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Murmur—hypertrophic obstructive cardiomyopathy (HOCM).
Systolic ejection murmur heard along the lateral sternal border that ↑ with Valsalva maneuver and standing.
Diastolic, decrescendo, high-pitched, blowing murmur that is best heard sitting up; ↑ with ↓ preload (handgrip maneuver).
Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ preload (Valsalva maneuver).
Treatment for atrial fibrillation and atrial flutter.
If unstable, cardiovert. If stable or chronic, rate control with calcium channel blockers or β-blockers.
Autoimmune complication occurring 2-4 weeks post-MI.
Dressler's syndrome: fever, pericarditis, ↑ ESR.
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve.
Diagnostic test for hypertrophic cardiomyopathy.
Echocardiogram (showing thickened left ventricular wall and outflow obstruction).
Eight surgically correctable causes of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.
Indications for surgical repair of abdominal aortic aneurysm.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured.
Treatment for acute coronary syndrome.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin.
What is metabolic syndrome?
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.
ECG findings suggesting MI.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves.
Coronary territories in MI.
Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal).
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
A young patient with a family history of sudden death collapses and dies while exercising.
Endocarditis prophylaxis regimens.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after.
The 6 P's of ischemia due to peripheral vascular disease.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia.
The most common cause of hypertension in young women. The most common cause of hypertension in young men.
OCPs. Excessive EtOH.
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
Basal cell carcinoma.
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Acanthosis nigricans. Check fasting blood glucose to rule out diabetes.
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Alopecia areata (an autoimmune process).
Pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-meatballs" appearance.
Four characteristics of a nevus suggestive of melanoma.
Asymmetry, border irregularity, color variation, and large diameter.
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma.
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma.
The most common cause of Cushing's syndrome.
Iatrogenic corticosteroid administration. The second most common cause is Cushing's disease.
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis.
1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia).
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
Should α- or β-antagonists be used first in treating pheochromocytoma?
α-antagonists (phentolamine and phenoxybenzamine).
A patient with a history of lithium use presents with copious amounts of dilute urine.
Nephrogenic diabetes insipidus (DI).
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
SIADH due to stress.
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids.
A patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus.
A 25-year-old Jewish man presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.
Inflammatory disease of the colon with ↑ risk of colon cancer.
Ulcerative colitis (greater risk than Crohn's).
Extraintestinal manifestations of IBD.
Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis.
Difference between Mallory-Weiss and Boerhaave tears.
Mallory-Weiss—superficial tear in the esophageal mucosa; Boerhaave—full-thickness esophageal rupture.
Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis.
A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157: H7.
Classic causes of drug-induced hepatitis.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.
A 40-year-old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Biliary tract obstruction.
A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make the patient NPO and give IV fluids, O2, analgesia, and "tincture of time."
Four causes of microcytic anemia.
TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia.
An elderly man with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer.
Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides, antimalarial drugs, fava beans.
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café au lait spots, microcephaly, and pancytopenia.
Medications and viruses that lead to aplastic anemia.
Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV.
How to distinguish polycythemia vera from 2° polycythemia.
Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels.
Thrombotic thrombocytopenic purpura (TTP) pentad?
"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities.
Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids.
Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.
Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.
An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements.
A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?
von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate.
A 60-year-old African-American man presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones.
A 10-year-old boy presents with fever, weight loss, and night sweats. Exam shows an anterior mediastinal mass. Suspected diagnosis?
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
Anemia of chronic disease.
An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL).
A late, life-threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever, bone pain, splenomegaly, pancytopenia).
A 50-year-old man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.
A 25-year-old African-American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2, analgesia, hydration, and, if severe, transfusion.
A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine.
The three most common causes of fever of unknown origin (FUO).
Infection, cancer, and autoimmune disease.
Four signs and symptoms of streptococcal pharyngitis.
Fever, pharyngeal erythema, tonsillar exudate, lack of cough.
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms—pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella.
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications.
A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B.
Meningitis in neonates. Causes? Treatment?
Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin.
Meningitis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin.
CSF: Low glucose, PMN predominance Normal glucose, lymphocytic predominance Numerous RBCs in serial CSF samples ↑ gamma globulins
Bacterial meningitis Aseptic (viral) meningitis Subarachnoid hemorrhage (SAH) MS
Initially presents with a pruritic papule with regional lymphadenopathy; evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.
Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms.
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis.
A 24-year-old man presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?
Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension.
Begin Pneumocystis jiroveci (formerly P. carinii) pneumonia prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?
≤ 200 for P. jiroveci (with TMP-SMX); ≤ 50-100 for MAI (with clarithromycin/azithromycin).
Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.
Classic physical findings for endocarditis.
Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots.
A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, and how did he get it? Treatment?
Lyme disease, Ixodes tick, doxycycline.
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
S. aureus or S. epidermidis.
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
Joint pain and stiffness that worsen over the course of the day and are relieved by rest.
Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Suspect ankylosing spondylitis. Check HLA-B27.
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma.
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid.
An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Duchenne muscular dystrophy.
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction.
An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?
Slipped capital femoral epiphysis. AP and frog-leg lateral view.
A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?
Broca's aphasia. Frontal lobe, left MCA distribution.
A crescent-shaped hyperdensity on CT that does not cross the midline.
Subdural hematoma—bridging veins torn.
A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely source? Treatment?
Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation.
Guillain-Barré syndrome (↑ protein in CSF without a significant ↑ in cell count).
Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathologic?
The most common 1° sources of metastases to the brain.
Lung, breast, skin (melanoma), kidney, GI tract.
May be seen in children who are accused of inattention in class and confused with ADHD.
The most common cause of seizures in children (2-10 years).
Infection, febrile seizures, trauma, idiopathic.
The most common cause of seizures in young adults (18-35 years).
Trauma, alcohol withdrawal, brain tumor.
Confusion, confabulation, ophthalmoplegia, ataxia.
Wernicke's encephalopathy due to a deficiency of thiamine.
What % lesion is an indication for carotid endarterectomy?
Seventy percent if the stenosis is symptomatic.
Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.
A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and ipsilateral leptomeningeal angioma.
Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of the affected lobe.
Classic ultrasound and gross appearance of complete hydatidiform mole.
Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination.
Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.
Shortest AP diameter of the pelvis.
Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis.
A patient fails to lactate after an emergency C-section with marked blood loss.
Sheehan's syndrome (postpartum pituitary necrosis).
Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.
Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.
The most common type of tracheoesophageal fistula (TEF). Diagnosis?
Esophageal atresia with distal TEF (85%). Unable to pass NG tube.
Not contraindications to vaccination.
Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity.
A two-month-old baby presents with nonbilious projectile emesis. What are the appropriate steps in management?
Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy.
An infant has a high fever and onset of rash as fever breaks. What is he at risk for?
Febrile seizures (roseola infantum).
Acute-phase treatment for Kawasaki disease.
High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms.
Treatment for mild and severe unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion (severe).
Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.
A homeless child is small for his age and has peeling skin and a swollen belly.
Kwashiorkor (protein malnutrition).
Defect in an X-linked syndrome with mental retardation, gout, self-mutilation, and choreoathetosis.
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency).
Causes of exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis.
Causes of transudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy.
Normalizing PCO2 in a patient having an asthma exacerbation may indicate?
Fatigue and impending respiratory failure.
Dyspnea, lateral hilar lymphadenopathy on CXR, noncaseating granulomas, ↑ ACE, and hypercalcemia.
Honeycomb pattern on CXR. Diagnosis? Treatment?
Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help.
Treatment for COPD exacerbation.
O2, bronchodilators, antibiotics, corticosteroids with taper, smoking cessation.
Treatment for chronic COPD.
Smoking cessation, home O2, β-agonists, anticholinergics, systemic or inhaled corticosteroids, flu and pneumococcal vaccines.
A tall white male presents with acute shortness of breath. Diagnosis? Treatment?
Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful.
Characteristics favoring carcinoma in an isolated pulmonary nodule.
Age > 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins.
Sequelae of asbestos exposure.
Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass).
Causes of hypoxemia.
Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch.
Classic CXR findings for pulmonary edema.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing.
Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.
Type I (distal) RTA.
A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (autosomal-dominant PCKD).
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure.
A 55-year-old man is diagnosed with prostate cancer. Treatment options?
Wait, surgical resection, radiation and/or androgen suppression.
Salicylate ingestion occurs in what type of acid-base disorder?
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
RCC or other erythropoietin-producing tumor; evaluate with CT scan.
A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP).
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.
Antipsychotics (neuroleptic malignant syndrome).
Side effects of corticosteroids.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies.
Treatment of supraventricular tachycardia.
If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine.
Causes of drug-induced SLE.
INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine.
A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?
Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant.
Radiographic evidence of aortic disruption or dissection.
Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus.
Radiographic indications for surgery in patients with acute abdomen.
Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography).
↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).
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