1

1. Valgus= joint towards midline

2. Pancreatitis has epigastric tenderness
3. Patients with atopy (eczema, asthma) at higher risk for anaphylaxis
4. Serotonin Syndrome has myoclonus and hyperreflexia whereas NMS has rigidity. Serotonin Sx also has GI
Sx
5. Cystic Fibrosis kids have nose bleeds and ecchymosis coz of vitamin K def due to malabsorption
6. venous thrombosis has swelling and warm skin whereas arterial is cold and no swelling. Both have pain
7. scleroderma renal crisis (SRC). occurs in 10% to 15% of patients, if untreated, it carries a mortality rate
approaching 90%. In SRC, involvement of afferent arterioles leads to glomerular ischemia and
hyperreninemia. The typical presentation is acute kidney injury and severe hypertension, mild proteinuria,
urinalysis with few cells or casts, microangiopathic hemolytic anemia, and thrombocytopenia. Some
patients develop pulmonary edema and hypertensive encephalopathy.
8. Cryoglobulins are proteins that contain immunoglobulins that precipitate in vitro at temperatures below
37.0 C (98.6 F). There are three types: type I (only monoclonal Ig, typically IgM), associated with
Waldenstrm macroglobulinemia or myeloma; type II (usually polyclonal IgG associated with monoclonal
IgM), associated with hepatitis C virus infection; and type III (polyclonal IgG and IgM), associated with
connective tissue disease and infections, including hepatitis C. Kidney involvement typically occurs more
often with type II cryoglobulins, which form immune complexes leading to a systemic vasculitic syndrome,
associated with glomerulonephritis typically with membranoproliferative features.
9. Patients with cryoglobulinemia may manifest a spectrum of kidney abnormalities, including mild proteinuria
and hematuria, the nephrotic syndrome, and rapidly progressive glomerulonephritis with rapid deterioration
of kidney function. C4 (and sometimes C3) complement levels are typically low, and rheumatoid factor is
positive.
10. If painless hard mass and Ultrasound shows likely testicular tumor-> do orchiectomy. don't do FNAC or
biopsy to confirm. confirm after taking out mass
11. There can be hypotension after a seizure
12. Cholestasis- ALP raised to at-least 4 times the normal
13. BUN/Cr > 20:1 = prerenal acute kidney injury
14. subcute/deQuervain thyroiditis- preceded by URTI. Tx of severe cases is glucocorticoids
15. If no definite pulse is detected within 10 seconds, chest compressions should begin without delay. In
patients with VT/VF, time to defibrillation is an important determinant of the likelihood of survival to hospital
discharge. Therefore, when a shockable rhythm is present, defibrillation should be performed as rapidly as
possible.In patients with asystole or pulseless electrical activity (PEA), CPR is continued with reassessment
of rhythm status for a shockable rhythm every 2 minutes. Epinephrine (1 mg intravenously) should be given
every 3 to 5 minutes, although vasopressin (40 units intravenously) can replace the first or second dose of
epinephrine. In patients with VT/VF, a shock is advised with immediate resumption of CPR and
reassessment of the rhythm in 2 minutes. Epinephrine should be given after the second shock and every 3
to 5 minutes thereafter. If VT/VF continues despite three shocks and epinephrine, amiodarone should be
given as a bolus.Patients with symptomatic bradycardia and hemodynamic distress should first be treated
with atropine. If atropine is ineffective, dopamine or epinephrine infusions can be attempted
16. atropine is initial treatment for bradycardia and hypotension. IV Glucagon in refractory hypotension coz of
Beta Blocker/CCB toxicity.
17. Dopamine/epinephrine/trancutaneous pacing if no response of bradycardia to atropine.
18. norepinephrine is used in hypotension and shock
19. Enthesitis- achilles, shoulder, elbow, hip, tibial tuberosity : in spondyloarthropathies like AS, psoriatic
arthritis and reactive arthritis
20. solid organ transplant patients- susceptible to PCP and CMV. CMV causes multi organ system problems
whereas PCP just pulmonary
21. osteogenesis imperfecta- opalescent teeth (dentinogenesis imperfecta), hearing loss
22. DM 1 seen in 4-6 yrs age(sec. enuresis) and then in early puberty
23. Acute hemorrhage- immediately place 2 IV large bore lines
24. CT after FAST in BAT if hypotension, abdominal guarding, LUQ pain, left abd bruising, pleuritic chest pain
25. Pulmonary veins are origin of atrial fib arrhythmia
26. SIADH- euvolumic hyponatremia- Tx is water restriction
27. Acute interstitial nephritis due to drugs can occur 5 days-several weeks later
28. Iron poisoning- GI mucosa corrosion
29. Bronchiolitis by RSV- winter infection. LRTI in children <2months. Develop apnea and recurrent wheezing.
Palavizumab is prophylactic.
30. Cephalohematoma- limited to one bone.
31. Acute Angle closure glucoma- woman >40, asian, inuit, severe eye pain with halos, conjuctival injection,
headache, nausea/vomiting as ICP^. dilated pupil. anti-cholinergic/sympathomimetic/eye dilation causes.
vision loss in 2-5 hrs
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32. communication failure btw physicians during signouts largest contributor to medical errors and poor
patient outcomes- prevented by signout checklist NOT detailed signouts
33. Non bilious emesis in neonate- do xray immediately. Contrast enema is treatment for meconium ileus in
infant
34. Calcium carbonate supplements in osteoporosis cause milk alkali syndrome- hypercalcemia
35. place urinary cathetar in spinal trauma patients to assess/prevent urinary retention
36. ^neutrophils in bacterial meningitis and ^lymphocytes in viral/funal meningitis
37. schizoid- loner, schizotypal- loner+magical thinking
38. orthostatic hypotension in elderly- coz of dec baroreceptor sensitivity and dec myocardial response
39. in carcinoid syndrome, liver lab may be raised coz of liver mets
40. calcium gluconate given for hyperkalemia causing ECG changes, >7 or rapidly rising
41. word finding difficulty is part of normal aging
42. pellagra dermatitis can show up as sunburn-symmetric , painful
43. give oral doxycycline for lyme disease. IV ceftriaxone only for cranial nerve palsies(except facial), heart
block and months to yrs later. Amoxicillin for pregnant women and children <8yrs
44. adhesive capsulitis(frozen shoulder)- Dec passive+active ROM of shoulder-abduction, flexion, rotation
45. Conn's Sx causes metabolic alkalosis as H+ thrown out and HCO3- taken in
46. psychiatric condition doesn't render a person incompetent to give informed consent for their medical
procedures
47. infectious mono can have enlarged tonsils with grey/white exudates. LYMPHADENOPATHY- cervical &
generalized. Jaundice
48. Streptococcal pharyngitis: TENDER anterior cervical adenopathy + tonsillar exudates + fever + pharyngitis
49. Splenic abscess(fever, leukocytosis, LUQ pain)- Infective endocarditis causes it
50. Pulse oximetry doesn't differentiate carboxyhemoglobin from oxyhemoglobin. ABG does
51. vaginal bleeding + discharge in neonate- withdrawal of estrogen
52. Progesterone given to those at risk of preterm delivery at <24wks.
53. short cervix <2cm in those without hist of preterm birth and 2.5cm in those with
54. Adam stokes attack-Differentiate this attack from epileptic seizures. Clues are the lack of respiratory
difficulty, no prodrome, no postictal sleep, EKG abnormalities, the pallor, and the flushing (patient feels hot
and looks red) after the attack. Type 2 and 3 heart block
55. pyloric stenosis- 1wk-5months. boys
56. shigellosis- may cause febrile seizures in very young.
57. bloody diarrhea- shigella, salmonella, EHEC, campylobacter
58. in sickle cell disease with fever and leukocytosis- give iv ceftriaxone
59. check beta hcg in reproductive age child even if no menses coz could be imperforate hymen
60. silver stain of bronchoalveolar fluid is for PCP
61. myotonic dystrophy- distal muscles. very slow relaxation after contraction
62. gestational DM causes hypocalcemia and can cause prolonged QT in child
63. tuberous sclerosis- seizures, hypopigmented
64. rotavirus transmission is faeco-oral
65. cerebral edema is a complication of DKA treatment in kids if fluid replaced fast- headache, mental status
change
66. VSD->less blood to organs->inc erythropoeitin and PAH
67. congenital hip dysplasia- click when abducted, flexed, lifted fwd
68. phototherapy is the tx for hyperbilirubinemia in new borns
69. neurogenic claudication/spinal stenosis/osteoarthritis of spine
70. vertebral metastasis- back pain worse at night
71. brain tumor has nausea, vomiting, headache, focal neurological deficits
72. papilldema is a sign of inc ICP
73. Presbycusis- bilateral sensorineural hearing loss coz of aging
74. Otosclerosis- chronic conductive bony hearing loss
75. Bedwetting is normal till 5 yrs age. No intervention reqd before then
76. venous stasis in lower legs causes venous hypertension locally
77. wegener's- lung nodules, tracheal narrowing with ulceration, weight loss
78. glucocorticoids can induce psychosis
79. matching of variables(controls have same baseline characteristics as cases) done in case control studies to
prevent confounding
80. PCP shows up as acute respiratory failure and inc LDH in patients who do not have HIV
81. Urticaria lesions arise over few hrs and then disappear within 24 hrs
82. prolactinomas have prolactin levels >200. also hypothyroidism can inc prolactin mildly
83. Zenker's diverticulum- aspiration is common. Contrast esophagram is the diagnostic test
84. Felty syndrome- rheumatoid arthritis, skin lesions(ulcers),
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85. isoniazid causes pyridoxine def- peripheral neuropathy
86. acute mediastinitis can present as mediastinal widening
87. esophageal atresia + tracheoesophageal fistula- aspiration pneumonia, polyhydramnios
88. diabetic ophthalmoplegia- CN3 inner fibers ischemia- diplopia, ptosis, down and out eye. Outer
parasympathetic fibers unaffected so no issue with pupillary dilation
89. torsades de pointes- defibrillation for unstable patients and IV Mg for stable ones
90. reactivation TB- cough with production in morning coz of pooling of secretions
91. Cryptococcal infection at CD4 <100
92. PCP- chest xray normal or diffuse infiltrates
93. salvage therapy- done after standard therapy fails. Neoadjuvant- therapy done before std therapy.
Induction therapy-inital dose to rapidly kill tumor cells. Consolidation therapy- therapy after induction
therapy. Maintenance therapy- given after induction, consolidation to keep in remission
94. patients with ongoing upper GI bleeding and depressed level of consciousness need to be intubated to
stabilize airway while endoscopy being prepared.
95. Plasma aldosterone concentration/plasma renin activity (PAC/PRA)>20 means primary aldosteronism. in
Pr. aldosternism hypokalemia can be precipitated when thiazides are started.
96. Trisomy 18- VSD. micrognathia, prominence at back of head, overlapping fingers, convexity on feet
97. systolic BP less than 90 and looks like shock, give IV saline to inc BP. Stop if volume overload and give
vasopressor(dopamine)
98. organ hypoperfusion can cause lactic acidosis
99. chronic pancreatitis can present as postprandial epigastric pain
100. CMV infection which mimics Infectious mono can raise liver enzymes. negative monospot
101. peritonitis signs- guarding, rigidity, rebound tenderness, reduced bowel sounds
102. viscus perfortion- fever, tachycardia, peritonitis. do upright XRay chest and abd
103. sickle cell disease kids need strep pnueumo vaccination and twice weekly penicillin prophylaxis till 5 yrs
104. acute uncomplicated back pain (<4-6 weeks)- give NSAIDS, recommend moderate activity. >6-12wks:
exercise therapy
105. transudate is coz of capillary pressures(dec oncotic/inc hydrostatic/dec intrapleural)pathology and exudate
is coz of local pleural/lung pathology (inc capillary permeability/inc pleural permeability/lymphatic outflow
obstruction)
106. serum LDH is 90. pleural fluid glucose<60 in local pleural/lung pathology (exudate) coz of high
leukocyte/bacterial activity
107. Hypergonadotropic hypogonadism and ovarian failure seen in women <40 treated with chemo and
radiation
108. Functional hypothalamic hypogonadism(hypogonadotropic hypogonadism):amenorrhea-> intense exercise,
calorific def
109. SAAG > 1.1 = portal hypertension . SAAG <1.1- no portal hypertension
110. bupropion- Tx of major depression. Increases energy, no sexual side effect, helps wt loss. Tx for quitting
smoking. Contraindicated in anorexia/bullemia/seizures->coz trigger seizure
111. CF patients may have nasal polyps, bruising (no K)
112. Strawberry hemangioma kids coz they need straw and Cherry in adults coz they pop the cherry. beta
blockers for strawberry hemangioma complications
113. Fetal Hydantoin Sx- Hirsuitism, cleft lip/palate, digit hypoplasia, microcephaly. Give prophylactic vit K in
last trimester as phenytoin degrades vit K
114. nocturnal headache and morning vomiting means inc ICP as supine position at night is responsible
115. Do CT for brain abscess even if it is a kid
116. New Atrial Fibrillation, should be screened for hyperthyroidism
117. diabetic nephropathy occurs after 10-15 yrs and never less than 5 yrs
118. in medically ill patients suffering concurrent depression there should be low threshold to start anti-
depressants
119. lactation provides amenorrhea for first 6 months postpartum in 50% women
120. expiratory phase prolonged in COPD, so exertional dyspnea as inc in airway resistance
121. Compliance and elasticity are opposites. Compliance inc in COPD and elasticity dec
122. in COPD flattened diaphragm has more difficulty contracting to inc thoracic cavity so more work done
123. Low threshold for spontaneous bacterial peritonitis in cirrhosis- fever, altered mental status, abd
tenderness. Ascitic fluid has >250 neutrophils
124. Laryngomalacia-inspiratory stridor with feeding and SUPINE. NO INFECTIOUS symptoms. peaks at 4-8
months age. self resolves. Dx-Laryngoscopy
125. OSA patients might have hypertension, depression, impotence, morning headache. >5 obstructive sleep
events(Sao2 dec 4% or resp cessation >10sec) is diagnostic
126. naso-pharyngeal carcinoma- assoc with EBV. causes epistaxis, headaches, otitis media
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127. for acute pain give opiods even in current or recovering opiod addicts. management doesnt change, but
follow up care needed
128. gabapentin given for post-herpetic neuralgia
129. Leriche Syndrome- arterial occlusion at bifurcation of aorta- buttocks, thigh , hip claudication + impotence
+ pulses soft/absent distally.
130. Osteonecrosis of femoral head- Dx-MRI early on as Xray normal. Later- Xray. Pain in groin, thigh, buttock
worsened with activity
131. adjustment disorder- last 3 months; conduct disorder before 18yo , antisocial after as start socializing as
adult
132. Mild hypothermia: 90-95F, Moderate: 82-90F, Severe: <82F
133. GI malignancy- Do CT abd with contrast
134. elevated alk phos and mildly elevated transaminases- infiltrative or cholestatic disease
135. hepatic hydrothorax occurs on the right
136. firm hepatomegaly- liver mets
137. villous, >1cm, >3 number, adenomatous polyps are considered greater risk for malignancy
138. Acalculous cholecystitis- in critical ICU patients. Pericholecystic fluid, gallbladder thickening/distention.
May have post-operative ileus. Tx-antibiotics, percutaneous cholecystostomy and finally cholecystectomy
when stable.
139. Non reactive NST-> do Biophysical profile(BPP) or contraction stress test(CST). CST contraindicated if
dont want labor
140. 0/10-4/10 BPP: fetal hypoxia coz of placental dysfunction. 8/10-10/10 BPP: normal
141. all sexually active women =/< 24 yo should undergo ANNUAL chlamydia/gonorrhea coz of high prevalence
in this age & asymptomatic
142. 21-65 pap smear test every 3 yrs. no before even in sexually active/multiple partners. co-testing with hpv
testing only after 30 nd every 5 yrs. HPV testing and pap smear are diff
143. acute pancreatitis pain relieved by leaning fwd. ^Amylase, lipase >3 times normal. Dx- RUQ U/S, not CT. if
non diagnostic , then ERCP
144. gallstone pancreatitis. ALP^, Alanine aminotransferase >150,^ BMI,
145. hyperthyroidism inc BP coz positive ionotrope, chronotrope. Hypothyrodism inc BP by inc systemic
vascular resistance
146. thyrotoxicosis inc receptor sensitivity to catecholamines
147. Lewy Body dementia- bizarre visual hallucinations(early), altered consciousness + cognition, falls, poor
sleep, Parkinsonian features. Alpha synuclein intracytoplasmic proteins.
148. Lewy body dementia Tx- cholinesterase inhibitors. If refractory- 2nd gen anti-psychotics. severe sensitivity
to dopamine antagonists(1st gen antipsychotics+risperidone)- avoid
149. Varicella vaccine- age 1 and 4 yrs
150. toxic megacolon - bloody diarrhea, fever, hypotension, abdominal tenderness and distention/peritonitis,
leukocytosis, tachycardia. Dx- Abd XRay (>6cm dilation). Tx- Bowel rest, antibiotics, corticosteroids
151. IVDU and incarceration- big risk for TB. Also dont fuck up milliary TB XRay- looks kinda like walking
pneumonia
152. digoxin toxicity- nausea, diarrhea, dec appetite, palpitations, inc fatigue
153. in children below 3, visual behaviour and in children above 3 yrs, visual acuity tested at every physician
visit as untreated eye problems can lead to blindness in kids
154. lead toxicity- pre 1978 housing
155. meningococcal vaccine at 11-12 yrs , booster at 16. Immunocompromised-hiv, asplenia, complement def-
2yrs age
156. neurogenic claudication- flexing causes widening of spinal canal and extension causes narrowing. Dx- MRI
157. Patellofemoral pain Sx- athletes, women, overuse, trauma, pain anterior knee, worse with activity. pain
reproduced by pressing patella. Tx- NSAID, quadriceps stretching, strengthening exercises, reduce activity
intensity
158. PE can present with hemoptysis
159. hoarding disorder- Tx:CBT
160. cannabis is marijuana; opiod is heroin
161. brief psychotoc disorder: >1 day nd <1 month
162. Ankylosing spondylitis - inc ESR
163. priapism- prazosin, trazodone(antidepressant+sleep)
164. neonatal polycythemia- respiratory distress, cyanosis due to hyperviscosity and high RBC mass. Tx-
hydration, partial exchange
165. Legg Calve Perthes: 4-10yo boy, unilateral sub-acute hip pain, antalgic gait, thigh muscle atrophy, collapse
of femoral head
166. Myasthenia gravis- Do CT/MRI to evaluate for thymoma
167. slit lamp exam- for anterior eye- conjunctiva, anterior chamber, cornea, iris
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168. trisomy 18-edwards: CARDIAC DEFECT- VSD; IUGR, closed fists overlapping fingers ->older moms, die
within 1st month
169. Migraine in children- bifrontal. Tx- acetominophen, NSAID, supportive. Triptans only if 1st line fails
170. pseudotumor cerebri- in obese. Dx- lumbar puncture
171. Erysipelas- well demarcated, unilateral, raised , dermis infection with Strep pyo A + fever, red, warm,
tender, rapid, lymphadenopathy
172. Peri-infarction pericarditis: <4 days after MI, diffuse ST segment elevation, inc risk in patients with delayed
repurfusion after MI (>3 hrs). Tx - supportive. No NSAIDS/steroids coz of complications
173. Post MI- ventricular aneurysm(wks-mnths), left ventricular free wall rupture (<2wks), interventricular septum
or papillary muscle rupture(3-5days)
174. Ehrlichiosis labs- thrombocytopenia, leukopenia, elevated liver enzymes and LDH. Tx- Doxy. 2nd line-
chloramphenicol
175. Ceftriaxone in Lyme's- given for cardiac and neurologic manifestations
176. malignant hyperthermia- inhaled anesthetic. high fever, (>40C/104F) tachycardia, acidosis, muscle rigidity,
rhabdomyolysis. cardiac arrest risk
177. Normal anion gap: 6-12. Inc anion gap is coz of acidosis by non chloride acids.
178. hepato/abdominojugular reflex- differentiates periperal edea, hepatomegaly, splenomegaly is coz of
hepatic or right heart cause. Pulmonary edema in left heart, volume overload and ARDS, not right heart or
hepatic
179. psychomotor retardation (P of SIGEMCAPS)- slowed speech, thinking and movements
180. Pseudodemenita- Elderly with severe depression have memory loss that is reversible. In contrast to true
dementia, pseudodementia patients are aware of memory loss
181. Iron stores must be evaluated prior to erythropoietin therapy as iron def can occur once tx started
182. hereditary spherocytosis- MCHC increased. Iron def anemia- RDW inc, TIBC inc, ferritin dec,
transferrin(iron/TIBC) dec
183. anemia of chronic dx- ferritin inc coz inflammation. TIBC dec
184. Iron def in infants- starting goat, cow, soy milk before 1 yr age with iron rich foods
185. glomerular disease causes albuminuria
186. multiple myeloma-proliferation of neoplastic cells in bone marrow: bone destruction, anemia. kidney injury
from protein deposition-granular casts
187. acute vertebral compression fracture- point tenderness, acute back pain, worse with lying, standing,
walking.
188. absent ankle reflexes- normal after 70 yrs age coz of aging
189. lumbosacral strain- with specific event. No radiation + no neuro symptom. paraspinal pain tenderness in
paraspinal region NOT point tenderness over vertebrae. improves with rest, worse with activity. Tx-
NSAIDS + early mobilization
190. postpartum blues resolves by 2 weeks
191. postpartum depression-within a month after birth. Tx: ANTIDEPRESSANTS (SSRI-sertraline),
psychotherapy
192. iron poisoning- GI mucosa corrosion Sx, hypotension, hematemesis, acidosis. Tx-whole bowel irrigation,
deforaxamine
193. sinusitis and cyanotic heart Dx - cause brain abscess by spread of bacteria
194. congenital hypothyroidism cause: dysgenesis of thyroid
195. Schizophrenia Tx- Trial of 2nd Gen Antipsychotic. If 2 fail then clozapine given
196. Classic appendicitis: Do surgery based on clinic Dx. No need for CT or U/S
197. Non bleeding moderate/large varices- Prophylactic Tx: Non selective beta blocker(propranolol,nadolol).
2nd line-endoscopic ligation
198. pertusis- follows mild cough, rhinorrhea/rhinits. post cough emesis. lymphocyte rich lymphocytosis
199. Pregnancy luteoma: hirsuitism + acne (hyperandrogenism in pregnancy). bilateral ovarian masses. more in
african/american. female fetus virilization. Tx- none
200. Catatonia- In severe psychiatric/medical illness. immobility+mutism+posturing. Tx- benzos, ECT
201. cyproheptadine- serotonin sx treatment
202. preterm labour: cervical dilation + regular, painful contractions <37 weeks
203. breech- CS as vaginal contraindicated coz of asphyxia/injury risk
204. costochondritis happens during exercising. Tx- reassurance, topical/systemic analgesics
205. Pseudogout: CPPD crystals released from chondrocalcinosis-calcification of articular cartilage/meniscus
into joint space
206. Pseudogout- leukocytosis and fever seen. seen in setting of surgery/medical illness
207. Dactylitis in SCD: 6mnths-4yrs age. swelling of fingers. fever. occlusion of vessels supplying
metacarpals/tarsals. Tx-hydration+pain control
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208. Vascular rings- Infants. Trachea compression(biphasic stridor, wheezing, coughing) + esophagus
compression(dysphagia, vomiting, feeding difficulty). Neck EXTENSION improves stridor
209. laryngomalacia- improves with prone positioning
210. Croup- viral, fever, rhinorrhea, barky cough, inspiratory stridor
211. Jervell Lange Nielsen Sx: deafness, syncope. - QT prolongation. may give Hx of SCD in family. Tx- beta
blockers, pacemaker
212. Alpha blocker (terazosin): first dose orthostatic hypotension
213. Benzos in elderly- Cause paradoxical agitation 1 hr after meds- agitation,
confusion,aggression,disinhibition
214. physiologic galactorrhea: bilateral, yellow/milky/clear/brown/green/gray discharge. Test pregnancy, TSH,
prolactin
215. Necrotizing enterocolitis: in premature infants(esp <32 weeks). GI symptoms(vomiting,abd distension,
gastric residual), leukocytosis(inflammation), metabolic acidosis(intestinal ischemia), hypothermia. XRAY-
Pneumatosis intestinalis(air in bowel wall), Portal venous air
216. Acute cholecystitis: fever, leukocytosis, mild elevation in transaminases, vomiting RUQ/epigstric pain
referred to scapula.
217. Inc Alkaline phosphatase: cholangitis or choledocholithiasis
218. Type 1 HIT: mild thrombocytopenia (>100,000), no Tx needed. Type 2 HIT: moderate
thrombocytopenia(rarely below 20k). Tx- alternate anticoagulant: argatroban, fondaparinux
219. heparin inactivates Xa so increases PTT
220. septic arthritis- elderly and those with joint anomalies more prone- RA, OA, prosthetic joints. Tx-
antibiotics+joint drainage
221. myasthenia gravis- may have symmetric proximal weakness of neck and arms
222. Drug induced acne- Corticosteroids. Monomorphic(all look same) inflammatory rash. upper back,
shoulders, upper arms
223. Diffuse cutaneous systemic sclerosis- more internal organ involvement(Interstitial lung disease). Worse
prognosis. Limited cutaneous systemic sclerosis- more vascular involvement, better prognosis
224. chemical pneumonitis is from aspiration of gastric contents
225. bronchiolitis obliterans- proliferative narrowing of medium/small bronchioles. viral, inhalational or RA assoc
226. bilateral wrist pain and clubbing of acute onset suggests Hypertrophic Osteoarthropathy. If chronic smoker
then could be hypertrophic pulmonary osteoarthropathy
227. all pregnant women should be screened for asymptomatic bacteriuria for pyelonephritis & low birth wt
228. basic drug test detects- amphetamine, cocaine, phencyclidine, opioids, marijuana
229. Reactivated TB causes apical cavitary lesion
230. flial chest: greater than or equal to 3 consecutive rib fractures in 2 places
231. pulmonary contusion: trauma < 24 hrs. hypoxemia. CT- patchy, irregular alveolar infiltrate. dec breath
sounds
232. ARDS- bilateral. CXR-patchy infiltrates. 24-48 hrs after trauma.
233. trachoma- tarsal inflammation, pale follicles, conjunctival injection, concomitant nasopharyngeal infection.
Chalmydia Trachomatis A,B,C
234. trachoma- leading cause of blindness worldwide. Spreads in crowded places. Tx- Azithromycin to
everyone
235. Gonococcal (2-5days) & Chlamydial(5-14days) conjunctivitis are diff from trachoma and present in new
born- ophthalmia neonatorum: red conjunctiva, discharge, swollen eyelids
236. orbital cellulitis differs from preseptal cellulitis: restricted eye movt, dec visual acuity, diplopia, proptosis
237. hepatic laceration coz of BAT presents as hypotension, free intraperitoneal fluid, rebound ab tenderness
and distention
238. analgesic mcc of papillary necrosis
239. atrophic vaginitis/vulvovaginal atrophy/menopausal genitourinary Sx: estrogen deficiency. Can cause
Urinary incontinence and recurrent UTIs. urinalysis to distinguish between the two. Tx- vaginal estrogen
240. urethral hypermobility causes stress incontinence
241. TMP-SMX: can cause hyperkalemia(blocking collecting duct Na channel) & creatinine inc(without affecting
GFR) in HIV
242. COPD: prolonged expiratory phase, polycythemia, plethoric face, cough with sputum
243. SAH: most commonly-berry(saccular) aneurysm. meningeal irritation(nausea/vomiting,photophobia)
244. SAH: negative CT. Do LP- high pressure, xanthochromia
245. hypertensive encephalopathy: cerebral edema-nonlocalizing neuro symptoms(confusion,restlessness). high
pressure-headache, vomiting
246. Cerebral amyloid angiopathy- lobar. >75 yrs age
247. Acute exacerbation of COPD(AECOPD): short acting bronchodilators , glucocorticoids, antibiotics. If fails
then NPPV. if fails then intubate and mechanically ventilate.
248. AECOPD - inc supplemental O2 will not address impaired ventilation.
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249. tinea versicolor- hypo/hyperpigmented salmon colored macules. Malassezia species. hot/humid places
250. Central cord syndrome: hyperextension in elderly with spondylosis. weakness in arms
251. Confusion + leukocytosis in hospitalized patient (with/without diarrhea+ abdominal tenderness): C. defficile.
Tx- Oral metronidazole. Severe- vanco. recurrent- Fidaxomicin. Dx- stool studies PCR. if negative-
colonoscopy-pseudomembranous colitis
252. SCC: assoc with UV. also burn wounds: Marjolin ulcer. also scar tissue
253. mycosis fungoides: cutaneous T cell lymphoma
254. Meniscal tear: catching/popping/locking of knee, crepitus, "occasional" limited ROM. Tx- mild: NSAID,
rest. Significant:>3-4wks: MRI then surgery
255. GOO: succussion splash positive. caustic acid can cause pyloric stenosis. Sx: wt loss, vomiting, early
satiety
256. pseudocyesis: somatization disorder. early pregnancy symptoms. not pregnant. negative preg test + thin
uterine stripe. Tx-psyche eval and tx
257. Friedrich Ataxia- presents in childhood not congenitally. dies by 20. Spinocerebellar Sx-scoliosis, ataxia,
dysarthria, falling, hammer toes. Death- cardiomyopathy
258. social anxiety- fear of embarrassment, negative evaluation in social situations. not phobia as not specific to
a stimulus whereas panic disorder , ppl afraid of the attacks themselves
259. Ankylosing Spondylitis: nocturnal pain. Inc risk of vertebral fracture coz of osteoporosis/osteopenia: inc
osteoclast activity- chronic inflammation
260. Initial hematuria(at beginning of voiding): urethral injury or urethritis
261. Total hematuria(blood throughout voiding): pathology in kidney or ureters
262. Terminal hematuria(blood at end of voiding): pathology in bladder neck, bladder, trigone, prostate
263. ADPKD: abdominal/flank pain. Mass in abdomen
264. PID. inpatient Tx for adolescents and those with severe presentation-vomiting, high fever, leukocytosis
265. PID: Polymicrobial, so Tx Inpatient- IV cefoxitin/cefotetan + oral doxy. Outpatient- IM ceftriaxone + oral
doxy
266. HEP C hepatitis: Having HCV antibody doesn't mean immune. It is present even in current chronic Dx
patients , so test for HCV RNA - if present has Hep C disease
267. In psychotic patient having command hallucinations(voices telling him to do things)- admit to hospital
involuntarily for safety
268. Late-term pregnancy: 41 weeks - 41 weeks 6 days
269. Post-term pregnancy: at or >42 Weeks
270. Late/post term complication: Oligohydramnios- deepest amniotic fluid pocket equal/less than 2cm or
amniotic fluid index less than or equal to 5
271. low birth weight: equal/less than 2.5 kg
272. Macrosomia: equal/more than 4.5 kg
273. Polyhydramnios: deepest amniotic fluid pocket equal/more than 8cm or amniotic fluid index equal/more
than 24
274. Meningococcemia in infants-beware of Waterhouse Friderichsen Sx: adrenal hemorrhage- purpura over
body, vasomotor collapse. 100% mortality
275. GERD- normal-give PPI. Alarm symptoms or >50yrs with symptoms >5 yrs/cancer risk- Endoscopy
276. Tinea capitis- children/immunocompromised. scaly, erythematous plaque on scalp with alopecia. Can have
postauricular/occipital lymphadenopathy. Tx- oral griseofulvin, terbinafine
277. Trichomomiasis: Tx sexual partner too
278. infective endocarditis embolic event Tx- IV antibiotics. Heparin/warfarin not indicated. Aspirin prevents
ischemic stroke from atherosclerotic embolic/thombotic events within first 48 hrs
279. Graves disease women- Their new borns have high risk of Anti-TSH antibody receptor mediated Neonatal
thyrotoxicosis even if women are hypo/euthyroid(treated/surgery done for graves). Self resolves. Tx-
methimazole+beta blocker
280. Mother's levothyroxine and T3/T4 does not cross placenta.
281. ACL injury- hemarthrosis+effusion
282. REM sleep disorder: elderly male. latter part of night. complex motor behaviour. awakened fast. recall
dreams. assoc prodromal signs -ataxia, anosmia, constipation. neurodegeneration sign of parkinsons/lewy
body dementia
283. Nightmare disorder- no motor activity
284. sleep terrors and sleep walking. Non REM. dont remember dreams
285. CMV reitinits: floaters, blurred vision, flashing lights, yellow white hemorrhagic exudates next to
foveal/retinal vessels.
286. HIV retinopathy: cotton wool retinal lesions. self resolve
287. Congenital Syphilis: rhinorrhea, desquamating rash (palms, soles),jaundice, hepatosplenomegaly, growth
restriction, abnormal long bone radiographs. Tx- penicillin
288. Congenital CMV: periventricular calcifications
 8
289. Congenital toxoplasmosis: intracranial calcifications, microcephaly, choriretinits
290. Cryptorchidism complications: TESTICULAR Ca, inguinal hernia, SUBFERtiLIty (sperm quality/count
substandard) even after surgery(done before 1 yr).
291. Pre menstrual syndrome: Dx- symptom diary over 2 menstrual cycles. Tx- 1st line:SSRI, 2nd
line:OCP(contraindicated in migraine coz of estrogen)
292. Menopause avg age: 52 yrs
293. Endometriosis: 3Ds- deep dyspareunia, dysmenorrhea, dyschezia (pain with defecation). Tx: 1st line-
NSAIDs, OCPs 2nd line- laproscopic evaluation
294. vaginismus: Tx- vaginal dilators
295. Torus Palatinus: Congenital benign hard solid bony mass on midline of hard palate. in young, asian, women
Tx- none till symptomatic
296. Parkinsonism: Gait-narrow based/shuffling/hypokinetic. stooped posture, mask facies, inc resistance to
passive flexion.
297. Waddling gait: muscular dystrophy; Spastic gait: UMN lesion; Wide based, high stepping gait: Sensory
ataxia
298. Thyroid storm: high fever, CK may be increased
299. Free plasma metanephrines inc: pheochromocytoma- episodic hypertension, episodic headache,
tachycardia, diaphoresis
300. hypertensive nephropathy: intimal thickening and narrowing of renal arterioles with sclerosis
301. Porcelain gall bladder can be palpated as firm non tender mass in RUQ. It is due to chronic cholecystitis
302. echinococcal cyst unlikely in someone who hasn't travelled outside the US
303. Bulimia nervosa Tx: Fluoxetine
304. Anorexia Nervosa patients may have dec T3/T4 due to euthyroid sick syndrome. No Tx necessary
305. Anorexia nervosa patients should be hospitalised when: Unstable vitals(HR<40, hypotension, hypothermia),
electrolyte imbalances(hypokalemia, hypophosphatemia), cardiac dysrhythmias, very low weight
306. Lichen Sclerosus: Assoc with autoimmune diseases. chronic inflammation of anogenital region.
vulvar/anogenital intense pruritus, dyspareunia,dysuria, painful defecation. thin, paper like, white, atrophy
of genital structures. Dx-punch biopsy
307. Lichen Sclerosus Tx: Clobetasol (high potency topical corticosteroid)
308. Primary syphilis: bilateral lymphadenotapthy+ papule->becomes->non exudative painless ulcer with
indurated margins
309. syphilis single genital lesion vs chancroid/behcet/herpes which have multiple
310. patients with negative nontreponemal(RPR/VDRL) but strong clinical evidence for primary syphilis should
get empiric IM benzathine Penicillin G coz of high false negative rate- highly contagious and patients may
not return as chancre resolves
311. Intussusception: preceding gastroenteritis/meckel's/polyp/hematoma.0.5-3yr olds. periodic pain+drawing
legs to abd. vomiting, may have grossly bloody stool. sausage shape mass in RUQ. Dx- clinical. 2nd line -
U/S (100% sensitive/specific)Tx- Air Enema
312. If symmetric fetal growth restriction-Cause: Chromosomal/1st trimester infection. Asymmetric- maternal
causes
313. Diffuse esophageal spasm- episodic retrosternal pain radiating to interscapular region(back). trigger-
stress, hot/cold food. relieved by nitrates/CCB . Dx- esophageal manometry
314. OA: bony enlargement, bland synovial fluid(low leukocyte count, no crystals), crepitus. Tx-lifestyle, then
NSAIDs
315. duodenal perforation: free air under diaphragm
316. Anterior Mediastinum Masses: Thymoma,Teratoma,Lymphoma,retrosternal thyroid
317. Middle Mediastinum Masses: Bronchogenic cyst,tracheal tumor,pericardial cyst,lymphoma, lymph node,
aortic arch aneurysm
318. Posterior mediastinum Masses: Neurogenic tumors-meningocele,enteric cysts,esophageal tumors,
diaphragmatic hernias, aortic aneurysms
319. Impetigo- no fever. no pruritis. painful pustules+honey colored crusted exudates. underlying skin
problem.Tx- topical antibiotics. cause- Staph aureaus, strep pyo
320. Eczema herpeticum: superinfection by HSV on areas of eczema. fever
321. hand foot mouth disease: vesicles on hands, feet, posterior oropharynx
322. herpetic whitlow: finger infected from HSV fluid from orolabial lesion
323. HPV vaccination: begins at 11-12 yrs. should be offered till 26 yrs to unvaccinated/did not complete series
324. MVP with coexisting MR : most common valvular abnormality in Infective endocarditis
325. Tricuspid regurgitation: most common valvular abnormality in IVDU IE
326. Tinea corporis: skin to skin sports, hot humid climate. red, pruritic rash grows centrifugally with central
clearing. Tx: TOPICAL antifungal-clotrimazole, terbinafine (3weeks). Topical nystatin IS NOT the tx for
dermatophytes, only candida
327. lyme disease: tick should be attached >48 hrs. rash appears >7days later
 9
328. tinea capitis(scalp): ORAL antifungal 1st line
329. Clostridium defficile: high fever, SEVERE diarrhea, LLQ pain/tenderness, recent antibiotic
330. Leukemoid reaction: Seen in SEVER infections. high leukocyte ALP score, leukocytes >50K, predominance
of late neutrophil precursors->metamyelocytes, bands (rather than myelo/promyelocytes)
331. CML has low Leukocyte ALP score and predominance of early neutrophil precursors-myelo/promyelocytes
332. Myelodysplastic Sx: infection+pancytopenia
333. Non allergic rhinitis Tx- intra-nasal antihistamine/glucocorticoid: azelastine, olopatadine (dont respond to
antihistamines without anticholinergic activity-loratadine)
334. Tx of acute bipolar depression: 2nd generation antipsychotic- quetiapine,lurasidone; lamotrigine, lithium,
valproate, olazapine+fluoxetine. NO antidepressant monotherapy
335. Septic arthritis: often preceding skin/URI. acute onset fever+joint pain+ inc ESR+inc CRP+inc leukocytes.
Management- Do arthrocentesis + start emperic antibiotics
336. duchenne muscular dystrophy: Dx- gene testing: deletion of dystrophin gene
337. serum creatine phosphokinase+ aldolase elevated: screening test for muscular dystrophies
338. Performance only social anxiety Tx- beta blocker or benzos(not preferred coz of substance abuse)
339. Appendicitis: give antibiotics pre-operatively to all. those with appendicitis>5 days: medical
management+delayed surgery
340. tracheobronchial perforation: treatment resistant pneumothorax + pneumomediastinum + subcutaneous
emphysema . cause- blunt thoracic trauma
341. esophageal rupture: amylase rich pleural effusion
342. traumatic myocardial rupture causes cardiac tamponade
343. Hypothyroid pregnant women: need more levothyroxine during pregnancy
344. How reduce decline in diabetic nephropathy with proteinuria nd dec GFR: Maintain BP at 130/80 or lower
with ACE/ARBs
345. diabetics 40-75 yrs old: give statins irrespective of lipid levels
346. Rectovaginal fistula- prolonged 2nd stage labour, 2nd/3rd degree laceration, red/velvety rectal mucosa on
post vaginal wall
347. neonate bacterial meningitis signs: full/bulging fontanelles, apnea, seizures
348. neonatal sepsis signs are non specific: hyperthermia/HYPOTHERMIA, poor intake, irritability, vomiting,
jaundice, resp distress. LABS: high/LOW WBC + bandemia
349. If you suspect neonatal sepsis, take blood/urine/CSF cultures and start parenteral antibiotics coz of high
morbidity/mortality
350. MCC of neonatal sepsis: GBS. So we do universal screening of pregnant women for GBS-->does not dec
late onset neonatal sepsis from horizontal transmission
351. Listeria symptoms in pregnant mother: flu like
352. MCC of orbital cellulitis: bacterial sinusitis
353. Grade 3/4 murmur in child: Do echocardiography even if ECG is normal and no symptoms to know size
and location of defect
354. Fibromylagia has point muscle tenderness vs Polymyalgia heumatica which doesn't
355. Drugs that impair folic acid causing megaloblastic anemia: Anti-epileptic: Phenytoin,
phenobarbitol,primidone. Methotrexate, TMP
356. Vasoocclusive crisis: in 95% SCD patients by 8 yrs age
357. Warm agglutinin Autoimmune Hemolytic anemia Tx is corticosteroids VS cold Tx: Rituximab +/- fludarabine
358. hyperemesis gravidarum: weight loss >5% pre-pregnancy wt. Dx- ketonuria. Also hypochloremic metabolic
alkalosis, hypokalemia, inc aminotransferases. Tx- hospital admission-IV anti-emetics, rehydration,
electrolytes
359. dermatomyositis: Malignancies are more common
360. dermatomyositis: eyes- periorbital edema, shawl sign- rash on neck + chest, gottron's papules. antibodies:
anti-jo-1(antisynthetase), anti-Mi-2 (against helicase)
361. Alzheimer's: >60 yrs, memory loss, then visuospatial deficits. gait later
362. Normal pressure hydrocephalus: Broad based shuffling gait early on. cognitive problems later
363. multi-infarct dementia: executive dysfunction early on then memory problems
364. loss of cellular(T cell immunity)- fungi, virus, opportunistic infections. loss of humoral(B cell immunity):
bacterial infections
365. SCID Tx- stem cell transplant. Common immuno-variable diseas Tx- Immunoglobulins
366. esophagitis in HIV: candida most common. dyphagia/odynophagia, substernal burning
367. pill esophagitis: tetracyclines, bisphosphonates, potassium supplements
368. Acute exacerbation of COPD Tx: short acting bronchodilators, glucocorticoids, antibiotics. If fail, then
NPPV. if fail then endotracheal mechanical ventilation
369. Rheumatic mitral stenosis: during pregnancy asymptomatic patients acutely decompensate presenting
with atrial fibrillation + signs of pulmonary edema coz of inc blood and tachycardia due to pregnancy
370. Peripartum cardiomyopathy: >36wks, rapid onset systolic HF
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371. milk/soy induced proctocolitis: Infant has non projectile vomiting after feed +/- painless bloody stool +/-
eczema. Tx- remove soy/diary milk from mom's food if breastfed. switch to hydrolysed formula if formula
fed
372. peritonitis: reduced bowel sounds, guarding, rigidity, rebound tenderness
373. bacterial meningitis: inc neutrophils, low glucose
374. encephalitis has confusion, strange behaviour whereas meningitis doesnt have it
375. HSV encephalitis: temporal lobes hemorrhagic destruction- inc RBC(in CSF), brain imaging shows lesions.
CSF- inc lymphocytes, inc proteins. Dx- PCR is gold std. Tx- IV acyclovir
376. Femoral hernias do not protrude into the scrotum. Most commonly in older women
377. Varicocele: in 20% postpubertal men. inc with standing and valsalva and does not transilluminate. dec with
lying down. irregular. left more common
378. hydrocele transilluminates vs varicocele which doesnt
379. Colon cancer: chronic occult blood loss + abdominal pain + wt loss
380. Diverticulosis bleeding: large frank painless bleeding. MCC of lower GI bleeding in adults. may have
lightheadedness + hemodynamic instability. Dx- colonoscopy. Tx-self limited. surgery/endoscopy if doesnt
resolve
381. Ischemic colitis: abd pain+ tenderness in watershed areas and bleeding
382. Ionized Ca- active form. In PE>tachypnea>causes resp alkalosis>H+ dissociates from albumin>albumin
binds ionized Ca>hypocalcemia>crampy pain, paresthesias, carpopedal spasms
383. Neurofibromas- nerve sheath tumors. Manifest as cutaneous lesions in NF1.show up in adolescence/early
adulthood
384. NF- HYPERpigment (cafe au lait) VS Tuberous sclerosis- HYPOpigmented (ash leaf)
385. GBS- CSF has inc protein
386. avoidant personality: loner with longings. fears criticism, humiliation, hypersensitivity to rejection.
387. Tuberculous pleural effusion: inc lymphocytes, protein and LDH. tend to occur on Rt. side
388. Psoas abscess: pain with hip extension and relief with flexion. Dx- CT
389. Hip septic arthritis: Pain with hip flexion
390. Abruptio placentae: Due to maternal hypertension, concaine, trauma. back/abdominal pain, Painless
bleeding, uterine distention + contractions(from blood), fetal HR problems(fetal O2 compromised)
391. Ototoxicity- LOOP diuretics(more so in renal failure), Aminglycosides, Chemotherapeutic drugs, Aspirin
392. Phobia Tx: Behavioral therapy using exposure
393. NAFLD: insulin resistance-> inc free fatty acids in liver->produce cytokines-> liver damage
394. Metabolic Syndrome: Co-occurence of metabolic risk factors for both DM 2 and CVD
395. Maternal estrogen effects in newborn: mammary enlargement. white discharge, bleeding. Tx- Observation
+ routine care
396. Reversible inducible myocardial ischemia on SPECT: CAD. give antiplatelet therapy, beta blocker,
modification of risk factors
397. Exercise induced bronchoconstriction: can be in those without asthma. coz of cold, dry air. Tx: 1st line-
beta agonist(10-20 min before exercise) 2nd line-anti-leukotriene or inhaled corticosteroids in those who
exercise daily
398. Pink eye(viral conjuncitivits): can be single eye. grittiness in eye. Following adenovirus/viral URI. self limited.
Tx-warm/cold compress
399. mast cell stabilizing agents: olopatadine, azelastine-> for allergic conjunctivitis
400. Folate def: normal methylmalonic acid vs cobalamin def. seen in alcoholics in 5-6wks. pancytopenia if
severe
401. Retinal detachment: flashes of light, spots in visual field, curtain coming over eyes, grey, elevated retina.
Trauma/myopia. Tx- cryotherapy, laser therapy
402. Systemic sclerosis: causes smooth muscle atrophy + fibrosis
403. Leydig cell tumor: nodule in testis. gynaecomastia, inc testosterone + estradiol
404. Hip osteoarthritis: pain in buttock, groin, pelvis can radiate to thigh
405. Aortoiliac atherosclerosis: diminished pedal pulses
406. amputation injury: wrap in saline moistened gauze with plastic bag on ice
407. Leiomyomata uteri(fibroids)- can cause pregnancy size-date discrepancy. cause pressure symptoms
before pregnancy and irregular uterus enlargement during preg
408. Molar pregnancy- vaginal bleeding, hyperemesis gravidarum, regularly enlarged uterus
409. breech: Do CS only if vaginal not indicated. Do external cephalic version >/= 37 wks if no contraindication
to vaginal delivery and NST normal
410. internal podalic version: convert second twin from transverse to breech for delivery
411. Cancer related anorexia/cachexia syndrome Tx- progesterone analogue(megestrol acetate)-for longer life
expectancy , corticosteroid- for shorter
412. HIV cachexia Tx- synthetic cannabinoids like dronabinol
413. male breast cancer risk- klinefelter syndrome
 11
414. Pubertal gynaecomastia- 2/3 boys. unilateral/bilateral. resolves by itself in 2 yrs
415. Nightmares: REM, remember dream, fully alert ,can be consoled. normal. VS sleep terror: Non REM, don't
remember, unresponsive, partial arousal
416. Cold thyroid nodule: hypofunctioning. Inc risk of malignancy
417. Hot thyroid nodule: Thyroid adenoma/Toxic multinodular goitre. Tx- beta blocker (symptoms), thionamides
to dec secretion.
418. Hyperthyroidism activity on bone: osteoclastic->osteoporosis->fractures,hypercalcemia/hypercalciuria
419. Fetal hyperthyroidism: seen in graves as TSH receptor antibodies cross placenta
420. Cerebral Palsy: <32wks premature birth-biggest risk factor. group of syndromes. prematurity cause
"spastic type"(hypertonia, hyperreflexia of feet with feet pointing down and in). Intrapartum Hypoxia NOT a
risk factor
421. Cushing Syndrome: need 2 out of 3 tests positive: 1)low dose dexamethasone suppression 2) late night
salivary cortisol 3) 24 hr urine free cortisol . symptoms: wt gain, hypertension, psychiatric issues, proximal
muscle weakness, hirsuitism
422. Early morning cortisol: low in primary adrenal insufficiency. No use in cushings as it is normal
423. Rheumatic heart disease: in immigrants. MS occurs. becomes symptomatic at 40-50 yrs. Left Atrial
fibrillation causes acute decompensation. LA inc in size- left bronchus elevated, recurrent laryngeal
affected. dyspnea on exertion, orthopnea, pul congestion
424. Social anxiety disorder/Social phobia Tx- pharma 1st line- SSRI, SNRI. non pharma-1st line CBT. DON'T
use Benzos/beta blockers unless it's performance-only subtype of social anxiety
425. Epidermal inclusion cyst: central punctum. filled with keratin+lipid->cheesy white. anywhere on body. self
resolve. epidermis in dermis coz of trauma/comedones. benign
426. Dermatofibroma: fibrous, hyperpigmented nodule. Dimpling in center
427. BCC: pearly VS SCC: scaly
428. stress fracture. 2nd metatarsal most common. Tx-rest for 2nd,3rd,4th metatarsal. splint/cast for 5th
429. TCA overdose Tx- Sod Bicarb-> inc extracellular SODIUM preventing TCA from inhibiting fast Na channels
in myocardium and preventing inc QRS >100msec/arrhythmia
430. Sod bicarb in aspirin overdose: urine alkalization
431. Slipped Capital Femoral Epiphysis: High clinical suspicion coz referred pain to knee. in Obese adolescent
boys. ext rotation of thigh when hip flexed. Tx- surgical pinning
432. HOCM: young person- dyspnea, chest pain and syncope with exertion.
433. HOCM murmur: crescendo decrescendo. left sternal border systolic murmur without radiation to carotid VS
AS murmur on right sternal border
434. Maternal contraindications to breast feeding: active,untreated TB, varicella infection,herpetic breast
lesions, current chemo, drug use- marijuana, cocaine, opioids
435. Infant contraindication to breast feeding: galactosemia
436. infants of mothers with Hep B can breastfeed if given Hep B immunoglobulin + vaccination started
437. breech presentation >37wks: we may(not preferred) deliver vaginally if no contraindication. Previous low
transverse CS is not a contraindication but previous classical CS IS!
438. Contraindications to vaginal delivery: placenta previa, active herpes lesion, prior classical CS
439. CS in persistent breech done at 39wks
440. Hereditary angioedema: late childhood. follows infection, dental procedure or trauma. NO URTICARIA.
Rapid edema of genitals, intestines(ABD PAIN), face, limbs, larynx. C1 inhibitor deficiency. C4 levels
normal. edema producing factors: C2b and bradykinin
441. acquired angioedema: Low 4 levels. age>/=30
442. Meds to give in preterm labor: <34 wks: tocolytic(indomethacin,nifedipine)+corticosteroid. <32wks: MgSO4
+ <34 wks meds->to lower neuro morbidities
443. Preterm labor: regular contractions <37 wks that cause cervical dilation and/or effacement
444. Indicators of premature birth: Fetal fibronectin , shortened cervix
445. sunburn: inflammation due to UV. apply sunscreen 15-30 before going out and reapply every 2 hrs. SPF
15-93%, 30-97%,50-98%
446. Abnormal uterine bleeding(AUB) in adolescents post menarche: immature hypothalmic-pituitary-gonadal
axis->dec GnRH production->no ovulation->no progesterone->only break through bleeding. Tx-only if
heavy,anemia,disrupts activities-OCP. self resolves in 1-4yrs
447. exogenous progesterone in AUB: bleeding eliminates estrogen def(pr. ovarian insufficiency), endometrial
abnormalities(adhesions), outlet tract abnormalities(imperforate hymen)
448. PCOS: excess LH
449. Dihydropyridine Ca channel blocker(nifedipine, amlodipine): can cause peripheral edema
450. Gonorrhoea: non tender cervical lymphadenopathy + pharyngitis possible coz of oral sex. lower abdominal
pain coz of PID
451. Folate deficiency common in sickle cell disease
452. De Quervain tenosynovitis: new mothers hold infants. passive stretch of tendons(finkelstein test) elicits pain
 12
453. Airborne infections: negative pressure room+N95- measles, chicken pox, TB
454. Droplet infections: surgical mask- influenza, RSV
455. Measles- cephalocaudal maculopapular rash. spares palms/soles. prevention- 2 doses live attenuated
vaccine
456. Post-exposure passive immunization: chicken pox, rabies- give antibody
457. Human bite infection: polymicrobial. Tx- Amoxicillin clavulanate
458. STEMI Tx- PCI within 90 mins in equipped hosp and within 120 min in referred hosp. immediate IV beta
blockers contraindicated as cause brady
459. No therapy for reperfusion injury following MI
460. Hepatic hydrothorax: Cirrhotic patients develop pleural effusion commonly on right coz hemidiaphragm
weak there. is transudative. Tx- diuretic, restrict salt. Do thoracocentesis if a lot
461. Neonatal tetanus hallmark- hypertonicity. stridor and respi symptoms coz respi muscles contract. Tx-
passive antibody, antibiotics
462. omphalitis: can lead to sepsis but doesnt cause hypertonicity
463. HCV infected: do abdominal U/S every few months for HCC surveillance
464. Inferior wall MI(aVF): 50% have Right ventricle MI->lungs clear, JVP normal(</=3cm). Dec RH preload-
>cardiogenic shock.. Tx- Saline bolus to inc preload. Nitrates contraindicated as cause dec preload->
profound hypotension
465. temp pacemaker: in transient bradycardia or AV block
466. Bath salts effects for days-wks VS PCP which is hours. Bath salts not part of routine urine toxicology,
whereas PCP, Cocaine are
467. Bath salts- agitation, combativeness, delirium, psychosis
468. BAT: left diaphragm more prone to rupture. mediastinum moves to right. In children may present month to
yrs later. Dx- CT
469. Abnormal Uterine Bleeding: >5 days + >1 pad/2hrs
470. Nephrolithiasis prevention: inc fluid intake, sodium/potassium restriction, thiazide/amiloride diuretics
471. Gout: redness, swelling, inflammatory fluid-leukocytosis, inc neutrophils. Tx- NSAIDs, colchicine,
corticosteroids. Prophylactic- Allopurinol
472. Tetanus: KIDS- 3 doses: 2,4,6 months. ADULTS: 1 dose-Tdap, booster with Td every 10 yrs
473. Side effect of short acting benzos(alprazolam): seizures. seen within 24 hrs of withdrawal sometimes
474. TCA/Bupropion: seizures with dose dependent inc
475. Upper GI bleed: BUN/Creatinine ratio increases->inc urea production->from inc intestinal Hb breakdown.
Not seen in lower GI bleed
476. Lynch Syndrome: Genetic testing for strong fam Hx- >/=3 relatives in multiple generations
477. Lynch Syndrome: Do colonoscopy for COLON Ca screening. Do annual endometrial biopsy(starting 30-
35yo) for ENDOMETRIAL Ca screening. Do prophylactic hysterectomy+bilateral oophorectomy(=/<40yo) if
family completed as susceptible to OVARIAN Ca too.
478. Severe Cancer pain Tx: short acting opioid(oxycodone, morphine, hydromorphone). Long acting only if no
relief at night, frequent dosing. Transdermal fentanyl is long acting
479. Epiglottitis: SUDDEN ONSET. DROOLING, inspiratory stridor and TRIPOD position, HIGH FEVER. no
cough. seen in vaccinated kids too. Tx- intubation, then antibiotics
480. Failed trial of SSRI in major depression patient- next line anti-depressant based on individual. no one better
than other
481. Bupropion: norepinephrine/dopamine reuptake inhibitor. does not cause wt gain. no sexual side effects
482. Quetiapine used in bipolar depression but not in unipolar depression
483. TCAs are the last preferred class of anti-depressants coz of side effects. Mirtizapine similarly causes wt
gain,sedation
484. Recognize Akathasia- someone wanting to walk around. restless. gets agitated and aggressive when
stopped. increases with anti-psychotic dose, so differentiate from psychotic agitation which doesnt
increase with dose
485. Akathasia Tx: anti-psychotic drug dose reduction(don't stop) + beta blocker, benztropine or benzo
486. Posterior Urethral Injury: blood at urethral meatus, inability to void, perineal/scrotal hematoma, high riding
prostate(prostate pulled cephalad). Most commonly injury at bulbomembranous junction
487. Dx of urethral injury: Retrograde urethrogram- take xray after passing radio-opaque contrast
488. Anterior urethral injury: coz of straddle injury not pelvic fracture
489. retrograde cystogram: to diagnose bladder rupture(most commonly with pelvic fracture)
490. Simple renal cyst need no treatment. It's homogenous, regular, unilocular and seen >50 yo
491. BUN/Cr > 20: Pre-renal AKI. Seen in elderly coz of impaired thirst response+ inability to obtain
water>acute inc in Cr
492. Post Herpetic Neuralgia: neuratic pain lasting >4 months. Tx-: gabapentin/TCAs/pregabalin. Shingles acute
Tx: valacyclovir/famciclovir/acyclovir within 72 hrs. if >72 hrs, Tx only if new lesions appearing
 13
493. Drugs to stop in pregnancy: Isotretinoin- 2 forms of contraception needed 1 month before till 1 month after
Tx. cause many congenital defects. Lithium- Abstein's in 1st trimester. wean in stable bipolar pregnant
mom. Corticosteroids are safe
494. alveolar hypoventilation: due to dec tidal vol or resp rate
495. intrapulmonary shunt: V/Q mismatch. V=0 in pneumonia, pulmonary edema and atelactasis: supplemental
O2 doesnt inc )2 saturation
496. Pyloric Stenosis: first born males at 3-5 wks age. Tx- first fix alkalosis(hypochloremic,hypokalemic) and
dehydration(if present)-> dec post-operative apnea, then do pyloromyotomy
497. Pre-renal AKI: Oliguria(<500ml/day), no casts in urinalysis. seen in post op patients. Tx- IV isotonic saline
498. Acute interstitial Nephritis: rash and leukocytosis
499. Early Puerperium(1-3 days postpartum)normal physiology: shivering, temp upto 100.2. difficulty
initiatingvoiding. lochia rubra-red/reddish brown vaginal discharge(uterine shedding+blood)
500. lochia serosa(3-4 days postpartum)- pink/brown discharge. lochia alba(2-3wks post partum)- yellow/white
discharge
501. Grief: waves. sadness mixed with positive memories
502. Chronic cough(>8wks) i.e. nocturnal, lungs clear, not responding to PPI, antihistamine: Do
Spirometry(PFT)- to rule out asthma
503. Alcohol has dose dependent casual effect on breast cancer
504. BRCA and HER2 testing done in those with breast cancer <50yo or those with ovarian Ca
505. OCP- dec ovarian Ca risk. No effect on breast Ca
506. Non bullous impetigo: In kids.NOT pruritic, NO fever. papules>turn to pustules>honey crusted
ruptured>face, fingers. Strep/staph cause
507. Celiac disease: ATROPHY of intestinal villi. prevalence increases with age. D-xylose test-dec in urine
508. Cryptococcal meningoencephalitis: in HIV (CD4<100, thrush). Tx- induction: amphotericin B+flucytosine;
consolidation/maintainence-fluconazole. Start anti-retroviral 2-8 wks after induction or will have immune
reconstruction syndrome
509. Tx of cerebral toxoplasmosis: sulfadiazine-pyrimethamine
510. Melanoma diameter >/=6mm
511. Lentigo: intraepidermal melanocytic hyperplasia seen in elderly
512. Monoarticular arthritis+ chondrocalcinosis: suspect pseudogout
513. hemochromatosis- iron deposition promotes CPPD> pseudogout in these patients
514. Proteinuria in kids: do 2 additional urine dipstick test to confirm coz transient
proteinuria(fever,stress,exercise,seizure) and orthostatic proteinuria(when kid is standing) is common. also
otherwise normal urinalysis should support benign proteinuria
515. Differentiate Polyuria: DM- glucose level/polydipsia-hyponatremia(Na<137)/DI-normal or hypernatremia,
central has impaired thirst mechanism and Na>150 whereas nephrogenic has intact thirst and Na generally
normal
516. SIADH: urine osmolality>serum osmolality
517. Autism kids might be doing academically well and have no health problems but have high suspicion if not
interested in social relationships and like repetitive interests/behaviors and want routine
518. Hydrocele: observe and reassure if diagnosed in infant as it resolves by itself by 1 yr. if doesn't then do
surgery to prevent hernia in future
519. Pancreatic adenocarcinoma:weight loss and epigastric pain all the time radiating to back, esp at night +
chronic pancreatitis. Dx- if obstructive jaundice, inc ALP, steatorrhea- do U/S to image head of pancreas.
VS if NO obstructive jaundice, do CT to image body+tail of pancreas
520. Idiopathic intracranial hypertension: young obese women, isotretinoin, excessive vit A. holocranial
headaches, diplopia, blurry vision, papilledema, empty sella, tinnitus. Dx- Do MRI and MRI venography and
Lumbar puncture which will show pressure >250
521. Angiodysplasia: >60yo. frequently missed on colonoscopy and maroon colored as opposed to
diverticulosis,hemorrhoids. painless recurrent GI bleeding. Associated with aortic stenosis, vWF def, renal
disease. Tx- cautery if symptomatic
522. Vesicovaginal fistula: urinalysis may indicate infection
523. 1st trimester combined test(9-13weeks):risk of trisomy 18 and 21. screening test. beta-hCG, pregnancy
assoc plasma protein, nuchal translucency.
524. Fetal Aneuploidy diagnosis. inc beta-hCG and inc nuchal thickness on 1st trimester combined test
screening. confirmed by amniocentesis(15-20wks) or chorionic villous sampling(10-13weeks)
525. food stuck in esophagus- GERD; food stuck in throat- oropharyngeal dysphagia
526. oropharyngeal dysphagia: coughing, choking, recurrent right lower lobe pneumonia, difficulty swallowing,
nasal regurgitation. Causes: stroke, dementia, malignancy, myasthenia gravis. Dx- videofluoroscopic
barium swallow
 14
527. Massive PE: vascular resistance in blood going to lungs inc coz of V/Q mismatch->back pressure on RV-
>pulmonary valve closes late-> RV can't push blood->HYPOTENSION as LA doesnt get blood. RV
hypokinesis except apex area. SYNCOPE also seen
528. Tension pneumothorax: hypotension , elevated JVP, dec breath sound on that side
529. Septic shock: inc cardiac output initially and it can decrease later and show up as hypotension
530. Umbilical hernia: african american, premature, hypothyroidism, beckwith-wiedemann. spontaneously close
by 5yo. surgery is doesn't(less likely in >1.5cm)
531. Gastroschisis: right of umbilicus. red intestines, no covering
532. Omphalocele: under umbilicus. peritonuem covering. Umbilical granuloma: after umbilicus separated. Tx-
silver nitrate
533. Tracheobronchial rupture: BAT. persistent pneumothorax following chest tube, pneumomediastinum,
subcutaneous emphysema. rt bronchus commonly. Dx- CT, bronchoscopy. Tx- surgery
534. Esophageal rupture: pleural effusion, pneumomediastinum
535. Myocardial rupture causes cardiac tamponade whereas myocardial contusion causes tachycardia, bundle
branch blocks, rib fractures NOT mediastinal widening or enlarged heart
536. Major depressive disorder: >/=2weeks
537. ADHD Tx: Atomexitine(NERI), methylphenidate(stimulant)
538. Narcolepsy Tx: modafinil- wakefulness
539. DLCO measures whether alveolar and capillary structure are intact. Normal in bronchitis, asthma. Dec in
emphysema(wall destruction) and ILD.
540. Bronchitis VS bronchiectasis: FVC normal in formal and less than 80% in later and less xray vascular
markings on former
541. Fibroids associated with pregnancy loss except subserosal fibroid
542. Anti-phospholipid syndrome - Fetal loss in 1st trimester. Tx-anticoagulation: heparin/LMWH (in pregnancy),
warfarin(contraindicated in pregnancy)
543. Absence seizure: 3Hz spike wave EEG
544. Patient wants to quit drinking but still drinking: Naltrexone. wants nd abstinent: Disulfiram. If abstinent
nd maintenance: Acamprosate
545. Supraspinatus tear(rotator cuff injury): drop arm test- arm drop abruptly in mid adduction. weakness in
abduction. seen in fall on outstretched arm
546. axillary nerve injury-surgical neck humerus. deltoid abduction problem(15-90 degrees). long thoracic nerve
injury-serratus anterior injury:problem abduction >90 degrees
547. SIADH is euvolemic and central salt wasting is hypovolemic
548. HF with preserved ejection fraction: Diastolic HF- LV can't relax coz of wall stiffness-> LA pressure inc-
>pulmonary pressure inc. in 50% CHF patients
549. Cor pulmonale: RHF due to pulmonary cause. No bibasilar crackles
550. Acute Mesentric Ischemia: embolus from PAD, valve vegitation, atherosclerosis. Urge to defecate, nausea,
vomiting. SEVERE, diffuse, mid abd pain. Leukocytosis, inc amylase, metabolic acidosis
551. Dx of ankylosing spondylitis: PelVIC XRAY-sacroilitis. lumbosacral TENDERNESS. have suspicion in
anyone <45yo having low back pain and stiffness >3 months
552. confounder: has no relationship to prevalence in the population of interest
553. Infertility in women: can't conceive after >6months of unprotected sex in >35yo
554. Diminished ovarian reserve: dec after 35. normal menstrual cycle. number/quality oocyte dec->
inhibin,estrogen dec-> day 3 FSH testing will show inc FSH
555. Complications of small for gestational age new borns(<10th percentile weight): hypoxia, asphhxia->
polycythemia. hypoglycemia, hypocalcemia,hypothermia(less subcutaneous fat), meconium aspiration
556. Large for gestation age (>90th percentile/ >4kg): high risk for hip subluxation, talipes calcaneovalgus
557. RhD alloimmunization: presence of Rh anti-D antibodies in a Rh + woman after 1st Rh - fetus. Prevention:
ANTI- D immune globulin at 28weeks and then within 72 hrs of birth(2nd dose depends on Kleihauer-Betke
test)
558. Cystic fibrosis- bruising coz of Vit K def(malabsorption), nasal polyps
559. SCID die before 1yr age without bone marrow transplantation
560. Cold sore: HSV on lips
561. Coxsackie A virus in kids (Herpangina)- lesions on posterior oropharynx + 1mm gray vesicles on tonsils,
fever. Cervical lympjadenopathy maybe. In summer/fall. Tx- hydration + analgesia. Resolves in a week
562. HSV gingivostomatitis- lesions on ANTERIOR oropharynx + lips
563. Coxsackie A virus also causes Hand, foot, mouth disease
564. Blood transfusion for Anemia: Hb>10: No; 8-10:symptomatic/bleeding/surgery/ACS; 7-8:cardiac
surgery/Ca Tx/HF;<7:Yes
565. Hepatic encephalopathy Tx- lactulose VS Uremic encephalopathy Tx: Hemodialysis
566. Kids dont have personality disorders as personalities are still forming
567. Anti-phospholipid syndrome: has increased APTT and dec platelets
 15
568. Schizophrenia neuroimaging result: cortical tissue loss + VENTRICLE ENLARGEMENT(lateral most
common). Decreased hippocampul+amygdala volume
569. Charcot joint(neurogenic arthropathy): seen in DM and other diseases affecting nerves. osteophytes, loose
bodies in joint(bone fragments) Tx: special shoes
570. Acute exacerbation of COPD: antibiotics(amox-clav, azithromycin/fluoroquinolone) for a week given when
moderate/severe AECOPD
571. Moderate/severe AECOPD- 2 cardinal symptoms(dyspnea/sough/sputum) with inc sputum or mechanical
ventilation( NPPV or endotracheal).
572. Cervical spondylosis: >50 yo. Nech pain, limited neck rotation/lateral bending -> due to muscle spasm and
osteoarthritis. Sensory loss symptoms in arm-> coz of osteophytes/bony spur caused radiculopathy. Disc
bulging
573. Gestational age most accurate with 1st trimester U/S
574. Treatment resistant schizophrenia with suicidality Tx- Clozapine: reserved for such patients coz of
agranulocytosis
575. Post traumatic hypovolemic shock: small LV + increased ejection fraction. Hypotension(flat neck veins),
tachycardia, cold extremities
576. Mx of lethal fetal anamolies(anencephaly, bilateral renal agenesis, pulm hypoplasia) pregnancy: expectant
vaginal deliveries. Point is to care for mom. Fetus will anyway die
577. Pregnancy tests: 6-7th month- Hb/ Ab screen if Rh D - /OGTT. 35-37 weeks: Group B strep
578. Gestation DM: placental hormones in 2nd/3rd trimester that promote fetal growth but inc maternal insulin
resistance
579. Breastfeeding failure jaundice: 1st weeks of life. dehydration- red urate crystals on diaper, dec birth weight,
dec no of stools(1st week no of wet diapers=age in days); jaundice. Coz of lactation failure(mom of infant
causes)
580. Breast Milk Jaundice: NO dehydration. Starts 3-5 days and peaks at 2 weeks age
581. Biliary atresia: 1st 2 months of life. Hepatomegaly, dark urine, clay colored stools. Conjugated
hyperbilirubinemia
582. Galactosemia: vomiting, growth failure, jaundice, conjugated hyperbilirubinemia. Tx: soy based formula.
Cows milk/breast milk are an absolute CONTRAINDICATION.
583. Breast feeding failure Tx: 1st month-Feeds every 2-3 hrs, 10-20min each breast. Hydration. If bilirubin
keeps increasing, switch to formula supplementation
584. Hyperbilirubinemia in newborn Tx- phototherapy >/= 20; exchange transfusion >/= 25
585. HCM Tx: negative ionotropes. 1st Line- Beta blocker. 2nd line- no dihydropyridine CCB, disopyramide
586. Ranolazine: anti-anginal in those refractory to nitrates/beta blocker/CCB
587. Overflow incontinence: high post void residual volume >50. Neurogenic bladder coz of diabetic autonomic
neuropathy is a cause
588. Hypersensitivity Pneumonitis: bird fanciers lung, farmers lung. FEVER, cough, dyspnea. Xray-
HAZINESS/ground glass in lower lungs. Chronic-Pulmonary fibrosis and restrictive pattern on spirometry.
Tx- avoid antigen.
589. Alcoholic hallucinosis: 12-24 hrs after last drink. Just hallucinations. Vitals stable VS delirium tremens: after
48 hrs. fever+ autonomic hyperactivity + hallucinations
590. Granulosa Cell tumor: post menopausal women-breast tenderness, vaginal spotting and prepubertal-
>precocious puberty (<8yo): breast buds, pubes, vaginal discharge. Inc estrogen. Pelvic mass. Malignant.
Do Endometrial BIOPSY to rule out endometrial Ca. Tx- surgical removal
591. Emphysematous cholecystitis: Fever, RUQ pain, leukocytosis. gas in gall bladder wall, air fluid levels in
gallbladder, crepitus in abdominal wall next to gall bladder, pneumobilia, moderate unconjugated
hyperbilirubinemia, moderate inc in liver enzymes
592. Emphysematous cholecystitis: Cause- DM, vascular compromise, Immunosuppression . clostridium/E.
Coli. Tx- Emergent cholecystectomy + antibiotics
593. Acute Cholangitis: Has JAUNDICE apart from RUQ + fever
594. Chorioamnionitis/Intraamniotic infection: Dx- Maternal fever + uterine tenderness/purulent vaginal
discharge/malodorous amniotic fluid/maternal or fetal tachy(atleast one of these symptoms)
595. Chorioamnionitis: Cause- Prolonged rupture of membranes(>18hrs btw ROM and birth) Mx: broad
spectrum antibiotics(ampicillin/gentamycin/clindamycin) + oxytocin to accelerate labor
596. Abruptio placenta: Lower abd/back pain + tender uterus + vaginal bleeding. Risk factors:1) precleampsia
2)tobacco. Maternal complications: 1) DIC 2) hypovolemic shock. Fetal complications:1) hypoxia 2) preterm
labor(premature ROM)
597. Acetaminophen >2g/day for >1week increases risk of bleeding with warfarin
598. Spinach/Brussel sprouts: source of K
599. Nitrazine positive fluid mean amniotic fluid is present in discharge meaning ROM
600. Preterm premature ROM(<37weeks): deliver >34 weeks. Deliver <34 weeks if infection(chorioamnionitis) or
fetal compromise. Tx: Intrapartum antibiotic(penicillin) + delivery
 16
601. Kawasaki Disease: IRRITABILITY, >1.5cm lymph node, <5 yrs. Tx- Aspirin +immunoglobulin. Do baseline
Echo
602. Scarlet Fever rash spares palm/soles VS Kawasaki which doesnt. Also scarlet has tonsillar exudates VS
Kawasaki which doesnt
603. Acute PE: bilateral wheezing can occur(cytokine induced bronchoconstriction). Increased A-a gradient
604. Hyponatremia is an indicator of heart failure: Dec CO and systolic pressure causes ADH, Renin and
norephinephrine release to inc systolic pressure-> absorb water and cause dilutional hyponatremia. Tx-
fluid restriction, ACEI, loop diuretics
605. Post partum psychosis: days to weeks after birth. Tx- hospitalize. Dont leave mom with kid alone.
Antipsychotics, antidepressants, mood stabilizers
606. Hip fracture: Tx- surgery. In elderly if coz of fall- Do cardiac markers, Echo, CXR before surgery(can wait for
73hrs) to rule out cardiac/pulmonary comorbidity that would cause high risk surgery
607. Infective Endocarditis: Acute- collect blood samples for culture within 1 hr from 3 separate sites, then start
antibiotics immediately. Sub-acute(no fever)- delay antibiotics till culture report is in
608. MCD: 85% kids <10yo. Proteinuria + edema. Tx- start empiric steroids if suspected.
609. Paresthesia: burning/prickling sensation
610. Compartment Syndrome: swelling, paresthesia, pain main symptoms. Time to fasciotomy is critical
prognostic factor
611. Biggest homicide risk: access to guns
612. Tet spells: in TOF. May show up few months after birth. Cyanotic during feeding/crying/agitation. RVOT
obstruction. Harsh, systolic, ejection murmur, single S2, over left upper sternal border, hypoxemia. Tx-
knee chest position, O2 therapy
613. Abruptio placenta: pain+/- bleeding, uterus distended, tender. Premature separation of placenta->decidual
vessels rupture. Cause- Cocaine, hypertension.
614. Vasa previa: Painless bleeding. fetal blood vessels over internal os. Rupture during amniotomy.
615. Placenta previa: painless bleeding
616. Bulging fontanelles and prominent scalp veins in infant: Do CT. suspect hydrocephalus
617. RA has metacarpophalangeal involvement VS OA which has interphalangeal involvement
618. PAD: Is a CAD risk equivalent. Intermittent claudication Tx- give aspirin, statins and ask to start EXERCISE
therapy- 3times/week for 12 weeks(30-45min) for all with claudication. Cilostazol, PCI/surgery if persists.
Anticoagulants NOT recommended
619. HSP: abdominal colicky coz of vasculitis. Renal involvement- DEPOSITION IN MESANGIUM of IgA.
Arthralgia of HSP doesnt cause permanent damage, is reversible
620. FSGS: MCC of nephrotic syndrome in US adults
621. Small intesting bacterial overgrowth syndrome Tx- Rifaximin
622. Chronic HepB infection: HBsAg in serum for >6 months
623. Rabies Post exposure prophylaxis:immune globulin+ vaccination- given immediately for high risk wild
animals(bats, raccoons, foxes) WAIT In domestic animals, observe for 10 days or give if animal is
symptomatic as incubation lasts several months. No need to euthanize animal
624. CNS lymphoma: EBV DNA in CSF is pathognomic. Generally periventricular
625. Secondary amenorrhea: Do prolactin, TSH, FSH test after beta hCG
626. Exertional/Non extertional heat stroke: temp >105. Rhabdomyolysis: blood in urine but no RBC casts.
627. Malignant hyperthermia pathophys(inhaled anesthetics): calcium efflux from SR and accumulation in cells
in muscles
628. Acute UNILATERAL lymphadenitis in children:. Staph aureus, strep pyogenes. <5 yrs. Submandibular
nodes affected. Tender, red, enlarged. Tx- empiric- clindamycin
629. Meningococcal meningitis: highly CONTAGIOUS. Hospitalize + isolate patient even if doesnt want.
Chemoprophylaxis(rifampic,Cipro) for family/hospital contacts
630. Schizotypal ppl: have social anxiety. May have flat affect VS schizoid- dont have odd/magical thinking
631. Frostbite Tx: 1st- Rapid REWARMING with WARM WATER BATH(98.6-102.2). Analgesia. Debridement after
water bath based on extent of injury. Thrombolytics in very severe injury
632. Galactosemia( GALACTOSE-1-PHOSPHATE TRANSFERASE DEF): newborn/infant. hypoglycemia-as
seizures, cataracts, jaundice, vomiting, poor feeding, poor wt gain, hepatomegaly, splenomegaly. Inc RISK
for E. coli NEONATAL SEPSIS
633. Galactokinase Def: only cataracts, asymptomatic
634. Antidepressant adequate trial: >/= 6 weeks -> time for antidepressant to be effective
635. If switching from SSRI to MAO(phenelzine) give 5 week washout period to prevent serotonin syndrome
636. Clavicle fracture: Do neurovascular exam for brachial plexus, subclavian artery damage. If bruit heard, do
ANGIOGRAM
637. Right ventricular MI: ST elevation in aVF, inferior wall->50% chance of RV involvement. Clear lungs,
Low/normal JVP(</=3cm at 30-45% recumbency) or increased JVP, PROFOUND hypotension-> coz
impaired RV filling-> Cardiogenic shock
 17
nd
638. RV MI Tx: Isotonic saline bolus. 2 line- IV dopamine. Contraindicated: nitrates, diuretics, opiates
639. Parapneumonic effusions: In Immunocompromised(HIV/transplant). Pneumonia causes pleural effusion. If
infected-> empyema. Tx of empyema: Antibiotics+drainage (no drainage if effusion not infected)
640. PCP pneumonia in HIV: CD4 < 200. Non productive cough
641. Monosymptomatic enuresis: Atleast twice a week after 5yrs. Boys with family history are more prone. Tx:
1st line- behavioral, enuresis alarms. Pharma- ORAL Desmopressin(high relapse on discontinuation). TCAs
2nd line
642. Hormonal contraceptives: include ring, patch. Contraindicated in Breast Ca
643. Parkinsons earliest symptoms: asymmetric resting tremor in one/both hands. 4-5Hz. NOT accompanied
by gait/posture problems. Rigidity possible. Tx- anticholinergic (Trihexyphenidyl) for early stage
644. Radial head subluxation(nursemaids elbow): pronated arm against chest. In preschool children.
SWINGING/PULLING a child by arm. Tx- HYPERPRONATION or SUPINATION WITH FLEXION- full
recovery confirms Dx
645. INTRADUCTAL PAPILLOMA: Unilateral COPPER colored/Reddish brown/PINK NIPPLE discharge. blood.
Single duct involved. BENIGN. Arises from duct. Dx- Biopsy/duct excision
646. Benign Breast Cyst: Tender Fluid filled breast mass. Tx- Fine needle aspiration with drainage
647. Infiltrating Ductal Ca: discharge + lymphadenopathy + mass. Dx- microcalcifications
648. Decreased Cardiac Output-> dec venous O2 (MvO2)-> tissues extract more O2 from venous blood
649. Follicular Thyroid Ca VS Follicular Adenoma: Both same cytologically- follicular cells. Cancer INVADES
TUMOR CAPSULE/Bl VESSEL and spreads hematogenously. It is cold nodule and discovered incidentally
650. Medullary Thyroid Ca: Calcitonin levels used in Dx and follow up
651. Papillary thyroid Ca: ground glass cytoplasm. Psamomma bodies
652. Small Bowel Obstruction: Can present with acute vomiting+ abd pain+ abd distention +
dehydration/hypokalemia/orthostatic hypotension + hyperactive bowel. Cause: ADHESIONS coz of
surgery.Tx- nasogastric suction, bowel rest, observation
653. HIV and Hep B testing: High risk- multiple partners, homosexual men
654. Hep C testing: received blood transfusion before 1992, IVDU
655. IVDU with HIV: Have high suspicion of INFECTIVE ENDOCARDITIS- might look like pneumonia but ISNT-
fever, chills, pleuritic pain, CAVITARY lesions. Cause: SEPTIC EMBOLI. MCC- Staph aureus
656. Large VSD in kid: failure to thrive(dec wt gain), easy fatigability, tachypnea/shortness of breath. Classic
murmur- Left lower Pansystolic + diastolic rumble(inc flow across mitral valve)
657. TOF: left upper sternal border harsh, systolic murmur
658. Catatonia Syndrome: decreased motor activity+ lack of responsiveness during interview+ mutism. In mood,
psychiatric disorders or in medical illnesses.
659. Catatonia: Tx- 1st line: Benzos(lorazepam)- improvement with challenge test confirms Dx. 2nd line: ECT .
Antipsychotics are contraindicated
660. Anterior dislocation shoulder: MC joint dislocation. Axillary nerve injured- Teres minor + deltoid: weakened
abduction. Sensory loss over lateral shoulder. By blow to abducted, externally rotated arm
661. Winging of scapula: Long thoracic N injury. Cause: Axillary laceration or axillary lymphadenectomy
662. Radial N injury: affect extensor muscles of wrist

663. Mastitis: pain, redness, fever. Unilateral. Tx- antibiotics(dicloxacillin, cephalexin). If complicated by
abscess: FLUCTUANT, tender , palpable mass. Tx- needle aspiration under U/S. Keep breastfeeding
664. Breast abscess incision, drainage & packing: If >/= 5cm, not responding to antibiotics, necrotic material
665. Inflammatory Breast Ca: edema, redness, Peau dorange, retracted nipple, lymphadenopathy
666. Tests before starting Li: Thyroid tests, Kidney-Cr,BUN,urinalysis and ECG-those with CAD
risk(hypertension,DM,smoking). Periodic tests: 6-12 months. 5-7 days after dose change
667. Perforated Peptic ulcer with intraperitoneal free air: Tx- urgent exploratory laparotomy
668. Q waves on ECG- OLD MI
669. Atheroembolism(Cholesterol embolism): CARDIAC CATHETAR complication. Signs: livedo reticularis, GI
ischemia, Kidney injury, blue toe syndrome(cyanotic toe+intact pulses), pancreatitis, retinal artery may have
yellow, refractile plaques- Hollenhorst plaques. Tx- supportive, statins
670. Osteomyelitis: MCC in children/infants- Staph. MCC in SCD- Salmonella
671. Ectopic Pregnancy DX: Beta-hCG + TRANS VAGINAL ULTRASOUND. Tx of ruptured ectopic preg with
hemodynamic instability and abd pain: Laporoscopy. Do laparotomy if acute bleeding
672. Blood/fluid in Cul-de-sac(post vaginal wall)- Means ruptured ectopic pregnancy
673. Pseudocyesis: somatization of stress affects hypothalamic pituitary gonadal axis. Non psychotic
674. Missed abortion: Non viable intrauterine pregnancy
675. MgSo4: prevention of eclamptic seizures
 18
676. Mg toxicity: In renal insufficiency-> e.g HELPP. Respiratory depression, somnolence, loss of reflexes. Tx-
Ca gluconate
677. Pre-eclampsia: newly diagnosed at >/= 20 wks. Hypertension + end organ damage OR hypertension +
proteinuria
678. Pre-eclampsia tests: 2 BP readings >/= 4 hrs apart. Proteinuria test: Urine protein/Cr ratio >/=0.3 or 24hr
total protein excretion >/= 300mg
679. Splenic Injury symptoms: hypotension, anemia, pleuritic pain, abd guarding, left shoulder pain. Dx-
hemodynamically stable- DO CT if FAST negative. Do CT without FAST if altered mental status. Exploratory
laparotomy- Hemodynamically unstable with positive FAST
680. Amaurosis fugax(PAINLESS transient loss of vision in one/both eyes): Cause- embolus in retinal artery.
Retina is white with red spots. Tx- ocular massage to dislodge embolus. Oxygen(hyperbaric) therapy.
681. Acute angle closure glaucoma: red, painful, sudden vision loss. Tx- beta blocker, pilocarpine
682. HCM: MITRAL valve LEAFLETS systolic ANTERIOR motion contributory. Symptoms: exertional dyspnea,
syncope, palpitations, chest pain, fatigue
683. MR: dilation of mitral annulus in dilated/ischemic cardiomyopathy. Murmur radiates to axilla
684. Tourette: Comorbid conditions- OCD(peak in adolescence/early adulthood) and ADHD
685. Myasthenia Gravis: Extra ocular- ptosis, diplopia & bulbar- dysarthria, dysphagia
686. HUS: toddlers. 90% by shigella/E. coli 0157:H7 preceding diarrhea. 10% by Strep pneumo-preceding
meningitis/pneumonia. Tx- Supportive. 50% kids req dialysis for renal failure
687. HSP DOESNT have purpura
688. Normal deep tendon reflexes: 2+. Hyper-reflexive: 4+ Clonus: 5+
689. NMS has RIGIDITY + normal reflexes + inc CK+ leukocytosis VS Serotonin syndrome has MYOCLONUS +
hyperreflexia + GI symptoms(vomiting, diarrhea)
690. Acute dystonia Tx: Diphenhydramine
691. Growing pains: Bilateral leg pains in 2-12yo kids at night. Everything is normal. Tx- reassurance, massage
692. Osteoid Osteoma: in 20s. Unilateral leg pain worse at night. Limp + tenderness.
693. Perivalvular abscess: suspect when Conduction block/abnormality arises in an IE patient. IVDU risk factor
694. Conduction abnormalities seen with AV valve problems not tricuspid
695. Conduction block in heart may cause syncope
696. AR: when caused by valvular problem-early diastolic murmur in left 3rd/4th. When aortic root disease- right
border
697. Prothrombin Complex Concentrate(PCC): contains Vit K dependent clotting factors: 2,7,9,10
698. Warfarin assoc hemorrhage Tx: 1st line PCC. If not available then fresh frozen plasma. IV Vit K lastly-takes
12-24 hrs to act
699. Protamine sulfate- Heparin reversal
700. HIT Tx- argatroban
701. VSD- holosystolic murmur at lower left sternal border
702. Cyanide toxicity: Causes neuro signs- seizures, altered mental status, coma, lactic acidosis. Seen in inc
NITROPRUSSIDE infusiom +/- renal failure-> given for hypertensive emergency
703. Hypertensive emergency: severe hypertension(>/=180/120) + end organ damage
704. Severe hyperkalemia(>7): DOESNT cause SEIZURES. Cause arrhythmias, muscle weakness/paralysis
705. TCA overdose: apart from cardiotoxic, causes- anticholinergic + CNS(sedation, seizure, coma)
706. Primary prophylaxis (before disease) in HIV with CD4<200: TMP-SMP->for pneumocystis pneumonia. For
CD4<50: Azithromycin/clarithromycin-> for M. avium
707. Lumbar Spinal Stenosis: Back pain radiating down thighs +legs. Tingling +numbness. BILATERAL.
RELIEVED with SPINE FLEXION VS Lumbar Disk Herniation: UNILATERAL + inciting event. WORSE with
FLEXION
708. Parkinsons tremor: Starts in one hand. More pronounced with distractibility (performing mental tasks)
709. UPPER GI Bleeding (NOT LOWER GI bleed)- Inc BUN/Cr
710. HIV tests: SCREENING- Assay for p24 antigen + HIV antibodies. Confirmatory- HIV1/HIV2 antibody
differentiation immunoassay. HIV RNA for those with negative blood tests but high HIV suspicion
711. HCV risk: born between 1945-65, Blood transfusion before 92 or clotting factors before 87
712. MCC of out of hospital sudden cardiac arrest: Ventricular tachycardia/fibrillation due to MI
713. Most critical factor affecting survival in SCA: Time to effective resuscitation- CPR (COMPRESSION ONLY.
NOT RESCUE BREATHING) + rhythm analysis + defibrillation
714. Epinephrine in SCA: if asystole/PEA/refractory ventricular arrhythmia to resuscitation
715. Normal Anion Gap: 6-12
716. Vasospastic angina (prinzmetals/variant): episodes of chest discomfort at night/during rest. Typically in
young without CAD risk. Its coz of arterial VASOSPASM. ST elevation during episode. Dx- ambulatory
ECG. Tx- CCB
717. Lacunar strokes: Coz of lipohyalinosis/microatheroma from hypertension/DM. Basal ganglia, Pons, white
matter arteries blocked
 19
718. Normal person STD test: Just do HIV. No need for Herpes, Gonorrhea, Hep C, Syphilis if no risk factor or
pregnancy
719. SBO: look for any previous surgery in question- ADHESIONS is cause. Vomiting + abd pain+ hyperactive
bowel sounds. Labs: MILD leukocytosis, amylase increase. Tx- nasogastric suction, iv fluids, bowel rest
720. Complicated SBO: change in pain, fever, hemodynamic instability (hypotension, tachycardia), metabolic
acidosis. Tx- Urgent exploratory laparotomy
721. SBO has obstipation(no shit) and air fluid levels VS mesentric ischemia which doesnt
722. Pinworm(enterobius vermicularis): may present as vulvovaginitis with ITCHING at NIGHT more so in school
kids. Question may try to distract with skin condition or abuse. Dx- tape test. Tx- albendazole, pyrantel
pamoate(for househole contacts too)
723. Tension pneumothorax-> obstructs vena cava-> dec RA blood-> dec LA and cardiac output
724. MI can cause-> Cardiogenic shock-> Severe hypotension, dyspnea(pulm edema) and chest pain
725. Common Fibular N injury: Problem walking on heels(dorsiflexion. CAN walk on toes(plantar flexion).
UNILATERAL foot drop. TRANSIENT Tingling+ Numbness over DORSUM. Compressive injury-Bed rest,
Cast
726. Ant. Chord Syndrome (SPINAL ART ATHEROTHROMBOSIS): bilateral symmetric acute paralysis +
bladder/bowel dysfunction. Diminished pain/ temp. preserved vibration/proprioception
727. Reactive arthritis: ENTHESITIS and MUCOCUTANEOUS LESIONS like mouth ulcers when present with
urethritis and asymmetric oligoarthritis should raise suspicion. Classic triad not always present. Tx- NSAID
728. Gonococcal arthritis and reactive arthritis look similar except former has fever
729. Depersonalization/derealization disorder: Memory intact. Feelings of unreality/detachement
730. Dissociated amnesia: localized or selective amnesia(autobiographical). Called dissociative fugue when
associated with purposeful travel
731. Dissociated identity disorder: 2 or more identities
732. Factitious: assume sick role VS malingering: external incentive
733. Reye: MICROVESICULAR hepatic steatosis. Encephalopathy coz of hyperammonemia. ^transaminases +
^PT/PTT/INR
734. MACROVESICULAR steatosis: Alcoholic/NAFLD hepatitis
735. Biliary atresia: Bile plugs, portal tract edema, fibrosis
736. Intraventricular hemorrhage(4 grades) in newborns: risk inversely proportional to BIRTH WEIGHT. Risk:
PREMATURE infants. Dx- transfontanel U/S- shows germinal matrix bleed. Symptoms- focal neurological
signs, bulging fontanel, cyanosis, pallor, hypotension, seizure, bradycardia
737. Vesico-uretral reflux- RECUREENT UTIs and PYLEONEPHRITIS in infants/children. Dx- Voiding
Cystourethrogam. Complications- renal insufficiency, anemia, hypertension. Tx- prophylactic TMP-SMZ.
Surgery in grade 3-4
738. Renal scintigraphy with dimercaptosuccinic acid: evaluation of renal scarring
739. Autosomal recessive polycystic kidney disease kids: potter facies, respiratory distress(pulm hypoplasia),
flank masses
740. Dermoid cyst(teratoma): CALCIFICATIONS with HYPERECHOIC NODULES
741. Follicular cysts: small physiologic cysts in 1st half of menstrual cycle. Asymptomatic
742. PCOS: ovaries with multiple simple cysts
743. Theca lutein cysts: In PREGNANCY. Bilateral multi-septated cysts. Stimulated by Beta-hCG
744. Ovarian torsion: In OVARIAN MASS. Acute unilateral pelvic pain, fever, nausea vomiting. Tangles around
ligaments which carry bl supply-> ischemia. Dx- U/S showing ischemia. TX- surgical detorsion, cystectomy
745. Acute Pancreatitis: Inc LIPASE IRRESPECTIVE of etiology. Hypertrigyceridemia- 3rd MCC
746. Eruptive xanthomas: Familial hypertriglyceridemia. Do fasting serum lipid profile
747. ERCP: done if biliary pancreatitis suspected-> ALT>150 OR recurrent pancreatitis of unknown etiology
748. Gestational hypertension: after 20 weeks
749. White coat hypertension: not with diastolic above 105
750. Hypertension in pregnancy effects on fetus: Preterm, oligohydramnios, fetal growth restriction
751. Influenza in elderly: >65yo and chronic medical illness(DM, CAD) develop complications-> Pneumonia
MCC: Influenza(bilateral, diffuse infiltrates, leukocytosis <15K) , Strep Pneumo(lobar, leukocytosis >15K)
752. RSV causes wheezing
753. Croup (laryngotracheitis): 3mnth-3yo kids. GRADUAL ONSET. Non specific URTI symptoms. STRIDOR
(high pitched breathing sound) MOST imp- inspiratory or biphasic in severe. Other symptoms maybe-
fever, suprasternal retractions, barking cough.
754. Croup: Dx- Steeple sign on XRay. Tx- Corticosteroids. Racemic epinephrine added for stridor at rest
755. Bronchiolitis: Wheezing NOT stridor/cough
756. Wheezing is lower resp tract and prominent in expiration VS stridor is upper resp tract and prominent in
inspiration
757. Retropharyngeal abscess: Limited rotation of neck. MC in <4yo
 20
758. Gastrinoma (Zollinger-Ellison): jejunal ulcers, multiple ulcers, diarrhea, thickened gastric folds. Dx- Fasting
serum gastrin >1000 pg/ml. 20% assoc with MEN 1
759. Secretin stimulation test: Increased gastrin means gastrinoma otherwise not
760. Provoked DVT Tx: Anticoagulation. Duration- 3 months. Target INR: 2-3
761. Anticoagulation in ESRD: Unfractionated Heparin bridge(4-5 days) with long term warfarin. LMWH and
rivaroxaban contraindicated
762. IVC filter: Used in DVT where anticoagulation is contraindicated- active bleeding or high risk of
763. RCC: Hematuria (40%) . Constitutional symptoms(20%)- fever, fatigue, wt loss. Unilateral Varicocele(10%)-
doesnt reduce when recumbent. LABS: ^Hb, ^PLATELETS(may look like blood cancer)-
ERYTHROPOIETIN, PARANEOPLASTIC. Dx- CT abd
764. Developmental dysplasia of hip: leg length discrepancy, asymmetric inguinal skin folds, palpable clunk on
Barlow/Ortolani maneuvers. Dx: U/S- <4 months. XRAY- >4 months. Tx- Pavlik harness
765. Congenital dermal melanocytosis: Blue-grey macule on sacrum. Benign
766. MCD: <10 yo kids, nephrotic syndrome. foot processes effacement of podocytes on EM. Light microscopy
& immunofluorescence are normal. Tx- Corticosteroids
767. Second gen antipsychotics side effect: METABOLIC- Hyperglycemia, dyslipidemia, wt gain, risk of DM.
Olanzapine & clozapine greatest risk. Tests- baseline, 3 mnths, annual: fasting glucose, lipids, BP, waist
768. Agranulocytosis: Clozapine NOT olanzapine
769. Herpes Zoster: MC after 50 yrs age. localized pain(triggered by stress like CANCER/immunocompromised),
BURNING, HYPERESTHESIA, then comes vesicular rash. Tx- acyclovir dec likelihood of post herpetic
neuralgia
770. Unprovoked 1st ep of DVT, test to do: Age appropriate cancer screening
771. Lung Ca screening: Annually 55-80 yo in those with >/= 30 pack yrs AND quit within last 15 yrs/current
smoker. Dx- Chest CT
772. Primary ovarian insufficiency: Ovarian failure before 40 yo age. Infertility + irregular cycles OR menopause.
Have Hx of autoimmune disorder(hypothyroidism) or turners
773. PCOS: ^GnRH, ^LH, NORMAL FSH, ^ Estrogen(peripheral conversion)
774. Zenkers diverticulum: swallowing difficulty, regurgitation, halitosis, aspiration pneumonia, palpable mass(If
big). Dx- CONTRAST ESOPHAGRAM NOT endoscope coz may cause perforation
775. Aortic Arch Injury: MEDIASTINAL widening, anxiety, tachycardia, hypertension. Can present WITHOUT
hypotension. Have high suspicion in MVA and fall from >10 feet. Dx CXR. If unequivocal- CT & angio
776. Hypertensive hemorrhage affect: BASAL GANGLIA (PUTAMEN), cerebellar nuclei, thalamus, pons, internal
capsule. Small penetrating arteries involved
777. Time progression of neuro deficits: In SAH & embolic stroke- maximal at onset. In thrombotic stroke-
stuttering progress. In hypertensive hemorrhage- gradual over mins/hrs
778. Lobar hemorrhage: >60 yo coz of amyloid angiopathy
779. Medial medullary syndrome: verterbral/spinal artery occlusion. Contralateral arm+ leg paralysis,
contralateral loss of position sense, tongue deviation towards lesion
780. Conversion disorder: Acute onset neuro symptoms assoc with stress not compatible with any disease
781. Neonatal abstinence syndrome: Opiods(Heroin) addict mom. HIGH PITCHED CRY, seizures, tremors, poor
sleeping, vomiting, diarrhea, sweating, tachypnea. Tx- small frequent feeds, low stimulus environment,
swaddling. Pharma- morphine
782. Ixodes Scapularis Tick: Causes Anaplasmosis, Lymes and Babesiosis. Should be attached 2-3 days. NE
USA
783. Babesiosis: In immunocompromised or >50yo or splenectomy ppl. Flu like symptoms(fever, chills, malaise)
Intravascular hemolysis vignette with tick history. Dx- BLOOD SMEAR- maltese cross. Tx- Atovaquone +
Azithromycin (7-10days) OR Quinine + Clindamycin (sever illness)
784. SLE can cause ACUTE PYSCHOSIS 1st symptom of neuropsychiatric SLE. Can cause depression, mania,
anxiety. THROMBOCYTOPENIA and MIGRATORY SYMMETRIC ARTHRITIS
785. Anit-psychotic induced parkinsonism- Risperidone MC in 2nd gen antipsychotic apart from 1st gen. looks
like depressed mood (mask like facies), slowed movt (bradykinesia). Tx- Benztropine(anti-cholinergic),
Amantadine(NMDA antagonist)
786. Cell free fetal DNA test of maternal plasma: For women >/= 35 yo -> fetal aneuploidy risk. Done at >/= 10
wks preg. Detects trisomy 21,18,13, fetal sex, sex chromosomal abnormalities
787. Amniocentesis: In 2nd trimester
788. Fetal karyotyping: In 1st trimester
789. Quadruple Screening: 2ND TRIMESTER. Trisomy 18: everythin dec, inhibin A normal. Downs: B-hCG +
Inhibin A^, AFP + Estriol dec. Neural tube defects: AFP inc, everything else normal
790. Febrile non-hemolytic blood transfusion rxn: 1-6 hrs after. Due to CYTOKINES released during bl storage
791. PE can cause FEVER
792. Endometrical Ca: Abnormal menstrual bleeding. ESTROGEN excess cause in OBESE. Tx-
hysterectomy+staging+chemo/radio
 21
793. Shock liver/Ischemic hepatic injury: MASSIVE TRANSAMINASES(>1000) ACUTELY. Cause:
HYPOTENSION- septic shock, heart failure. Tx- self limited
794. Alcoholic liver disease: AST <300
795. Newborn care: Clear airway secretions>Dry and keep warm (thermoregulatory centre
underdeveloped)>give sliver nitrate (prevent gonococcal ophthalmia)> give Vit K
796. Pheochromocytoma/Paraganglionomas: Paroxysms of HIGH BP, PALLOR(vasoconstriction) in->surgery;
anesthetic; intra-abd pressure(tumor palpation, positional change); beta blockers. Tx- give alpha
blockers(phenoxybenzamine)
797. Brocas area: in FRONTAL lobe. Has difficulty speaking, repeating but UNDERSTANDS. Expressive
aphasia
798. Arcuate: can speak and understand fine. Very poor repetition VS Wernicke: Poor understanding and
repetition
799. MCL tear: medial joint line tenderness, ecchymosis. Tx- RICE, analgesics
800. ACL tear: Acute HEMARTHROSIS
801. Drug induced interstitial nephritis: EOSINOPHILIA, EOSINOPHILURIA, FEVER, ARTHRALGIA, RASH. NO
RBC casts but WBC casts may be present
802. Post strep glomerulonephritis: 10-20 days after skin/throat infection. Nephritis symptoms + RBC Casts +
Low C3
803. Interstitial cystitis: PAINFUL bladder syndrome. Unknown etiology. Pain with bladder filling, pain with ant
vaginal wall palpation, sex, exercise, alcohol. Relieved by voiding. Urgency, frequency ^. Tx- palliative
804. Cystocele: Bladder prolapse into vagina
805. Acute Cholangitis: jaundice, fever, RUQ pain (charcot triad) + HYPOTENSION, CONFUSION (Reynolds
pentad- in severe cases). Labs: ALP^, leukocytosis, neutrophilia. Dx- U/S or CT shows CBD dilation. Tx-
antibiotics, biliary drainage ERCP with sphincterotomy or percutaneous transhepatic cholangiography
806. Acetominophen toxicity: transaminases >3000
807. Primary sclerosing cholangitis: cholestasis but chronic. Asymptomatic or PRURITIS+ FATIGUE
808. Brain death: Brain stem and cortical function loss. Spinal cord may still be active- deep reflexes present
809. VZV post exposure prophylaxis in non immune: Vaccination in immunocompetent and Immunoglobulin in
immunocompromised. Nothing in kids <1yr
810. Compartment syndrome: Eschar can cause(3rd degree burn)-> venous/lymphatic drainage obstruction. Pain
+ Swelling. PALLOR, decreased sensation. Tx- Escharotomy)if burn. Fasciotomy
811. Toxoplasmosis: Dormant. Reactivate in immunocompromised. Advanced HIV (CD4<100): high risk.
ECNCEPHALITIS form MC: fever, focal neuro defects, headaches. Tx- sulfadiazine + pyrimethamine
812. Acute psychosis Tx: 1st line- 2nd GEN Anti-Psychotic except clozapine (only after 2 failed trials) coz of EPS
side effects of 1st Gen
813. Tests before starting lithium: Ca, Kidney tests, Thyroid tests, ECG- causes DI, thyroid dysfunction,
hyperparathyroidism
814. Ovarian mass in POST MENOPAUSAL woman: Rule of Ca-> Do ultrasonography(large, septations, solid
are concerning) + CA-125 (raise in malignancy). Role of CA-125 in pre-menopausal limited as seen in other
diseases too
815. Epithelial ovarian Ca risk factors: Nulligravid, BRCA mutation, inc age, use of fertility drugs
816. Serum sickness like rxn by Beta-lactams and TMP-SMX. 1-2 wks after drug started. Symptoms-
Polyarthralgia (painful, tender joints), Fever, Urticaria, lymphadenopathy. Labs- Elevated ESR, CRP,
hypocomplementemia. Tx- stop drug. If severe- give glucocorticoid
817. HSP rash- legs not arms. Scarlet fever rash is SANDPAPER like.
818. Stevens Johnson has painful hemorrhagic oral lesions
819. HELLP syndrome: Abnormal placentation-> SYSTEMIC INFLAMMATION->Coagulation cascade activation-
>Platelets used + thrombi in portal tract-> hepatocellular necrosis. Symptoms: nausea, vomiting,
epigastric/RUQ pain
820. HELLP Fetus management: deliver if >/=34wks. Deliver if abnormal fetal testing or worsening maternal
status at any fetal age
821. Infectious mono complications: Autoimmune hemolytic anemia, thrombocytopenia-> inc bilirubin,
transaminases 2-3 weeks later
822. Conductive hearing loss: obstruction of ext sound to inner ear. Causes- cerumen, middle ear
tumor/fluid/infection, dec movt of small bones of ear. OTOSCLEROSIS is a common cause- 20-30yo,
mainly females, treated by hearing aid or stapedectomy
823. Sensorineural hearing loss: involving inner ear, cochlea, auditory nerve. Causes- Menieres, presbycusis,
ototoxic drugs, acoustic neuroma/vestibular schwannoma
824. Rinne Test: Normal- Air conduction > Bone conduction. Abnormal in conductive hearing loss
825. Weber Test: lateralises to ear with abnormal rinne or conductive hearing loss. Opp in sensorineural
 22
826. Actinomyces: slow growing , NON tender mass, sinuses. Direct invasion following trauma/infection in
mouth. Immunocompromised more susceptible. Tx- Mild dx- oral penicillin. Severe dx- IV penicillin +/-
surgery
827. Nocardia: gardening, farming. Non painful chronic skin lesions with sinuses. Tx- TMP-SMX
828. New bone formation steps: Osteoclasts create cavity on bone surface-> osteoblasts fill it up with matrix->
Ca and Phosphorous deposit in matrix to mineralize it
829. Vit D/Calcium deficiency- No mineralization. Calcium and phosphorous BOTH needed for mineralization
830. Pagetss: Accelerated focal bone remodeling
831. Tx of pain crisis, acute chest syndrome in SCD: Hydroxyurea- side effect: Myelosuppression (neutropenia,
thrombocytopenia, anemia)
832. Long distance flights do not qualify as immobilization in wells criteria
833. Normal D-Dimer useful in excluding PE in those with high NPV for PE. Inc doesnt rule in PE and CT would
need to be done to confirm and normal in those with high PPV for PE doesnt rule out PE
834. Postpartum Urinary retention: causes- epidural, perineal edema, nulliparity, prolonge labour. Tx-
CATHETARISATION
835. Bladder capacity: 350-400ml. Post-void vol: <150ml in women
836. Urge incontinence Tx- Oxybutynin: anticholinergic
837. Carpal tunnel: pain + paresthesia particularly at NIGHT. Tx- 1st line: wrist splinting at night. 2nd line-
corticosteroids. 3rd line: decompression surgery
838. Leukocyte adhesion deficiency: SKIN (cellulitis, omphalitis, abscess) + MUCOSAL (periodontal) infections +
poor healing + no pus(no neutrophils). Labs: LEUKOCYTOSIS, NEUTROPHILIA during infection.
839. Complement deficiency: Infection with encapsulated- strep PNEUMO, H. influenza, N. meningitidis
840. Methylphenidate: Tx of ADHD. Biggest side effect: Dec appetite
841. All patients of cirrhosis should have screening ENDOSCOPY even if guaiac negative- to determine risk of
varices and their prevention
842. Most imp management in cirrhosis first and foremost: Pr prophylaxis for variceal bleed in those with
medium/large or small with risk of bleeding varices- Esophageal Variceal Ligation OR non selective beta
blockers which dec portal hypertension
843. TIPS: Tx for refractory ascites and variceal bleeds not responding to ligation/medical Mx
844. Safe vaccines in pregnancy: Tdap, Rho D, Injectable Influenza NOT intranasal. Influenza vaccine imp to
prevent maternal morbidity and can be given in any semester
845. Macular degeneration: MC cause of blindness in US. Risk factors: Increasing Age, Smoking. Dx- GRID
TEST- straight lines appear wavy. Difficulty reading, driving. fundoscopy- drusen deposits in macula
846. Hydroxychloroquine: side effect- RETINAL TOXICITY. Tx for SLE. Do baseline eye exam, then annual exam
after 5 yrs as side effect shows up after 5-7 yrs therapy
847. PAINFUL, TENDER mobile breast mass in <30yo woman: Benign if simple cyst. Tx- Aspirate and FOLLOW
up in 2-4 months, then annually if resolved. Ultrasound will show posterior acoustic enhancement-fluid
848. We dont do mammography <30yo coz not beneficial
849. Breast MRI done in BRCA carriers/1st degree relative or in known Breast Ca to evaluate recurrence
850. BCC Tx: trunk or extremities- electrodessication & curettage. Face/cosmetic/high risk- Mohs surgery: thin
layers removed & microscopically inspected
851. Types of BCC: 1. Pearly/Nodular 2. Ulcerated with rolled borders 3. Pale scar like 4.
Oozing/bleeding/Crusted sore 5. Red/irritated area
852. Pneumonia in Cystic Fibrosis: KIDS-STAPH AUREUS. ADULTS- PSEUDOMONAS AERUGINOSA
853. Uncomplicated cystitis(suprapubic tenderness, dysuria, urgency) Tx: TMP-SMX (3days) OR
NITROFURANTOIN (5days) OR FOSFOMYCIN (1day). Dx- urinalysis. Culture only if Tx failure
854. Complicated cystitis(DM, Preg, CKD, catheter, nosocomial) Dx- DO culture before therapy. Tx: oral
fluoroquinolones
855. Pyelonephritis: FEVER + FLANK PAIN. Take sample for Culture before starting Tx.
856. Sickle cell kids susceptible to sepsis(Leukocytosis + bandemia) with: STREP PNEUMO(have functional
asplenia) even with vaccination coz of non vaccine serotypes. PROPHYLAXIS with PENICILLIN till 5yo age
857. TSS: Staph aureus: shock symptoms + diffuse red macular rash + thrombocytopenia + vomiting +
diarrhea+ fever. Tx- IV fluids + remove foreign body + anti staph aureus antibiotics
858. Upper GI perforation: Tx- Exploratory Laporatomy NOT Endoscopy
859. Randomization in a study prevents CONFOUNDING NOT effect modification
860. Normal pupil size: 2-4mm in bright light. 4-8mm in dark
861. Most predictive & reliable sign of OPIOD intoxication: DEC RESP RATE. Other sympstom- Altered mental
status + HYPOTHERMIA + miosis(may not be due to co-ingestants). Tx- NALOXONE + protect airway +
improve ventilation
862. SITUATIONAL/REFLEX syncope: During micturition/coughing/defecation coz of neutrally mediated
Cardioinhibitory/vasodepressor response
 23
863. Innocent childhood murmurs: Grade I/II. Decrease with standing, peak early/mid systolic. Tx- Nothing.
REASSURANCE
864. Allergic rhinitis: Tx- Intranasal Corticosteroids
865. Acute urinary incontinence in elderly: ATYPICAL SYMPTOMS- Do Urinalysis+ culture first coz maybe UTI
even if no fever
866. CMV retinitis: PAINLESS, hemorrhagic/fluffy/granular lesions on retina. NO conjunctivitis or keratitis
867. HSV/VZV retinitis in HIV: PAINFUL + Conjunctivitis, keratitis. Fundoscopy- Pale periphery and central
retinal necrosis
868. Aortic stenosis: SOFT S2. mid-late systolic murmur
869. Osler Weber Rendu: Recurrent epistaxis, telangiectasias (ruby colored papules). AVM cause-
POLYCYTHEMIA(^hematocrit), HYPOXEMIA
870. Benzodiazepine overdose: Slurring + drowsiness + unsteady gait+ lethargic
871. Phenytoin toxicity: horizontal NYSTAGMUS + cerebellar ataxia + confusion
872. Blunting of costophrenic angle: hemothorax or pleural effusion
873. ICH: headache + poor SLEEP(headache worse at night) + focal neuro signs (BLURRY VISION or unsteady
gait) +/- mental changes(cognition affected/falls) +/- nausea/vomiting +/- papilledema. Symptoms worsen
with maneuvers that inc intracranial pressure- Valsalva/Cough/leaning fwd
874. Cushing reflex: (hypertension + bradycardia + respi depression)-> brainstem compression
875. Sinusitis: headache worsens by leaning fwd. purulent nasal discharge
876. Non contrast CT DOESNT pick ischemic stroke only hemorrhagic
877. Ischemic stroke Tx: Give aspirin within 24 hrs and continue indefinitely
878. Morton neuroma: mechanically induced neuropathic injury in runners. Pain + numbness + burning from
metatarsals to 3rd-4th toes. Dx- Mulder sign- crepitus on squeezing 3rd+4th toe & plantar pain. Tx- shoe
insert below metatarsals. If fails then surgery
879. Plantar fasciitis: Point tenderness at REAR FOOT/HEAL NOT forefoot
880. Tarsal tunnel syndrome: fracture at ankle-> pain, numbness, burning distal foot coz of tibial N
compression.
881. Post Hep B exposure: if unvaccinated -> Hep B immunoglobulin + vaccinate
882. Hep B immune titre: >/= 10 mIU/ml
883. Methanol damages EYE(OPTIC DISK HYPEREMIA) VS Ethylene glycol damages KIDNEYS
884. Methanol poisoning symptoms: epigastric pain, nausea, vomiting
885. Side effect after starting anti-thyroid drug(propylthiouracil/methimazole): FEVER + SORE THROAT-> means
agranulocytosis-> STOP DRUG + give antibiotic + G-CSF(to inc WBC)
886. Why ARDS coz of IV fluid infusion ?
887. Ulcerative colitis: Bimodal: 15-40 yo & 50-80yo. +/- WT LOSS +/- fecal incontinence +/- ARTHRITIS +/-
uveitis +/- erythema nodosum +/- PRIMARY SCLEROSING CHOLANGITIS. Labs: ^ESR, ^WBS.
Endoscopy- RED, FRIABLE mucosa
888. C. deficille WATERY DIARRHEA
889. ADHD before age 12
890. Perimenopause (menopausal transition): begins yrs before menopause. Symptoms- insomnia + wt gain +
fatigue + irregular periods
891. Menopause: confirmed by ^FSH
892. Hereditary spherocytosis: Prone to bilirubin GALLSTONES, APLASTIC CRISIS (B19 causes). Have
INCREASED RBC distribution width. Dx- 1)eosin-5-maleimide binding test 2) osmotic fragility test
893. Hb A2- Beta thalassemia. Hb F- Beta thal, SCD, congenital aplastic anemia
894. Cytoscopy: visualizes bladder. Done for bladder Ca
895. Fibroids can cause urinary stress incontinence. Dx- Pelvic U/S
896. Thymus seen in CXR in kids <3yo
897. 1st Line Tx for smoking cessation: 1) Nictotine replacement (patches/gum) 2) Varenicline 3) Bupropion
898. Varenicline: Side effect- mood changes/suicidality and contraindicated in patients with cardiac illness
899. Asymmetric fetal growth restrictions: Head larger than abd coz in 2nd/3rd trimester abd grows but coz of
placental dysfunctions->maternal hypertension, gestational DM->blood shunted to vital head
900. Symmetric fetal growth restriction: 1st trimester-> aneuploidy, infections(TORCHS). Whole body small not
just abd
901. Fetal growth restriction: <10% wt for gestation
902. Diverticulitis: Dx- fever, LLQ pain, nausea. Labs- ^WBC. 2 types:1) complicated 2)uncomplicated-give
antibiotics+bowel rest
903. Complicated Diverticulitis: 1) perforation 2 )obstruction 3)peritonitis 4)abscess-Tx: CT guided drainage. If
fails, surgical drainage
904. Aspirin (salicylate) toxicity: Resp Alkalosis(tachypnea) + Metabolic acidosis(anerobic respi). FEVER+
TINNITUS
905. Acid Base correct compensation: PaCO2=(1.5 x HCO3) +8 +/-2 | HCO3=0.1 x PaCO2
 24
906. Normal PaCO2: 36-44 Normal HCO3: 20-28
907. ADPKD complications: 1)colonic diverticula 2) hernia 3) Mitral prolapse/AR
908. Supracondylar fracture in kid: MC fracture coz supracondylar are thin and weak in kids coz of remodeling.
Outstretched hands. Complications:1) Brachial art 2) Median N 3) Volkmann contracture 4) Cubitus Varus
909. Crohns: 15-40yo. Symptoms: mouth to anus->skin tags, anal fissures, aphthous ulcers(canker sores),
arthritis. Risk factor-smoking. Tx- 5-aminosalicylic acid. If severe- corticosteroids/biologicals(infliximab)
910. Chagas: south America. MEGACOLON/MEGAESOPHAGUS + Cardiac
911. Cardiac arrhythmia patients: Prone to SYNCOPE (seizure possible in prolonged syncope)
912. Stool osmotic gap: 290 2 [stool Na + stool K] = if >100: osmotic diarrhea. If <50: secretory diarrhea
913.