeloma?!?!?

2895

Internal
Medicine

Hepatology

President Wilson on the copper penny-> dx liver biopsy + ceruloplasmin levels in blood; trx:
chelators, zinc, transplant

2901

Internal
Medicine

GIT

Antibiotics before LP vs. Antibiotics after paracentesis!!! ** high SAAC (serum albumin- ascites
albumin) > 1.1 -> portal htn/ liver problem/ sbp. -> probs just need antibx if bacterial peritonitis is
SECONDARY (from ruptured appendicitis for example) -> you'd see MULTIPLE types of bacteria,
sUPER LOW GLUCOSE, SUPER HIGH LDH & PRTN -> get IMAGING and CONSULT SURGERY

2920

Internal
Medicine

GIT

PBC is in WOMEN. vs. PSC associated with UC. (dx: cholangiogram and liver biopsy)

2924

Internal
Medicine

Hepatology

Bodgan the Jew has Dubin-Johnson syndrome. Asymptomatic but shockingly black. Conjugated
hyperbilirubinemia. Rotor similiar but normal color.

2924

Internal
Medicine

Hepatology

CONJUGATED hyperbili -> DJ Rotor!!! (Dubin-J - guiness colored liver), (Rotor-lacks color) vs.
UNconjugated hyperbili -> Gilbert (gentle) or Crigler-Najjar (this is the EVIL one, need transplant)

2934

Internal
Medicine

GIT

ACUTE PANCREATITIS DIAGNOSIS: (2/3) -PAIN RADIATING TO BACK -ENZYMES 3X

-IMAGING (CT CONTRAST OR U/S) SHOWING ENLARGED PANCREAS

2936

Internal
Medicine

GIT

PT (11-15) - teens PTT (25-40) - middle aged

2938

Internal
Medicine

Hepatology

neuropsych sx and basal ganglia -> slit lamp that shit and get ceruloplasmin levels for WILSON'S
DISEASE

2950

Internal
Medicine

Hepatology

"only people who wear lipstick get PBC. how did you get it??"

2953

Internal
Medicine

Hepatology

hypokalemia/diuretic use -> ammonium (NH4+ -> NH3 which crosses BBB) ->hepatic
encephalopathy -> replace potassium + albumin

2961

Internal
Medicine

Hepatology

hep B trx (even if decompensated cirrhosis)-> entecavir or tenofovir

2968

Internal
Medicine

Hepatology

cutie amoeba protozoas! -> bloody diarrhea but only get 1 liver cyst and trx is metronidazole.

2977

Internal
Medicine

GIT

dark urine/ + urine bili -> conjugated -> rotor's syndrome -> no trx

2986

Internal
Medicine

Hepatology

HEP B is NBD. 90% recover some -> chronic. somse -> fulminant (encephalopathy within 8weeks
of acute liver failure) -> need transplant!!!

2995

Internal
Medicine

ID

hilar nodes-> sarcoidosis, histoplasmosis (histo in ohio)

2995

Internal
Medicine

ID

ANY TIME THEY GIVE YOU A LOCATION -> PAY SOME FUCKING ATTENTION TO ENDEMIC
DISEASES. TB looks like histo and blasto and sarcoidosis!

3011

Internal
Medicine

ID

human or dog bites-> amoxi-clav (d-augmentin)

3012

Internal
Medicine

ID

acute infective endocarditis -> 3 blood cultures, then empiric antibx. vs. subacute -3 blood cultures
spaced further apart + tailored antibx once cultures back

3014

Internal
Medicine

ID

healthcare associated endocarditis -> staph vs. community-acquired -> strep

3021

Internal
Medicine

Respiratory

pleural plaques if b/l -> likely due to asbestosis vs. if unilateral -> mesothelioma

3024

Internal
Medicine

Respiratory

asthma presenting in adulthood or after lying down -> GERD

3029

Internal
Medicine

Respiratory

Pneumonia in same location -> bronchogenic CA?? -> CT +/- bx

3042

Internal
Medicine

Respiratory

pulse ox (O2 sat) < 88%, abg Pa02<55%, hematocrit >55% -> start OXYGEN trx

3062

Internal
Medicine

Hem&Onc

ankyrin scaffolding protein on RBC fucked up -> AD hereditary spherocytosis -> increased osmotic
fragiliility on acidified glyceorl lysis test and abnormal binding test. coombs test negative-> folate,
transfusions, splenectomy or else pigment gallstones + aplastic crises

3069

Internal
Medicine

Cardiology

arthymmia from WPW -> IV procainamide or cardioversion (AV nodal blockers like BB, CCB,
adenosine, digoxin will send them into VFib!!!!)

3083

Internal
Medicine

Endocrinology

constipation -> hyper-ca?? -> hyper- vitamin D???

3083

Internal
Medicine

Endocrinology

FAD DIET -> VIT D TOX -> HYPERCALCEMIA

3085

Internal
Medicine

Electrolytes

orthostatic hypotension with loss of Na+ and K+ in urine -> DIURETIC ABUSE????!?!?!?

3086

Internal
Medicine

GIT

4 mos -> folate def 4yrs -> b12 def

3090

Internal
Medicine

Cardiology

Young ppl with chest pain -> AS from bicuspid aortic valve?!?!?!??! vs. HCM

3096

Internal
Medicine

Cardiology

atrial tach (from increased ectopy) + AV block (increased vagal tone) -> digitalis TOXICITY

3099

Internal
Medicine

Endocrinology

Hyperventilation -> resp alkalosis-> hypocalcemia (more bound to albumin, less free) ->
paresthesias, spasm

3105

Internal
Medicine

ID

ALL TRANSPLANT pts need TMP-SMX to prevent PCP (pneumocystis pneumonia).

3131

Internal
Medicine

ID

EBV -> Monospot dx (My one spot Bar). ABs against EBV can attack RBCs and plts-> coombs test
positive hemolytic anemia

3149

Internal
Medicine

Rheumatology

synovial fluid analysis to distinguish: septic arthritis vs. gout vs. pseudogout.

3150

Internal
Medicine

Rheumatology

gout PREVENTION-> allopurinol and probenecid

3150

Internal
Medicine

Rheumatology

Prevent gout with probenecid & alloPurinol

3153

Internal
Medicine

Rheumatology

suspicious joint fluid -> inflammatory vs. outrageous joing fluid -> septic. (purulent arthritis in
person having sex -> GONORREA until proven otherwise)

3157

Internal
Medicine

Rheumatology

exertion -> exacerbates vascular claudication vs. posture (extension)-> exacerbates neurogenic
claudication

3161

Internal
Medicine

Poisoning

METHANOL (anti-freeze) MESSES WIth YOUR VISION. vs. ETHYLENE (sweet radiator fluid)
EFFS UP YOUR KIDNEYS. *trx- fomepizole or ethanol. B1, B6, Folate

3161

Internal
Medicine

Poisoning

IF THEY GIVE YOU A CHEM PANEL -> DO YOU THINK YOU NEED TO CALCULATE AN ANION
GAP?!?!?!?!?

3168

Internal
Medicine

Rheumatology

diagnose rotator cuff tendinitis -> improvement with lidocaine!!

3173

Internal
Medicine

Rheumatology

Hydroxychloroquine cleans out your (retina)-screen

3203

Internal
Medicine

Rheumatology

different pathophysiologies for CTS.

3208

Internal
Medicine

Rheumatology

dermatomyositis -> cancer????

3211

Internal
Medicine

Rheumatology

pain with flexion, SLR (also flexing)-> pressure on anterior herniation -> HERNIATED DISK. vs.
pain with extension -> spinal facet problem -> SPINAL STENOSIS.

3230

Internal
Medicine

Endocrinology

young person w/ HTN and diuretic-induced hypo-k -> PRIMARY HYPERALDOSTERONISM????

-> morning aldosterone: renin >20, and plasma aldos >15

3231

Internal
Medicine

Endocrinology

aldosterone:renin over 20 -> 1* HYPERALDOSTERONISM -> CT and cut adrenal tumor out or
aldosterone antags

3245

Internal
Medicine

ID

immunocompromised or old -> vanc + amp + cephalosporin for bacterial meningitis (amp gets
listeria)

3246

Internal
Medicine

ID

tb prophylaxis -> 9 months isoniazid + B6 +liver fx tests vs. active, sx tb treatment -> combo drug
regimen

3248

Internal
Medicine

ID

bloody diarrhea -> EHEC, Shigella, or Campylobacter

3256

Internal
Medicine

ID

PCN allergic pt with syphilis -> doxy unless pregnant

3261

Internal
Medicine

ID

Dirty (maculopapular rash) hands and soles -> syphilis

3263

Internal
Medicine

ID

erysipelas -> group A strep

3266

Internal
Medicine

ID

rubella (rapidly spreading) + joint problems or postinfectious encephalitis vs. measles (migrates
over days)

3267

Internal
Medicine

ID

eosinophils <1% normally

3267

Internal
Medicine

ID

Eosinophils < 3%

3317

Internal
Medicine

Rheumatology

Osteoarthritis morning stiffness is ONLY 30 min or less. Vs. rheumatoid/inflammatory is really long.

3449

Internal
Medicine

ENT

ENDOlymph in INNER ear -> menIERE's

3462

Internal
Medicine

Neurology

transient arm weakness -> ACS? MS?

3483

Internal
Medicine

Endocrinology

hypercholesterol/TG -> make sure no hypothyroidism before prescribing statins!

3484

Internal
Medicine

Endocrinology

you DONT need to FNA everyone with a fucking thyroid nodule!! only those with cancer risk
factors or suspicious U/S findings or normal/high TSH. Low TSH -> scan -> if hot nodule most
likely benign so just treat for hyperthyroidism; if cold nodule -> FNA that shit too.

3489

Internal
Medicine

Endocrinology

vit D deficiency -> decreased calcium + phosphate absorbtion -> PTH -> bone resorption and
lower phosphate-> bone pain and osteomalacia

3490

Internal
Medicine

Endocrinology

vit D deficiency -> decreased Ca and Phos absorption -> osteomalacia, secondary
hyperparathyroidism

3492

Internal
Medicine

Endocrinology

bromocriptine, cabergoline -> DA AGONISTS for prolactinomas before surgery.

3493

Internal
Medicine

Endocrinology

functioning pituitary adenoma -> prolactin >200 vs. nonfunctionig -> inert substantces +
compression effects (decreased TSH) *hypothyroidism ddx

3496

Internal
Medicine

Endocrinology

anti-TPO ABs -> high risk Hashimoto's

3498

Internal
Medicine

Endocrinology

Papillary thyroid cancer is most Popular. Radiation, family hx risk factors. Best prognosis.

3498

Internal
Medicine

Endocrinology

Carcinoma-> lymphatics (except HCC, rcc, follicular, choriocarcinoma) Vs. Sarcoma -> blood
(connective tissue)

3499

Internal
Medicine

Endocrinology

if i had to choose a thyroid cancer it would be PAPILLARY with PSAMMOMA bodies.

unencapsulated but FUCKING FANTASTIC prognosis even with mets!! :)

3499

Internal
Medicine

Endocrinology

You want to see psamomma bodies -> papillary thyroid cancer good prognosis :]

3502

Internal
Medicine

GIT

air in thorax -> eso perf -> gastrographin (barium inflammatory) vs. blood in thorax -> aortic
dissection

3506

Internal
Medicine

Cardiology

restrictive lung disease -> NO AMIODARONE vs. obstructive lung disease -> NO BETA BLOCKERS

3518

Internal
Medicine

Endocrinology

increased alk phos + mixed lytic/blastic lesions + hat size + secondary aosteoarthritis -> paget's
disease -> bone scan + bisphosphates if sx

3520

Internal
Medicine

Endocrinology

MEN 1 -> 3Ps (pit, pancreas, PTH) vs. MEN 2a -> PTH, medullary thryoid cancer, adrenal pheo
vs. MEN 2b -> marfanoid and mucosal stuff, medullary thyroid cancer, adrenal pheo

3526

Internal
Medicine

Cardiology

warmth/swelling/tenderness -> venous thrombosis (HIT) vs. lose pulses -> arterial clot (LV
thrombus after MI, LA thrombus from AFib, aortic atherosclerosis)

3561

Internal
Medicine

ID

ANaerobic gram+ branching in face with sulfure granules and draining sinuses -> actinomyces ->
PCN vs. aerobic gram+ branching -> nocardia -> Bactrim

3585

Internal
Medicine

GIT

Pain or anorexia w/ jaundice -> obstruction -> U/S for biliary obstruction/dilation vs. without
jaundice -> CT w/ contrast

3619

Internal
Medicine

Neurology

migraine headache -> COMPAZINE(prochlorperazine) +/- ketoralac *metoclopramide 2nd line

*sumatriptan only good for prophylaxis

3635

Internal
Medicine

Cardiology

pericaridial scarring (kussmaul's sign, sharp x and y descents-imparied relaxation, pericardial

knock, diastolic dysfunction)-> 2/2 viruses/radiation/surgery in US vs. TB in developing countries

3637

Internal
Medicine

Neurology

pseudotumor -> bridging therapy (LP, steroids) + then ACETAZOLAMIDE (decreases actual CSF
production)

3648

Internal
Medicine

Genitourinary

acute renal failure -> hyperkalemia, brady -> IV calcium gluconate to protect heart membranes

3680

Internal
Medicine

Hem&Onc

back pain worse lying down -> cord compression vs. improved with recumbency ->msk

3693

Internal
Medicine

Genitourinary

nitrites in urine (just like in smoked meats you eat) -> enterobacteria vs. LEUK esterase -> pyuria
(bacterial infection)

3698

Internal
Medicine

Cardiology

no QRS -> VF -> first debibrillator (CPR if unwitnessed or >5 min) -> then epinephrine/Q3min while
CPR ongoing -> debrillator again-> antiarrhythmics (amiodarone, lidocaine, magnesium) if
warranted.

3717

Internal
Medicine

Respiratory

high suspicion PE in unstable pt-> IV heparin, don't wait for CTA

3729

Internal
Medicine

Endocrinology

polyuria w/: -high glucose -> DM. -concentrated urine -> DI (central ro renal resistance). -dilute
urine -> polydipsia

3738

Internal
Medicine

Neurology

dominant (L) frontal lobe -> broca's aphasia, contralateral weakness, look to lesion

3778

Internal
Medicine

Rheumatology

DIURETICS MAKE GOUT WORSE!!!!!!!!! diuretics -> hypovolemia -> increased uric acid levels

3829

Internal
Medicine

Cardiology

PVCs: -> nothing if asymptomatic -> BB -> amiodarone

3863

Internal
Medicine

Preventive
Medicine

50-74 women -> 2 boobs Q2 years until you're too fucking old. 21-65 women -> 3 hole area check
Q3 years. 65+ -> DEXA

3873

Internal
Medicine

ID

MMR ok in AIDs if CD4+ >200

3874

Internal
Medicine

Respiratory

hoarse voice/persistent cough with afib and elevated left main bronchus-> left atrial
enlargement?? -> MS from rheumatic fever???

3890

Internal
Medicine

GIT

bronze diabetes-> hemochromatosis!!!! (high ferritin and high transferrin saturation)

3892

Internal
Medicine

ID

when you're 65 years old -> PCV13, then PPSV23 or just PPSV23 if you're comorbidy

3895

Internal
Medicine

Genitourinary

eating protein bars BAD -> increased Ca2+ kidney stones.

3918

Internal
Medicine

GIT

types of polyps: hyperplastic-nbd. vs. hamartomatous-nbd. vs. adenoma-small risk premalignant

(increased if sessile (structurally) or villous (histologically)). **Villous Villian Adenoma!!!!!**

3930

Internal
Medicine

Hem&Onc

alcoholics can get folate deficiency in four weeks!

3936

Internal
Medicine

GIT

NSAIDs -> GI bleeding -> iron def anemia

3945

Internal
Medicine

Cardiology

nitrates -> dilate veins -> decrease preload -> decrease O2 requirement of heart

3951

Internal
Medicine

Genitourinary

nosebleeds, bruising, all sorts of bleeding during chronic renal failure -> due to platelet dysfunction
(BT prolonged, but everything else normal) -> give DESMOPRESSIN (increases vWF release).
DESMOPRESSIN FOR DAT FUCKING PLATELET DYSFUNCTION.

3958

Internal
Medicine

Cardiology

dehydrated?? -> what's the BUN/Cr ?????? (>20 is very SENSITIVE but not specific for
hypovolemia)

3958

Internal
Medicine

Cardiology

drop in 20/10 from supine to standing-> orthostatic hypotension 2/2 volume depletion (BUN/Cr
>20) OR baroreceptor sensitivity problem

3976

Internal
Medicine

Endocrinology

Bb -> unoppposed alpha -> increases bp in cocaine tox and pheo

3977

Internal
Medicine

Cardiology

severe HTN -> hypertensive urgency vs. severe HTN + papilledema/retinal bleed-> malignant htn
vs. severe HTN + cerebral edema/neuro sx -> hypertensive encephalopathy

3979

Internal
Medicine

Cardiology

uremia ( increased BUN) -> pericarditis without EKG changes.

3987

Internal
Medicine

Genitourinary

acyclovir -> not very soluble in urine -> crystal induced acute kidiney injury!!! -> give lots of FLUIDS

3994

Internal
Medicine

Cardiology

old people -> lose elasticity -> increased systolic bp -> widened pulse pressure -> give anti-htn
med

4001

Internal
Medicine

Biostatistics

RANDOMIZE to control for CONFOUNDING.

4003

Internal
Medicine

Cardiology

wide pulse pressure-> decreased elasticity, AVM, AR vs. narrow pulse pressure -> AS,
tamponade, blood loss

4007

Internal
Medicine

Genitourinary

chronic analgesic abuse -> papillary necrosis + tubuloinsterstitial nephritis (polyuria, sterile
pyuria/WBCs)

4024

Internal
Medicine

Respiratory

pneumonia trx; outpt healthy-azithro vs. outpt unhealthy-levo vs. inpt/ICU- levo OR vanc+ zosyn +
levo OR CTX + azithro.

4027

Internal
Medicine

Genitourinary

stones invisible to X-ray: uric acid, xanthine, or super small calcium stones (<3mm). or maybe
there's a blood clot or tumor!! Uric acid stone -> alkalinize urine w/ k-citrate (Urocit-K), low purine
diet vs. calcium stones -> HCTZ (loops lose calcium) vs. xanthine stone (genetic)-> low purine diet
vs. cysteine (genetic) or struvite (urease infection) stones -> staghorn -> surgery

4037

Internal
Medicine

Hem&Onc

isoniazid -> B6 def -> sideroblastic anemia (microcytic/hypochromic anemia with increased iron,
decreased TIBC)

4040

Internal
Medicine

Respiratory

Only intubate if face-mask fails (unstable, pH <7.1, )

4048

Internal
Medicine

Respiratory

any sort of problem or change in health status-> theophylline toxicity?!?!?!??!?!?

4053

Internal
Medicine

Respiratory

MORE PROTEIN AND LDH IN PLEURAL FLUID THAN SERUM + ACIDIC PH-> EXUDATE
(INFECTION, MALIGNANCY, INFLAMMATION, PE)

4054

Internal
Medicine

Cardiology

coronary steal- tax cuts for the rich

4057

Internal
Medicine

ID

cat scratch gram negative bartonella -> Z-pack

4061

Internal
Medicine

Cardiology

heart problems after virus (coxsackievirus)-> DILATED CARDIOMYOPATHY -> systolic

dysfunction. vs. sudden cardiac death -> asymmetric septal hypertrophy vs. chronic pressure
overload (HTN, AS)-> concentric hypertrophy vs. chronic volume overload (valvular regurg) ->
eccentric hypertrophy

4068

Internal
Medicine

Cardiology

amiodarone, lidocaine for vtach

4073

Internal
Medicine

Respiratory

effusion with a low pH -> probs an empyema -> put in a chest tube (thoracostomy)

4078

Internal
Medicine

Rheumatology

positive straight leg test & radiating pain -> HERNIATED DISK

4082

Internal
Medicine

Endocrinology

Low Calcium? 1. Check albumin-> For every decrease in albumin by 1, calcium falls 0.8. 2. Check
mag (alc-> low mag-> PTH resistance -> low Ca) 3. Check PTH (if low -> hypoparathyroidism vs. if
high -> resistance, vit D def, inflammation)

4083

Internal
Medicine

Rheumatology

radicular pain + SLT -> herniated disk vs. pain worse with extension + better with shopping cart
flexion -> stpinal stenosis vs. point tenderness after injury + normal neuro + osteooporosis hx ->
vertebral compression fracture

4091

Internal
Medicine

Dermatology

cone acne -> topical retinoids vs. any other type of acne -> 1.topical antibx 2. oral antibx 3. oral
retinoids

4099

Internal
Medicine

Ophthalmology Herpes (HSV) HURTS. even in the eye. CMV doesn't.

4120

Internal
Medicine

ID

recent UTI/infection + FOCAL back pain -> osteomyelitis? -> esr/crp, X-rays -> if X-ray normal, get
MRI then biopsy

4123

Internal
Medicine

Rheumatology

smoking hx -> cancer -> paraneoplastic syndromes -> MG, Lambert eaten, dermatomyositis
(gottron's papules, heliotrope rash..confirm with muscle bx)

4127

Internal
Medicine

Cardiology

chronic angina -> BB. (+/-CCB) vs. acute angina -> nitrates.

4133

Internal
Medicine

Cardiology

hepatojugular/abdominaojugular reflux -> rise in jvp w/ compression of abdomen -> means you/re
RV is failing

4139

Internal
Medicine

Neurology

seizure in someone with fever and acting strangely -> HSV-1 encephalitis?!?! -> LP and PCR the
CSF

4147

Internal
Medicine

Hem&Onc

Folate supplementation for phenytoin, tmp, methotrexate!

4150

Internal
Medicine

GIT

inflammation, infection -> INCREASE in platelets (want to stick up/contain disease)

4161

Internal
Medicine

Endocrinology

fractured penis -> venous ED (PENIS IS VENOUS) vs. fractured pelvis -> neurogenic ED

4163

Internal
Medicine

ID

endocarditis in IV druggie -> R sided vs. endocarditis in heart mumur hx pt (mitral valve
problem)-> L sided

4206

Internal
Medicine

Neurology

hemi-neglect syndrome -> right (non-dominant) parietal lobe

4216

Internal
Medicine

Electrolytes

TRANSFUSIONS during surgery -> citrate binding -> HYPOCALCEMIA -> muscle cramps,
hyperactive DTR.. *hypomagnesemia -> PTH resistance -> mimics hypocalcemia

4228

Internal
Medicine

Endocrinology

parasympa lets you pee (detrusor contracts, internal sphincter relaxes), so a neurogenic bladder
-> overflow incontinence (high post-void volume, dribbling, poor stream)

4233

Internal
Medicine

Respiratory

hotels, cruise ships -> Legionella gram negative rod -> hyponatremia, brady with fever, hepatitis,
confusion, GI problems, pneumonia -> urine antigen testing, macrolide or fluoroquinolone

4236

Internal
Medicine

Electrolytes

vomit = HCl + KCl -> hypochloremic hypokalemia with elevated bicarb

4257

Internal
Medicine

ID

nail puncture in tennis shoes (mike burnim) -> PSEUDOMONAS

4266

Internal
Medicine

Genitourinary

FACE OR ANKLE EDEMA -> LIKE YUJ!!! ..NEPHROTIC SYNDROME? -> HYPERCOAGULABLE
STATE. BEWARE RENAL VEIN THROMBOSIS.

4268

Internal
Medicine

Neurology

contralat sensory/motor deficit, conjugate eye deviation, homonymous hemianopia,

aphasia/hemineglect (cortical signs) -> MCA occlusion vs. pure M or pure S or lacunar syndrome
-> infarct in BG or subcortical white matter

4278

Internal
Medicine

Hepatology

normal liver (<12cm) less than a dozen everything reversible (steatosis, alcoholic hepatitis, early
fibrosis) ..except cirrhosis! Respect SIR-cirrhosis.

4282

Internal
Medicine

ENT

cipro gets pseudo!! (as does piptaz, aminoglycosides, penams, aztreonam)

4282

Internal
Medicine

ENT

pseudo -> cipro, zosyn (pip-taz), AGs, pens CTX (3) none but CefTazidime(3) and cefepime(4) do

4297

Internal
Medicine

Respiratory

25% COPD pts -> Cor pulmonale -> edema, hepatomegaly/ascites, exertional sx, distant heart
sounds, increased jvp, tricuspid regurg. *MR, TR, VSD, AS -> all holo-systolic mumur

4303

Internal
Medicine

GIT

Upper GI

4304

Internal
Medicine

Endocrinology

hyperCa + hyperPTH ->primary hyperparathyroidism. vs. hyperCa + hypoPTH-> badness (cancer,

sarcoid, vit D tox)

4307

Internal
Medicine

Endocrinology

hyperthyroid -> bone loss + afib complications

4309

Internal
Medicine

Endocrinology

sitting for long periods of time -> BONES GET RESORBED!!!!! -> hypercalceima. especially if
young, paget's disease, or chronic renal insuff ****give bisphosphonates and hydrate **albumin =
4, calcium =10; LOW ALBUMIN -> LOW CALCIUM; for every 1 decrease in albumin, -.8 for calcium

4309

Internal
Medicine

Endocrinology

4 weeks not moving -> clasts absorb bone (don't use it, you lose it). *prevent with H20 and
bisphosphonates.

4316

Internal
Medicine

Hem&Onc

decreased plts? -> HIT 2 ?!?!?!?!?!!?!??!?!?!

4331

Internal
Medicine

Hem&Onc

no G6PD -> hb denatures into Heinz bodies- > bite cells

4338

Internal
Medicine

Hem&Onc

PLATELETS PAYS THE DINNER BILL 150-400K. *LOW PLATELETS + ANEMIA + INCREASED
BILI -> TTP? -> PERIPHERAL BLOOD SMEAR FOR SCHISTOCYTES

4339

Internal
Medicine

Hem&Onc

fragmented RBCs + low platelets (MAHA), bloody diarrhea, HTN, neuro findings, abdominal pain->
idiopathic TTP-HUS??? -> Plasmapheresis or pt will DIE (monitor plts and LDH)

4339

Internal
Medicine

Hem&Onc

Random MAHA -> idiopathic ttp-hus -> plasmapheresis to take out auto-AB or DiE

4351

Internal
Medicine

Hem&Onc

nodes <1cm -> nbd, just watch it.

4370

Internal
Medicine

Rheumatology

LOWER BACK PAIN: msk- spinal stenosis-shopping cart sign, slipped disk-radiating pain, fracture,
mechanical- strain/spasm/degen. vs. inflamm- worse with rest, gradual, hla-b vs. malig- old,
weight loss vs. infectious-fever, focal, IVDU, recent infection

4371

Internal
Medicine

Rheumatology

chronic inflammation/stress -> increased platelets (reactive thrombocytosis) to help stick germs to
wbcs

4385

Internal
Medicine

GIT

just fibrinogen, VWF, or F8 deficiency -> Cryo vs. clotting factor def, DIC, or overdose warfarin ->
FFP (ALL clotting facotrs) vs. platelets <50,000 in bleeding pt -> platelets vs. hg<9 in sx pt or hg<7
-> packed RBC

4387

Internal
Medicine

Respiratory

decreased breath sounds -> pleural effusion(dullness to percussion, egophony) or

pneumothorax(hyperresonnant to percussion) or emphysema (hyperresonant, vesicular
breathsounds) vs. bronchial breath sounds (louder, esp expiratory), dullness to percussion,
egophony, crackles -> consolidation vs. vesicular breath sounds/crackles at end inspiration ->
interstitial lung disease vs. no breath sounds -> COLLAPSED airway

4393

Internal
Medicine

Neurology

GI loss, anorexia, hyperaldosteronism, diuretics-> hypokalemia -> flattened T waves, U waves, ST

depression, premature ventricular beats

4396

Internal
Medicine

Cardiology

pleuritic chest pain -> PE????? vs. pericarditis????

4401

Internal
Medicine

Neurology

Ach -> excitatory in skeletal muscle but inhibitory in heart muscle! so... anticholinergic -> dilated
vessels/flushing but tachy (loss of inhibition!)

4419

Internal
Medicine

Electrolytes

steriods -> hypokalemia

4422

Internal
Medicine

Electrolytes

it's easier to sweep potassium under the rug than get rid of it! (insulin + glucose works in 15
minutes!) fast but transient effect.

4425

Internal
Medicine

Electrolytes

hypernatremia -> DIABETES INSIPIDUS ??? (central or peripheral)

4428

Internal
Medicine

Electrolytes

For paralytic, SUCC SUCKS. ROC ROCKS. Succ-> hyperkalemia, brady, increased IOP. quick
recovery (10min) vs. Roc-> nothing too bad. just slower recovery but reversible.

4440

Internal
Medicine

Hem&Onc

thalassemia -> hemoglobin chain weird but normal # RBCs and normal RDW (range of
size)...unlike iron deficieny

4445

Internal
Medicine

Cardiology

2nd heart sounds: ASD -> fixed split. ASD IS FIXED PROBLEM. vs. Right heart prb (PS, RBBB) ->
Wide split. RIGHT IS WIDE. vs. Left heart prb (AS, LBBB) -> Paradoxical split. LEFT IS LOONY.
************ low bp, muffled sounds, distended vv -> Beck's triad -> TAMPONADE ************
tenneSEE -> S3 -> CHF vs. KEN-tucky -> stiff ventricles/ AS/HCM -> S4

4449

Internal
Medicine

Rheumatology

1/2 PV pts -> increased uric acid turnover -> gout

4450

Internal
Medicine

Cardiology

SVT -> try some vagal stuff ( valsalva, carotid sinus massage, ice-water) or adenosine ->
decreaes conduction through AV node; break out of reentry

4459

Internal
Medicine

Cardiology

increased pulse pressure -> decreased elasticity b/c you old vs. AV fistula???

4466

Internal
Medicine

Hem&Onc

CRAB + paraprotein gap -> Multiple Myeloma

4469

Internal
Medicine

Cardiology

LONE AF PEOPLE (CHADS VASC 0, < 65 YEARS, MALE, AND NO RISK FACTORS)-> NO
WARFARIN OR ORAL ANTICOAGULANTS NEEDED

4470

Internal
Medicine

ID

+ TB test if: >5mm induration for immunosuppressed people. >10mm induration for me. >15mm
for normal people.

4473

Internal
Medicine

Cardiology

acetaminophens + NSAIDS -> BLEEDY

4474

Internal
Medicine

Genitourinary

RIGHT kidney in ADPKD easier to palpate b/c LOWER.

4475

Internal
Medicine

ID

pneumo vaccine 13 for those more at risk: kids, elderly, and immunocompromised. vs. pneumo
vaccine 23 for smoking/alc/less than healthy adults (smokers, DM, lung/liver/heart prb). vs.
Sequential 13 + 23 for VERY HIGH RISK/DYING adults.

4477

Internal
Medicine

Preventive
Medicine

Td booster every 10 years + Tdap every pregnancy.

4482

Internal
Medicine

Neurology

deep lacunar strokes usually THROMBOTIC (embolism usually proximal; too big to make it
deeper), and may not see on CT b/c so fucking small.

4484

Internal
Medicine

Cardiology

pulsus parvus et tardus -> AS vs. diastolic mumur -> AR

4487

Internal
Medicine

Poisoning

anticholinergic effects + seizures + long QRS -> TCA OD -> Bicarb to treat hypotension

4487

Internal
Medicine

Poisoning

tCA od -> biCArb

4489

Internal
Medicine

Respiratory

Bicarb ~25 C02 ~35

4490

Internal
Medicine

Genitourinary

Cr > 1.5 -> renal insufficiency -> non-ionic contrast CT

4513

Internal
Medicine

Neurology

brain abscess from sinus infection -> STREP viridans or anaerobes/bacteroides vs. abscess from
surgery/trauma -> STAPH

4514

Internal
Medicine

Endocrinology

DKA-> osmotic diuresis causes K+ loss, but redistribution from acidemia creates appearance of
hyperkalemia.

4516

Internal
Medicine

Ophthalmology

infection/stress -> increased cortisol/cats -> insulin fucked up -> hyperglycemia -> osmotic
diuresis, ams, blurry vision (nonketotic hyperglycemia in DM2)

4522

Internal
Medicine

Poisoning

neuroleptic malignant syndrome -> Dantrolene + Dopamine agonists (bromocriptine, amantadine)

4524

Internal
Medicine

Cardiology

radiation, TB, virus/idiopathic -> scarred pericardial sac-> CONSTRICTIVE PERICARDITIS, RHF
-> hepatojug reflex, kussmaul's sign (JVP doesn't change with breath), pulsus
paradoxus,pericardial knock (mid-diastolic), pericardial thickening/calcification

4524

Internal
Medicine

Cardiology

Kussmaul- Inhaul -> paradox rise in neck veins (where you kiss) 2/2 right heart filling prb

4535

Internal
Medicine

Electrolytes

Increased BUN -> GI BLEED?????????? (blood proteins get broken down to urea)

4536

Internal
Medicine

Respiratory

If ABG shows pO2 really high: 1. Slowly decrease FiO2 to non-toxic levels (<60%). 21% is normal
sea level. 2. Increarse PEEP to maintain oxygenation GOAL : ABG pO2> 60

4564

Internal
Medicine

Rheumatology

short-lived morning stiffness -> OA vs. lingering morning stiffness -> inflammatory

4566

Internal
Medicine

Respiratory

coughing up a little blood with no fever/concern for pneumonia -> probably ACUTE BRONCHITIS
2/2 virus, NBD. been there, done that. yellowish sputum can be from epithelial sloughing too, not
neccessarily an infection.

4568

Internal
Medicine

Respiratory

untreated pneumonia -> pus in pleural cavity (EMPYEMA) -> drainage and antibx

4572

Internal
Medicine

Rheumatology

morning stiffness >1hr + systemic symptoms ->RA-> inflammation + RA treatment (steroids) ->
osteoporosis -> give bisphosphonates to kill osteoclasts!

4575

Internal
Medicine

Respiratory

ESR SHOULD BE <20!!!! <20. <20. <20.

4585

Internal
Medicine

Rheumatology

Chronic Inflammation -> secondary amyloidosis

4586

Internal
Medicine

Rheumatology

knee pain with crepitus, coolness, calm mornings (resolves within 30 min) and can be
monoarticular-> OA and not something inflammatory

4593

Internal
Medicine

Cardiology

COPD, diseases of lung -> pulm HTN -> right heart failure -> hepatic congestion + peripheral
edema

4611

Internal
Medicine

ID

bactrim in HIV pts for prevention of toxo reactivation and PCP

4616

Internal
Medicine

Cardiology

THROMBOSIS ON HEPARIN -> HIT (nonimmune vs. immune)

4620

Internal
Medicine

Neurology

early gait problems -> hydrocephalus vs. late gait problems -> alzheimer's

4627

Internal
Medicine

Endocrinology

elevated alk phos but normal everything else -> PAGET disease of bone.

4631

Internal
Medicine

Respiratory

any one of lights criteria met -> EXUDATIVE effusion -> pneumonia? cancer? inflammation?

4639

Internal
Medicine

Cardiology

erectile dysfunction + skin problems + joint problems + liver problems + DM + dilated CM->
hemochromatosis!!

4651

Internal
Medicine

Neurology

WET, WOBBLY, WACKY -> NPH

4671

Internal
Medicine

Hem&Onc

ABO mismatch -> within ONE HOUR: DIC, renal failure, fever (acute hemolytic transfusion rxn)

4679

Internal
Medicine

Cardiology

S3 in older people-> too much blood or filling too rapidly with blood -> heart failure, restritive
cardiomyopathy vs. S4 in younger people -> stiff ventricles, acute MI

4686

Internal
Medicine

Biostatistics

cohort-pick group based on RISK FACTOR. estimate incidence (# new cases of disease), allows
calculation of Relative RISK.

4700

Internal
Medicine

Neurology

ams -> thiamine before dextrose

4700

Internal
Medicine

Neurology

eyes, lies, capsize -> wernicke encephalopathy -> thiamine B1 def

4703

Internal
Medicine

Neurology

temp over 105 and AMS (w/ tachy, coagulopathic bleeding, renal failure, ARDS..) in workers in
humid weather -> EXERTIONAL heat stroke.

4707

Internal
Medicine

Cardiology

HTN -> elevated LV diastolic pressure -> LA dilates-> AFib. anemia, hyperthroidism, beriberi,
paget's, av fistulas -> ventricles work harder but can't compensate -> high-output heart failure.

4714

Internal
Medicine

ID

splenic abscess (fever, wbc, LUQ pain) -> infective endocarditis??

4718

Internal
Medicine

Respiratory

O2 saturation goal in COPD exacerbation -> 90-94% !!!!! (if higher, risk hypercapnia/Co2 narcosis
from V/Q mismatch)

4725

Internal
Medicine

Cardiology

(No pulse????) PEA or Asystole -> ACLS (CPR/2min, IV acess + pressors/4min!!!!) vs. Vfib or VT
with no pulse -> defibrillate vs. unstable Afib w/ RVR or symptomatic VT-> cardiovert

4742

Internal
Medicine

Cardiology

ASA or BB -> bronchoconstriction. *I'm depressed when I'm ischemic!! (ST depression ->
ANGINA/ischemia) * acute dyspnea-> arrhythmia, broncoconstriction, CHF/hypervolemia,
infection, aspiration, pleural effusion, PE, anxiety

4753

Internal
Medicine

Respiratory

if increased protein OR LDH in pleural fluid -> EXUDATE.

4771

Internal
Medicine

Cardiology

INCREASED PRESSURE IN PERICARDIAC SAC ( tamponade, copd, severe asthma) -> pulsus
paradoxus: deep breath-> more Q to RH-> less to LH -> exaggerated systolic bp drop.

4859

Internal
Medicine

Hem&Onc

clot -> trx w/ heparin -> HIT 2?!?!?!? -> more clots!!!. how ironic.

4866

Internal
Medicine

Electrolytes

metabolic alkalosis: -saline responsive/vomiting or volume depletion (retaining chloride) vs. -saline
resistant/mineracorticoid problem (peeing lots of chloride out)

4902

Internal
Medicine

ENT

rinne: + if you can feel ringing on mastoid but can 't hear it when next to ear. * confirm with weber.
fork in forehead-> noise louder in ear with conductive prb/wax

4920

Internal
Medicine

Cardiology

Skinny QRS -> SVT -> vagal manuevers/ IV adenoSine vs. Wide QRS -> VTach -> amiodaTone,
lidocaine

8823

Internal
Medicine

Psychiatry

no circadian rhythm -> shift work sleep disorder (my life) vs. takes forever to fall asleep. night owl
schedule-> delayed sleep phase syndrome -> light/behavioral therapy

8876

Internal
Medicine

Endocrinology

Calcium should be 8-10. Low calcium -> 1. Check mag. 2. Check PTH.

8901

Internal
Medicine

Endocrinology

GI disease-> vit D def -> hypo-calcemia and hypo-phos -> increased PTH

8905

Internal
Medicine

Respiratory

fev1 decreases in both obstructive and restrictive lung disease, but fev1/fvc < 70% -> Obstructive

8926

Internal
Medicine

Ophthalmology

fixed, dilated pupil + hazy cornea -> acute angle-closure glaucoma vs. inflammed iris -> anterior
uveitis

8933

Internal
Medicine

Rheumatology

yellow lighting bolts -> GOUT

10146

Internal
Medicine

Poisoning

smoke inhalation -> hydroxocobalamin antidote for HCN poisoning

10287

Internal
Medicine

Electrolytes

blood and protein and casts in urine -> GLOMERULEAR cause.

10301

Internal
Medicine

ID

SCREENING for HIV -> AG and AB combo test for early detection (before ABs made). if + ->
CONFIRM w/ AB differentiation assay... if negative blood tests but you still think person high-risk
-> plasma RNA testing

10767

Internal
Medicine

Cardiology

malignant htn + scleroderma -> scleroderma renal cris ( schistocytes and thrombocytopenia on
smear)

10780

Internal
Medicine

Neurology

Dystonia Akathisia Parkinsonism Tardive dyskinesia

10958

Internal
Medicine

Endocrinology

HTN + tachy + fever + lid-lag -> THYROID STORM???!?!?

11067

Internal
Medicine

GIT

PPIs -> C-diff!!! Shafik watch out!!

2344

Obstetrics &
Gynecology

OBGYN

S. Aureus -> dicloxacillni, cephalexin vs. MRSA-> Bactrim, Clinda, Vanc

2388

Obstetrics &
Gynecology

OBGYN

no boobs = no estrogen. like i've got no estrogen. don't even need to measure my estrogen levels.
say i've never gotten a period. 1. U/S -> if no uterues, get karyotype & testosterone vs. if uterus,
get FSH (if increased-> peri prb get karyotype vs. if decreased-> central problem get MRI)

2398

Obstetrics &
Gynecology

OBGYN

urethral hypermobilitly (weakened pelvic floor muscles)-> over 30* swab test angle -> stress
incontinence-> kegel then urethropexy

2405

Obstetrics &
Gynecology

OBGYN

meredith would totally get an amniotic fluid embolism.

2407

Obstetrics &
Gynecology

OBGYN

placenta rips off a little (placenta abruption) -> pain, increased uterine tone, increased freq

2411

Obstetrics &
Gynecology

OBGYN

ectopic with bHCG 1500-6500 1. transVAGINAL U/S 2. if negative, serial bHCGs

2412

Obstetrics &
Gynecology

OBGYN

turn try to turn baby until 37th week (3 week notice to self-fix)

2419

Obstetrics &
Gynecology

OBGYN

PMS -> SSRIs

2523

Obstetrics &
Gynecology

OBGYN

PAINLESS PREVIEW (bleeding). placenta previa.

2533

Obstetrics &
Gynecology

OBGYN

placenta previa->> painless bleeding vs. vasa previa->> painless bleeding + fetus deteriorates/dies

2536

Obstetrics &
Gynecology

OBGYN

dilated OS -> incomplete or inevitable abortion

2563

Obstetrics &
Gynecology

OBGYN

RBC CASTS -> TRUE NEPHRITIS. not just protein loss from HTN/preeclampsia.

2567

Obstetrics &
Gynecology

OBGYN

increased AFP -> NT or abdominal wall defect or multiple gestation (increased levels of
protein/protein spilling out of structural deformity!!!) vs. decreased AFP-> aneuploidies (your actual
baby is fucked up chromosomally).

2568

Obstetrics &
Gynecology

OBGYN

2nd trimester quad screen/ 4 things: Hcg Inhibin AFP Estriol in down syndrome, high HI, low AE

2925

Obstetrics &
Gynecology

Hepatology

PUPPP spares Palms (& soles & face) vs. intrahepatic cholestasis of pregnancy (dx of exclusion)
(itchy palms & soles, worse at night)

3110

Obstetrics &
Gynecology

OBGYN

decreased fetal movements or high risk pregnancy -> NST (fetal heart rate: at least 2 accels of at
least 15 above baseline lasting at least 15 seconds?) -> if not, NOISE stimulation.

3116

Obstetrics &
Gynecology

OBGYN

arrest of labor: >6 cm dilated with ruptured membranes but no change over 4 hours despite good
effort/contractions vs. no change over 6 hours despite weaker/inadequate contractions

3120

Obstetrics &
Gynecology

OBGYN

menorrhagia ddx: -bulky, boggy, globular, tender uterus -> adenomyosis vs. -pain with sex,
infertility -> endometriosis vs. -postmenopausal or obese or nulliparity -> endometrial
hyperplasia/cancer

3269

Obstetrics &
Gynecology

OBGYN

for preterm labor: >34 weeks -> just floor it and deliver vs. 23-33 weeks -> steroids for lungs, mag
sulfate for neuro, +/- tocolytics vs. <23 weeks -> not viable

3273

Obstetrics &
Gynecology

OBGYN

if fetus' kidneys fucked up-> gotta let it die

3337

Obstetrics &
Gynecology

OBGYN

lochia: bloody, serous/pale, alba/white. foul-smelling-> endometritis, otherwise low-grade fever ok

3370

Obstetrics &
Gynecology

OBGYN

during ovulatory phase, mucus CLEAR + THIN (stretches to 6 cm), more basic, ferns, vs. any
other time, mucus inhospitable (scant, thick, opaque)

3679

Obstetrics &
Gynecology

OBGYN

pH >4.5 is increased for vagina -> BV or trich....(or both)

3745

Obstetrics &
Gynecology

OBGYN

POSTERIOR vagina wall is where the penis goes (hpv 16,18, scc)

3868

Obstetrics &
Gynecology

OBGYN

puberty before 8 years old -> precocious. advanced bone age. Central (high FSH,LH) vs.
peripheral-gonads/adrenal (low FSH, LH)

3869

Obstetrics &
Gynecology

OBGYN

low amnioic fluid level, nuchal cord, cord proloapse -> cord compression -> variable decels -> if
RECURRENT, improve oxygenation, change mom's position, amnioinfusion

4124

Obstetrics &
Gynecology

Endocrinology

pregnant -> INCREASED total, binding, AND free T3,4 -> negative feedback -> DECREASED TSH

4136

Obstetrics &
Gynecology

OBGYN

menopausal or hyperthyroid? -High FSH vs. low TSH.

4148

Obstetrics &
Gynecology

OBGYN

pregnant women- elevated alk phos. increased renal Q and gfr-> decreased serum BUN,
creatinine

4220

Obstetrics &
Gynecology

Endocrinology

if i didn't get my period for 3 cycles..-> b-hCG for preg, prolactin for brain tumor, TSH for
hypothyroidism, FSH for premature ovarian failure

4221

Obstetrics &
Gynecology

OBGYN

prolactin is inhibited by dopamine and stimulated by serotonoin and TRH.

4221

Obstetrics &
Gynecology

OBGYN

Hypothyroid -> increased trh, tsh -> stimulates prolactin -> inhibits gnrh -> amenorrhea with
galactorrhea

4472

Obstetrics &
Gynecology

ID

bacteria in urine in preggers -> not acceptable -> no bactrim, no cipro, nitrofurantoin, augmentin,
or cephalexin OK

4530

Obstetrics &
Gynecology

Preventive
Medicine

All preggers need HIV, syphilis, and hep B screens for baby

4757

Obstetrics &
Gynecology

OBGYN

1st gen cephalosporins: cefazolin = ancef -> (Ancef Only IV) vs. cephalexin = keflex -> Eat keflex
on a kleenex. (oral available)

4758

Obstetrics &
Gynecology

OBGYN

HGSIL on pap smear-> colposcopy to rule out invasive cervical cancer -> if negative, repeat 6 wks
after delivery

4759

Obstetrics &
Gynecology

OBGYN

bHCG should DOUBLE/48 hrs if VIABLE. Slower rate if ectopic or nonviable. transvaginal U/S
1,500-2,000 -> you can see something

4767

Obstetrics &
Gynecology

OBGYN

estrogen-> builds endometrium. withdrawal of progesterone from corpus luteum after ovulation ->
menses. if no ovulation, no progesterone, no real menses, just breakthrough bleeding.

4775

Obstetrics &
Gynecology

OBGYN

<20 weeks -> spontaneous abortion vs >20 weeks -> intrauterine fetal demise -> autopsy to
prevent in future pregnancies

4779

Obstetrics &
Gynecology

OBGYN

new-onset htn (140/90) + proteinuria OR other end-organ damage AFTER 20 WEEKS ->
pre-eclampsia!! risk factors: multiple gestation, nulliparity, DM, being old, CKD, previous SEVERE
if >160/110, decreased plts, creatitine >1.1 or increasing, tarnsaminitis, pulm edema, new neuro sx

4779

Obstetrics &
Gynecology

OBGYN

acute infection -> inhibits plts severe preelampsia -> " vs. chronic inflammation -> increase plts.

4781

Obstetrics &
Gynecology

OBGYN

HELP ME REMEMBER HELLP SYNDROME!! severe preeclampsia: hemolysis, elevated liver

zymes, low plts

4782

Obstetrics &
Gynecology

OBGYN

preeclampsia -> arteries spazz out -> increased afterload -> pulmonary edema -> diuretics,
oxygen, fluid restriction

4791

Obstetrics &
Gynecology

OBGYN

Silent Syphilis (ulcer doesn't hurt) vs. chancroid - purulent ulcers with painful lymphadenopathy vs.
herpes -burning/itching then vesicles

4796

Obstetrics &
Gynecology

OBGYN

VERTEX is NORMAL. head down dumbass.

4802

Obstetrics &
Gynecology

OBGYN

spontaneous abortion (<20wks) with CLOSED CERVIX -> Missed or Threatened. Missed or
Threatened. Missed or Threatened.

8917

Obstetrics &
Gynecology

OBGYN

Yimu may well clear her infection. 50% sexually active women get HPV within 3 years; 50% clear
within 2 years.

8962

Obstetrics &
Gynecology

OBGYN

VEAL CHOP variable decel-cord compression/prolapse early decel-head compression accel- OK

late decel- placental insuff

10441

Obstetrics &
Gynecology

OBGYN

chromosomal screening at 10-12 weeks -> cell-free fetal DNA, then confirm with CVS. vs. at 15-20
weeks -> amniocentesis

2439

Pediatrics

Pediatrics

T wave inversion -> MI, myocarditis, myocardial contusion, digoxin tox

2445

Pediatrics

Endocrinology

Shitty AR Developmental Diseases w/ cherry-red macula: Niemann Pick- (spingomyelinase def)

)areflexia, hepatosplenomegaly vs. Tay-Sachs- (B-hexs def) hyperreflexia

2450

Pediatrics

Pediatrics

lupus dx-> anti-SMITH and dsDNA. Check Ms. Smith's DNA for SLE.

2465

Pediatrics

GIT

bilious vomiting -> NPO, NG decompression, IVF, & XRAY: -if free air or unstable - > SURGERY.
-if dilated loops bowel -> CONTRAST ENEMA to differentiate MECONIUM ILEUS vs.
HIRSCHSPRUNG. -if double bubble -> DUODENAL ATRESIA. -if NG tube misplaced -> UPPER GI
SERIES for malrotation/volvulus.

2468

Pediatrics

Pediatrics

Edward the vampire (Trisomy 18) has a hole in his heart (VSD).

2485

Pediatrics

Pediatrics

babies heal their clavicles in 1 week!!! amazing.

2513

Pediatrics

Genitourinary

don't get depressed with your toddler's potty-training -> try desmopressin!!! (risk hyponatremic
seizures though..)

2758

Pediatrics

Dermatology

Eczema = atopic dermatitis

2867

Pediatrics

Hem&Onc

MOST leukemias in kids are ALL. lymphoblastic (increased immature forms of B and T cells)
which are PAS, TdT+

3192

Pediatrics

Pediatrics

von gierke's: G6P -X> glucose. glycogen accumulates in liver, kidney....hypoglycemic seizures,
doll-face

3196

Pediatrics

Pediatrics

X-linked agammaglobulinemia: most eXtreme (decreased B cells and decreased Ig) vs. Common
variable: B cells fine, all common Ig decreased

3284

Pediatrics

Hem&Onc

painLESS lymph nodes -> lymphoma?!?!?!?!?!?!??! widened mediastinum on cxr may be

lymphadenopathy!! decreased plts-> petechiae. decreased RBC -> pallow. >25% blasts on bone
marrow bx diagnostic.

3284

Pediatrics

Hem&Onc

leukEMIA??? -> blood + BONE MARROW BIOPSY (>25% blasts) -> lymph node bx if bone
marrow negative or if worried about lymphOMA.

3289

Pediatrics

Respiratory

inspiratory stridor + dysphagia + drooling + tripoding + high fever + thumbprint sign on x-ray ->
epliglottis from Hib or other bacteria -> trach them vs. inspiratory stridor + barky cough + steeple
sign of x-ray-> croup -> nebulized epinephrine

3404

Pediatrics

Pediatrics

insidious hip pain in 6 yr old boy -> Legg calve perthes vs. 13 yr old boy-> scfe

3442

Pediatrics

Pediatrics

meningitis + rash -> ADRENAL HEMORRHAGE.

3459

Pediatrics

Respiratory

pO2 >75 (75 to pass the exam)

3543

Pediatrics

Cardiology

turner syndrome girls have grade-A problems (bicuspid Aortic valve, coarct of Aorta, Aortic root
dilatation)

3546

Pediatrics

Cardiology

standing (blood to LE), valsalva (blood to pelvis)-> decreased VR -> everything less except MVP
and HCM (decreased heart mumur -> INNOCENT/PHYSIOLOGICAL MUMUR :) vs. leg
raise/squats (exercise)-> blood to heart -> increased preload -> everything stronger except MVP,
HCM

3550

Pediatrics

Neurology

NF1- 1 cafe au lait pour moi vs. NF2-Bilateral acoustic neuromas

3554

Pediatrics

Pediatrics

scrotal/abdominal pain + palpable purpura + joint pain + kidney prbs after URI =
VASCULITIS?????? SAY IgA-mediated HENOCH-SCHONLEIN PURPURA ?!?!?! -> supportive,
steroids

3577

Pediatrics

ID

septic arthritis -> tap joint, then give IV VANC -> then adjust antibiotics

3640

Pediatrics

ID

sickle cell??-> you basically don't have a spleen -> PCN until at least age 5

3658

Pediatrics

Pediatrics

most common cancer in kid: LEUKEMIA (ALL) vs. most common SOLID cancer in kid: BRAIN
TUMOR (astrocytoma-benign so not gbm, infratentorial)

3669

Pediatrics

Pediatrics

Don't want Duchenne's. GOLD STANDARD is GENETIC STUDIES.

3688

Pediatrics

Genitourinary

babies with AN UTI -? U/S vs. babies wtih RECURRENT UTIs -> voiding cystourethrogram

3713

Pediatrics

Hem&Onc

acute infection-> inhibits/decreases plt production vs. chronic inflammation-> increased plts

3755

Pediatrics

Pediatrics

nontender blue patches in ethnic baby -> mongolian spot (congenital dermal melanocytosis)

3758

Pediatrics

Pediatrics

chlaymida in your baby's eye -> ORAL erythromycin (to get it out of their throat too) vs.
gonorrehea in your baby's eye -> IV or IM CTX

3867

Pediatrics

Endocrinology

secondary sex characteristics are different!! adrenals make androgen-> (hair and body odor, incr
DHEA> test) vs. ovaries make estrogen-> (big boobs)

3875

Pediatrics

Endocrinology

advanced bone age? -> someting is FUCKED up => check LH -> if High, central prb, if low
(inhibited), peri prb.

3875

Pediatrics

Endocrinology

if bone age is advanced -> there is a peri or central PROBLEM. not idiopathic. look at LH-> if high
central prb, if low (even with GnRH stimulaion) peri prb.

3924

Pediatrics

Pediatrics

headaches + weak legs -> COARCT, collaterals, rib notching

3924

Pediatrics

Pediatrics

Murmur everywhere over chest -> collaterals -> coarctation

3926

Pediatrics

Pediatrics

-fat in stool -> pancreatic enzyme deficiency -> CYSTIC FIBROSIS??? -not growing +recurrent
URIs -> CYSTIC FIBROSIS????

3991

Pediatrics

Cardiology

Left axis deviation in newborn -> tricuspid valve atresia (wimpy right heart)

4038

Pediatrics

Pediatrics

high fever and acute onset bone pain -> osteomyelitis! vs. gradual pain with no fever -> avascular
necrosis!!

4064

Pediatrics

Pediatrics

anterior slip/ step off-> spondylolis(SLIP)thesis

4183

Pediatrics

GIT

thickened (ion channel dysfx) meconium obstructing ileum -> meconium ileus -> CF? vs. normal
meconium obstructing colon -> hirschsprung disease -> DOWN SYNDROME?

4260

Pediatrics

Cardiology

most common cyanotic heart prb in newborns-> TRANSPOSITION (single S2) -> PGE

4271

Pediatrics

Neurology

VC + RV = TLC (capacity = sum) (VC= TV + IRV +ERV)

4290

Pediatrics

GIT

gastroschisis- naked bowel. usually isolated defect plastic wrap that shit and surgery immediately.

4302

Pediatrics

Pediatrics

angular cheilitis, normocytic anemia, seborrheic dermatitis -> riboflavin B2 def

4317

Pediatrics

ID

Cats dogs humans bite -> daugmentin

4823

Pediatrics

Pediatrics

obj permanence at 6 months. ...which leads to -> sep anxiety around 1 year

4845

Pediatrics

ID

ptosis-> heavy lids (horner's syndrome, mg) vs. prOPTosis/EX-ophtalmos -> eye bulging OUT
(graves, cellulitis)

4847

Pediatrics

Hem&Onc

decreased plts + recurrent infections + eczema => WAS

8772

Pediatrics

Hem&Onc

Onion-skin Ewing Vs. Sunburst osteoSarc

2482

Psychiatry

Psychiatry

Conduct disorder for Kids. vs. Antisocial for Adults.

2508

Psychiatry

Psychiatry

brief psychotic disorder (1 day-1 month) schizophreniform (1-6 months) schizophrenia (>6 months)

2510

Psychiatry

Psychiatry

MANIC episodes w/ or w/out depressive episode -> bipolar 1 vs. hypomanic episodes (not
hospitalized, not impairing fx, no psychosis) + depressive episode -> bipolar 2 vs. hypomanic +
depressive symptoms for at least 2 years -> cyclothymic disorder

2518

Psychiatry

Psychiatry

EPS -> usually from typical antipsychotics + risperidone. can change to clozapine but last resort
due to agranulocytosis risk

2521

Psychiatry

Psychiatry

illness anxiety disorder/hypochondriac = fear of getting disease but NO SX vs. somatic symptom
disorder = anxiety w/ physical SX > 6 months

3147

Psychiatry

Psychiatry

schizoid andrea. avoidant swetha.

3147

Psychiatry

Psychiatry

avoidant swetha. schizoid andrea. AS. SA.

3185

Psychiatry

Psychiatry

rich and single and genetics-> increased risk bipolar.

3375

Psychiatry

Psychiatry

tourettes act psychotic -> trx antipsychotics

3470

Psychiatry

Psychiatry

Cataplexy -> modafinil stimulant

3792

Psychiatry

Psychiatry

TELL ME MORE ABOUt thAT.

4815

Psychiatry

Psychiatry

Chelsea has ocpd. Personality disorder. Ego-syntonic.

2340

Surgery

Surgery

RBC scan less invasive than angiography. if colonoscopy neg for LGIB-> do RBC scan next.

2476

Surgery

GIT

hernia-covered with skin vs. omphalocele- covered with peritoneum vs. gastroschisis-butt naked

3182

Surgery

Surgery

acute diverticulitis ->First ask, complicated vs. uncomplicated?? If complicated

(abscess/perf/obstruction/fistula) -> then ask, <3cm (IV antibx) or >3cm (CT drain it)

3221

Surgery

Surgery

Blunt vs. penetrating trauma. If penetrating -> almost always exploratory lap

3223

Surgery

Surgery

CO. Colorless. Odorless. Cherry O lips. elevated carboxyhemoglobin level. pulse ox lies. give
100% O2.

3325

Surgery

Surgery

clean wound but uncertain vaccine status-> just give vaccine. dirty/severe wound -> give vaccine
unless recent booster (5 years)

3435

Surgery

Surgery

crohn's disease: lose calcium bound to fat and can't absorb bile salts -> increased oxalate levels
-> stones!

3572

Surgery

Surgery

lateral injury ("abduction injury")-> tear MCL -> dx valgus stress test vs. LCL doesn't really happen
(medial force to knee??) vs. hyperextension/torsional injury-> ACL vs. dashboard injury-> PCL.
*popping doesn't tell you anything. everything pops.

4293

Surgery

Surgery

femoral nerve

4364

Surgery

GIT

SBO- usually caused ADHESIONS (congenital vs. iatrogenic vs. inflammation)

4501

Surgery

Surgery

back/flank pain after cardiac cath -> retroperitoneal hematoma!! -> dx non-con abd CT; trx
supportive, prx don't lift heavy things after cath, and radial arter approach better

4527

Surgery

Cardiology

large left sided hemothorax after blunt trauma -> AORTIC INJURY (contained or else you'd be
dead already)

4527

Surgery

Cardiology

left-sided hemothorax -> AORTIC INJURY. vs. pneumothorax that does not resolve with chest
tube placement -> BRONCHIAL RUPTURE. vs. esophageal rupture-> don't really get with trauma.

4538

Surgery

Respiratory

TAKE CARE OF PNEUMOTHORAX BEFORE INTUBATION. distended neck vv-> PT or cardiac

tamponade. -> needle decompression and then chest tube placement (also treats hemothorax); if
still unstable, FAST for pericardial tamponade

4541

Surgery

Cardiology

Increased pcwp -> Left heart failure

4552

Surgery

Neurology

Epidural hematoma -> uncal herniation -> ipsilateral oculomotor and contralateral cerebral
peduncle

4554

Surgery

Surgery

Meniscal tears minimal sx: gradual swelling b/c indirecty perfused, Mcmurray's sign (snap with
terminal extension) vs. lightning ligamentous tears: rapid swelling from blood in joint

4698

Surgery

Neurology

syrinomyelia kind of like central cord syndrome (UE motor and sensory deficits)