The 6 P's of ischemia due to peripheral vascular disease.
Stasis, hypercoagulability, endothelial damage
The most common cause of hypertension in young women.
The most common cause of hypertension in young men.
Red plaques with silvery-white scales and sharp margins.
Basal cell carcinoma
The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.
A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.
+ Nikolsky's sign.
- Nikolsky's sign.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Iris-like target lesions.
A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.
Presents with a herald patch, Christmas-tree pattern.
Alopecia areata (autoimmune process)
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance.
Asymmetry, border irregularity, color variation, large diameter
Four characteristics of a nevus suggestive of melanoma.
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Lesions of 1° varicella
"Dewdrop on a rose petal."
Seborrheic dermatitis. Treat with antifungals
Associated with Propionibacterium acnes and changes in androgen levels.
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
Squamous cell carcinoma
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
The most common cause of hypothyroidism.
High TSH, low T4, antimicrosomal antibodies
Lab findings in Hashimoto's thyroiditis.
Exophthalmos, pretibial myxedema, and ↓ TSH.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
The most common cause of Cushing's syndrome.
A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.
Signs and symptoms of hypercalcemia
"Stones, bones, groans, psychiatric overtones."
1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)
A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.
A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.
α-antagonists (phentolamine and phenoxybenzamine)
Should α- or β-antagonists be used first in treating pheochromocytoma?
Nephrogenic diabetes insipidus (DI)
A patient with a history of lithium use presents with copious amounts of dilute urine.
Administration of DDAVP ↓ serum osmolality and free water restriction
Treatment of central DI.
SIADH due to stress
A postoperative patient with significant pain presents with hyponatremia and normal volume status.
An antidiabetic agent associated with lactic acidosis.
1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
Goal hemoglobin A1c for a patient with DM.
Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)
Treatment of DKA.
They can mask symptoms of hypoglycemia
Why are β-blockers contraindicated in diabetics?
Bias introduced into a study when a clinician is aware of the patient's treatment type.
Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.
If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.
The number of true positives divided by the number of patients with the disease is _____.
Sensitive tests have few false negatives and are used to rule _____ a disease.
Highly sensitive for TB
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?
Chronic diseases such as SLE—higher prevalence or incidence?
Epidemics such as influenza—higher prevalence or incidence?
Cross-sectional survey—incidence or prevalence?
Incidence and prevalence
Cohort study—incidence or prevalence?
Case-control study—incidence or prevalence?
High reliability, low validity
Describe a test that consistently gives identical results, but the results are wrong.
Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR
Difference between a cohort and a case-control study.
The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed
The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
1 ÷ (rate in untreated group − rate in treated group)
Number needed to treat?
Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer
In which patients do you initiate colorectal cancer screening early?
Prostate cancer is the most common cancer in men, but lung cancer causes more deaths
The most common cancer in men and the most common cause of death from cancer in men.
68%, 95.5%, 99.7%
The percentage of cases within one SD of the mean? Two SDs? Three SDs?
Number of live births per 1000 population
Number of live births per 1000 women 15-44 years of age
Number of deaths per 1000 population
Number of deaths from birth to 28 days per 1000 live births
Number of deaths from 28 days to one year per 1000 live births
Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)
Number of deaths from 20 weeks' gestation to birth per 1000 total births
Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity
True or false: Once patients sign a statement giving consent, they must continue treatment.
No. Parental consent is not necessary for the medical treatment of pregnant minors
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
Conflict of interest
A doctor refers a patient for an MRI at a facility he/she owns.
The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
False. Withdrawing and withholding life are the same from an ethical standpoint
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care
When can a physician refuse to continue treating a patient on the grounds of futility?
Treat immediately. Consent is implied in emergency situations
An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Conditions in which confidentiality must be overridden.
When treatment noncompliance represents a serious danger to public health (e.g., active TB)
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
Treat because the disease represents an immediate threat to the child's life. Then seek a court order
A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.
A patient's family cannot require that a doctor withhold information from the patient
A son asks that his mother not be told about her recently discovered cancer.
Emergent laparotomy to repair perforated viscus, likely stomach
Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
The most likely cause of acute lower GI bleed in patients > 40 years old.
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
Sentinel loop on AXR.
Fat, female, fertile, forty, flatulent
Risk factors for cholelithiasis.
Murphy's sign, seen in acute cholecystitis
Inspiratory arrest during palpation of the RUQ.
Identify key organisms causing diarrhea: ■ Most common organism
Identify key organisms causing diarrhea: ■ Recent antibiotic use
Name the organism: ■ Branching rods in oral infection.
Name the organism: ■ Painful chancroid.
Name the organism: ■ Dog or cat bite.
Name the organism: ■ Gardener.
Name the organism: ■ Pregnant women with pets.
Name the organism: ■ Meningitis in adults.
Name the organism: ■ Meningitis in elderly.
Name the organism: ■ Alcoholic with pneumonia.
Name the organism: ■ "Currant jelly" sputum.
Name the organism: ■ Infection in burn victims.
Name the organism: ■ Osteomyelitis from foot wound puncture.
Name the organism: ■ Osteomyelitis in a sickle cell patient.
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?
Lyme disease, Ixodes tick, doxycycline
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?
S. aureus or S. epidermidis.
A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
All-compartment fasciotomy for suspected compartment syndrome
A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?
Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.
MCP and PIP joints; DIP joints are spared
Joints in the hand affected in rheumatoid arthritis.
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.
Suspect ankylosing spondylitis. Check HLA-B27
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?
Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma
Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?
Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid
A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?
Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.
An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.
An active 13-year-old boy has anterior knee pain. Diagnosis?
Distal radius (Colles' fracture)
Bone is fractured in fall on outstretched hand.
Complication of scaphoid fracture.
Wrist drop, loss of thumb abduction
Signs suggesting radial nerve damage with humeral fracture.
Duchenne muscular dystrophy
A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.
Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction
A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
Slipped capital femoral epiphyses. AP and frog-leg lateral view
An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
The most common 1° malignant tumor of bone.
Unilateral, severe periorbital headache with tearing and conjunctival erythema.