Travel and Bloody Diarrhea Quiz
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Questions and Answers

What is the primary acid-base disturbance observed during the first 20 minutes of aspirin toxicity?

  • Mixed metabolic acidosis-respiratory alkalosis
  • Respiratory alkalosis (correct)
  • Metabolic alkalosis
  • Respiratory acidosis

What is the treatment for hypercalcemia when the calcium level is between 10.2 to 12 mEq/L?

  • Normal saline (0.9% NaCl) regardless of symptoms (correct)
  • Normal saline (0.9% NaCl) only if symptomatic
  • Calcium supplementation
  • Bisphosphonate immediately

What type of incontinence is characterized by a need to rush to the bathroom triggered by the sound of a key in a door?

  • Functional incontinence
  • Stress incontinence
  • Urge incontinence (correct)
  • Overflow incontinence

Which of the following symptoms is indicative of Wernicke encephalopathy?

<p>Ataxia and confusion (A)</p> Signup and view all the answers

What is the expected calcium and PTH status in a patient with hypercalcemia due to sarcoidosis?

<p>High calcium and low PTH (A)</p> Signup and view all the answers

What is the pharmacological treatment for urge incontinence?

<p>Oxybutynin (B)</p> Signup and view all the answers

In cases of chronic respiratory acidosis accompanied by confusion, which electrolyte disturbance may be suspected?

<p>Hypercalcemia (B)</p> Signup and view all the answers

What is the treatment approach for TCA toxicity?

<p>Sodium bicarbonate (C)</p> Signup and view all the answers

What is the most common cause of otitis media?

<p>Streptococcus pneumoniae (C)</p> Signup and view all the answers

What is the appropriate treatment for recurrent otitis media?

<p>Amoxicillin/clavulanate (A)</p> Signup and view all the answers

In which situation should tympanostomy tubes be considered?

<p>Three or more episodes of otitis media in 6 months (A)</p> Signup and view all the answers

What indicates iron deficiency anemia based on hematocrit and serum markers?

<p>Low hematocrit + low MCV + high transferrin (B)</p> Signup and view all the answers

Which condition is characterized by microcytic anemia that does not improve with iron supplementation?

<p>Thalassemia (C)</p> Signup and view all the answers

What is the recommended treatment for anemia of chronic disease if renal failure is the cause?

<p>Erythropoietin (EPO) (B)</p> Signup and view all the answers

In a patient with normotensive stroke, what diagnostic test should be performed first?

<p>Electrocardiogram (ECG) (A)</p> Signup and view all the answers

What is a common cause of anovulation accompanied by hirsutism in females?

<p>Polycystic ovary syndrome (PCOS) (A)</p> Signup and view all the answers

What is the effect of abnormal GnRH pulsation in terms of LH/FSH ratio in anovulation?

<p>It leads to a high LH/FSH ratio. (A)</p> Signup and view all the answers

What primary role does FSH play in the female reproductive system?

<p>Stimulates granulosa cells to produce aromatase. (D)</p> Signup and view all the answers

Which treatment approach is recommended first for a patient with PCOS and a high BMI?

<p>Weight loss. (D)</p> Signup and view all the answers

How does PCOS increase the risk of endometrial cancer?

<p>Due to high levels of unopposed estrogen. (A)</p> Signup and view all the answers

Which treatment is appropriate for acute gout if indomethacin is not effective?

<p>Colchicine. (A)</p> Signup and view all the answers

What type of crystals is diagnosed in pseudogout?

<p>Calcium pyrophosphate crystals. (B)</p> Signup and view all the answers

What is the genetic basis of Lesch-Nyhan syndrome?

<p>X-linked HGPRT deficiency. (C)</p> Signup and view all the answers

What is the primary role of leuprolide in the treatment of prostate cancer?

<p>Inhibits testosterone production. (A)</p> Signup and view all the answers

What is the most specific antibody for systemic lupus erythematosus (SLE)?

<p>Anti-Sm (anti-Smith) (D)</p> Signup and view all the answers

Which is the next best step in diagnosing viral-induced aplastic anemia?

<p>Bone marrow aspiration (B)</p> Signup and view all the answers

What is the mechanism behind immune thrombocytopenic purpura (ITP)?

<p>Antibodies against GpIIb/IIIa on platelets (C)</p> Signup and view all the answers

What treatment is considered the most effective way to decrease recurrence of ITP episodes?

<p>Splenectomy (A)</p> Signup and view all the answers

Which laboratory finding is characteristic of hemophilia?

<p>Normal PT and increased aPTT (D)</p> Signup and view all the answers

What is the main role of von Willebrand Factor (vWF)?

<p>Promoting platelet adhesion (C)</p> Signup and view all the answers

Which of these statements about the heme findings in immune thrombocytopenic purpura (ITP) is accurate?

<p>Increased bleeding time, normal PT, normal aPTT (B)</p> Signup and view all the answers

Which of the following drugs is associated with drug-induced lupus?

<p>Penicillamine (A)</p> Signup and view all the answers

Which treatment is considered a last resort for asthma management?

<p>Oral steroids (A)</p> Signup and view all the answers

What is the confirmatory diagnostic method for Goodpasture syndrome?

<p>Renal biopsy showing linear immunofluorescence (A)</p> Signup and view all the answers

Which condition is indicated by hematuria combined with eosinophilia?

<p>Churg-Strauss syndrome (B)</p> Signup and view all the answers

A patient with chronic mucocutaneous candidiasis has impaired cell-mediated immunity due to which dysfunction?

<p>T cell dysfunction (D)</p> Signup and view all the answers

In the case of acute pancreatitis, which diagnostic marker is most indicative of choledocholithiasis?

<p>High ALP with high direct bilirubin and normal amylase (B)</p> Signup and view all the answers

Which imaging technique is best suited for viewing gallbladder disease?

<p>Ultrasound (B)</p> Signup and view all the answers

What is the most effective way to decrease the recurrence of asthma symptoms in a pediatric patient already using a SABA?

<p>Initiating ICS therapy (A)</p> Signup and view all the answers

What is the typical test to diagnose primary biliary cirrhosis (PBC)?

<p>Anti-mitochondrial antibodies test (A)</p> Signup and view all the answers

Which fungal infection is characterized by a history of a rose thorn injury?

<p>Sporotrichosis (B)</p> Signup and view all the answers

In a patient presenting with fever and abdominal pain post-cholecystectomy, which condition should be suspected?

<p>Post-operative bile leak (A)</p> Signup and view all the answers

In patients with SCID, what is the most common infectious presentation?

<p>Bacterial, fungal, protozoal, and viral infections (D)</p> Signup and view all the answers

Which test is next best after identifying antibodies in Goodpasture syndrome?

<p>Renal biopsy (B)</p> Signup and view all the answers

What is the hallmark histological feature of Wegener's granulomatosis?

<p>C-ANCA positivity (D)</p> Signup and view all the answers

With high ALP, high direct bilirubin, and normal amylase or lipase after a remote cholecystectomy, what is the likely diagnosis?

<p>Pancreatic cancer (C)</p> Signup and view all the answers

What is the primary role of von Willebrand factor (vWF) in platelet function?

<p>To bridge platelet GpIb to collagen (A)</p> Signup and view all the answers

Which of the following is an expected clinical manifestation of von Willebrand disease (vWD)?

<p>Menorrhagia (B)</p> Signup and view all the answers

What underlying condition often causes vitamin K deficiency in adults?

<p>Chronic antibiotic use (D)</p> Signup and view all the answers

What mutation is responsible for sickle cell disease?

<p>Glutamic acid to valine (C)</p> Signup and view all the answers

Which drug is commonly used to increase the release of von Willebrand factor?

<p>Desmopressin (B)</p> Signup and view all the answers

What is the strongest indication for anticoagulation therapy?

<p>Prosthetic valve in the heart (A)</p> Signup and view all the answers

Which class of antibiotics is often used for the treatment of febrile neutropenia?

<p>Broad-spectrum IV antibiotics (D)</p> Signup and view all the answers

How is ganciclovir primarily used in medical treatment?

<p>Treatment of cytomegalovirus infections (C)</p> Signup and view all the answers

At what age should the first dose of the MMR vaccine be administered?

<p>12-15 months (C)</p> Signup and view all the answers

What is the correct follow-up vaccine for individuals aged 65 or older who received the Pneumo PCV13?

<p>PPSV23 (B)</p> Signup and view all the answers

In individuals with centri-acinar emphysema, what is the most likely contributing factor?

<p>Cigarette smoking (C)</p> Signup and view all the answers

What characteristic of emphysema is typically observed in a young adult non-smoker with a family history of hepatic cirrhosis?

<p>Pan-acinar emphysema (D)</p> Signup and view all the answers

In cases of restrictive lung disease, how is the FEV1/FVC ratio typically affected?

<p>Normal or increased (C)</p> Signup and view all the answers

What is the primary result of the acid-base disturbance in aspirin toxicity after the first 20 minutes?

<p>Mixed metabolic acidosis-respiratory alkalosis (D)</p> Signup and view all the answers

Which treatment is recommended for symptomatic hypercalcemia with levels above 14 mEq/L?

<p>Normal saline with additional therapies (B)</p> Signup and view all the answers

What is the underlying cause of low calcium or potassium levels that do not respond to supplementation?

<p>Hypomagnesemia (C)</p> Signup and view all the answers

Which condition is primarily indicated by ataxia, confusion, and ophthalmoplegia?

<p>Wernicke encephalopathy (D)</p> Signup and view all the answers

What is the main characteristic symptoms of urge incontinence in a patient with multiple sclerosis?

<p>Sudden urge to urinate (B)</p> Signup and view all the answers

In a young African American woman presenting with a dry cough and normal chest X-ray findings, what is the most likely diagnosis?

<p>Asthma (C)</p> Signup and view all the answers

Which treatment is commonly used for urge incontinence if pelvic floor exercises are insufficient?

<p>Oxybutynin (A)</p> Signup and view all the answers

What is the reasoning behind hypercalcemia seen in sarcoidosis with low PTH levels?

<p>Vitamin D related hypercalcemia (C)</p> Signup and view all the answers

What is the most common cause of otitis externa?

<p>Pseudomonas aeruginosa (B)</p> Signup and view all the answers

What is the typical treatment for earwax buildup?

<p>Carbamide peroxide drops (C)</p> Signup and view all the answers

Which laboratory findings are indicative of iron deficiency anemia?

<p>Low hematocrit, low MCV, low ferritin (B)</p> Signup and view all the answers

In a patient presenting with anemia and low hematocrit, what abnormality is expected in thalassemia?

<p>Normal iron and normal ferritin (A)</p> Signup and view all the answers

Which treatment is appropriate for patients with anemia of chronic disease when renal failure is not the cause?

<p>Treating the underlying condition (B)</p> Signup and view all the answers

What characterizes the hematological profile in iron deficiency anemia compared to thalassemia?

<p>Increased RDW (B)</p> Signup and view all the answers

In patients with recurrent otitis media, when is a tympanostomy tube indicated?

<p>Four or more episodes in a year (A), Three or more episodes in six months (C)</p> Signup and view all the answers

What is the treatment for otitis media caused by Streptococcus pneumoniae?

<p>Oral amoxicillin (D)</p> Signup and view all the answers

What causes hirsutism in women experiencing anovulation?

<p>High LH/FSH ratio due to abnormal GnRH pulsation (A)</p> Signup and view all the answers

Why does a high LH/FSH ratio contribute to anovulation and PCOS?

<p>It causes follicular maturation without ovulation (C)</p> Signup and view all the answers

What is the role of FSH in the female reproductive system?

<p>Promotes the production of aromatase in granulosa cells (A)</p> Signup and view all the answers

What is the first-line treatment for a patient with PCOS and a high BMI?

<p>Weight loss (A)</p> Signup and view all the answers

Which treatment should be avoided in patients with a history of uric acid stones?

<p>Probenecid (D)</p> Signup and view all the answers

In patients with pseudogout, what is the main crystal type found?

<p>Calcium pyrophosphate crystals (B)</p> Signup and view all the answers

What is the most effective drug for acute gout treatment in patients with renal insufficiency?

<p>Steroids (C)</p> Signup and view all the answers

What is the genetic cause of Lesch-Nyhan syndrome?

<p>HGPRT deficiency (B)</p> Signup and view all the answers

What symptom is typically associated with a platelet problem in von Willebrand disease (vWD)?

<p>Petechiae (D)</p> Signup and view all the answers

What is the secondary function of von Willebrand factor (vWF) in the blood?

<p>Stabilizes factor VIII in plasma (A)</p> Signup and view all the answers

Which of the following drugs is associated with causing agranulocytosis?

<p>Clozapine (D)</p> Signup and view all the answers

What is a common clinical presentation of sickle cell disease related to the kidneys?

<p>Renal papillary necrosis (B)</p> Signup and view all the answers

What is the recommended treatment for febrile neutropenia?

<p>Immediate broad-spectrum IV antibiotics (B)</p> Signup and view all the answers

Which condition is indicated by a deficiency of vitamin K?

<p>Increased PT and aPTT with normal bleeding time (D)</p> Signup and view all the answers

What inherent genetic inheritance pattern does sickle cell disease possess?

<p>Autosomal recessive (B)</p> Signup and view all the answers

Which of the following best describes the role of desmopressin in the treatment of von Willebrand disease?

<p>Increases release of von Willebrand factor (D)</p> Signup and view all the answers

What is the primary treatment for sarcoidosis?

<p>Steroids (C)</p> Signup and view all the answers

Which of the following conditions is characterized by hematuria and hemoptysis?

<p>Goodpasture syndrome (C)</p> Signup and view all the answers

In the diagnosis of primary biliary cirrhosis (PBC), which antibody is most indicative?

<p>Anti-mitochondrial antibodies (D)</p> Signup and view all the answers

Which treatment is recommended as a last resort for managing asthma symptoms?

<p>Oral steroids (A)</p> Signup and view all the answers

What is the most effective way to decrease the recurrence of asthma in a child already using a SABA?

<p>Inhaled corticosteroids (D)</p> Signup and view all the answers

What type of imaging is preferred for viewing gallbladder in suspected cholecystitis?

<p>Ultrasound (D)</p> Signup and view all the answers

Which finding is typical in a patient with chronic mucocutaneous candidiasis?

<p>T cell dysfunction (D)</p> Signup and view all the answers

What is the mechanism of action for Bruton’s agammaglobulinemia?

<p>Tyrosine kinase mutation (C)</p> Signup and view all the answers

Which condition is associated with eosinophilia in an asthma patient?

<p>Churg-Strauss syndrome (C)</p> Signup and view all the answers

In a patient who had a recent cholecystectomy with fever and abdominal pain, what condition should be suspected?

<p>Post-op bile leak (C)</p> Signup and view all the answers

What is the confirmatory test for Goodpasture syndrome?

<p>Renal biopsy (B)</p> Signup and view all the answers

What is the next best step for a patient diagnosed with choledocholithiasis?

<p>ERCP (C)</p> Signup and view all the answers

In Churg-Strauss syndrome, which laboratory marker is typically observed?

<p>p-ANCA (C)</p> Signup and view all the answers

Which condition is typically characterized by greasy, scaly scalp with itchy papules in adults?

<p>Seborrheic dermatitis (B)</p> Signup and view all the answers

Flashcards

Aspirin Toxicity (early)

Within the first 20 minutes, aspirin toxicity causes respiratory alkalosis, characterized by low CO2 and high pH, with normal bicarb (too acute) and normal O2.

Aspirin Toxicity (late)

After 20 minutes, aspirin toxicity progresses to a mixed disturbance, including metabolic acidosis and respiratory alkalosis. This results in low PCO2, low pH, and low bicarbonate levels.

Treatment for Aspirin Toxicity

Treatment involves bicarbonate, which increases aspirin urinary excretion through urinary alkalinization.

Treatment for TCA Toxicity

Sodium bicarbonate dissociates the drug from myocardial sodium channels, reducing toxicity.

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Normal Calcium Levels

Normal serum calcium levels are 8.4-10.2 mEq/L.

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Hypercalcemia Treatment (Mild)

Mild hypercalcemia (10.2-12 mg/dL), without symptoms, usually requires only normal saline (0.9% NaCl).

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Hypercalcemia Treatment (Moderate)

Moderate hypercalcemia (12-14 mg/dL) warrants normal saline (0.9% NaCl) and a bisphosphonate (like pamidronate) if symptomatic.

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Hypercalcemia Treatment (Severe)

For severe hypercalcemia (14+ mg/dL), normal saline and a bisphosphonate are combined and given immediately

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Hypercalcemia with polyuria

High calcium with excessive urination suggests nephrogenic diabetes insipidus.

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Hypercalcemia with confusion

High calcium often causes delirium.

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Low Calcium/Potassium unresponsive to suppl.

If low calcium or potassium levels don't improve with supplementation, low magnesium is often the underlying cause.

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Wernicke Encephalopathy

A neurological disorder caused by thiamine (vitamin B1) deficiency, marked by ataxia, confusion, and ophthalmoplegia.

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Korsakoff Psychosis

A chronic memory disorder developing in advanced stages of Wernicke encephalopathy. Symptoms include retrograde amnesia and confabulation.

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Wernicke-Korsakoff Syndrome

This is a combination of Wernicke encephalopathy and Korsakoff syndrome, often seen in alcoholics.

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Stress Incontinence

Involuntary leakage of urine during activities that put pressure on the bladder, such as coughing, laughing, or exercising.

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Treatment of stress Incontinence

Pelvic floor exercises (Kegels) are the first-line treatment. For insufficient results, a mid-urethral sling may be considered.

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Urge Incontinence

A condition where a person experiences a sudden, strong and uncontrolled urge to urinate, often leading to leakage.

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Treatment for Urge Incontinence

Oxybutynin (muscarinic antagonist) or mirabegron (beta-3 agonist) reduce bladder spasms and urgency, thereby helping manage urge incontinence.

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Otitis Media (OM) Most Common Cause

Streptococcus pneumoniae

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Otitis Media Treatment (OM)

Oral amoxicillin

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Recurrent OM Tx

Amoxicillin/clavulanate

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Tympanostomy Tubes - When

Three or more OM episodes in 6 months, or four or more in a year

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Otitis Externa (OE) Most Common Cause

Pseudomonas aeruginosa

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Otitis Externa Treatment

Topical ciprofloxacin + hydrocortisone drops

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OE Prevention (water exposure)

Alcohol-acetic acid ear drops

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Earwax Buildup Treatment

Carbamide peroxide ear drops

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Anemia of Chronic Disease, Lab Findings

Low hematocrit, low MCV, low transferrin, low TIBC, normal or low transferrin saturation.

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Iron Deficiency Anemia, Lab Findings

Low hematocrit, low MCV, high transferrin, high TIBC, super-low transferrin saturation.

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Iron Deficiency Anemia, RDW

Increased Red Cell Distribution Width (RDW)

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Thalassemia, RDW

Low/low-normal Red Cell Distribution Width (RDW).

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Thalassemia Diagnostic Test

Hemoglobin electrophoresis

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Thalassemia: Iron levels

Normal iron levels.

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Anemia of Chronic Disease, Pregnancy

Normal iron and ferritin in a pregnant woman taking iron supplements.

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Microcytic Anemia not improved by iron

Thalassemia

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Anemia of Chronic Disease, Renal Failure Tx

Erythropoietin (EPO)

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Anemia of Chronic Disease, Non-Renal Tx

Treating the underlying cause(e.g., IBD, RA, SLE)

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TIA/Stroke Risk Reduction (High BP, Smoker)

Lisinopril (blood pressure medication)

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Normotensive Stroke Pt

Atrial Fibrillation (AF)

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Hypertensive Stroke Pt

Carotid duplex ultrasound

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Normotensive Stroke Pt, next step

ECG, then Holter monitor if ECG is normal

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High BMI Female, Irregular Cycles

Anovulation

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Anovulation + Hirsutism

Polycystic Ovary Syndrome (PCOS)

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Insulin Resistance

A condition where the body's cells don't respond properly to insulin, leading to elevated blood sugar.

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Abnormal GnRH Pulsation

Irregular release of GnRH (gonadotropin-releasing hormone) which interferes with normal hormonal balance.

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Hirsutism in Anovulation

Excessive hair growth in women due to abnormal hormone levels, often linked to ovulation problems.

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High LH/FSH Ratio

An imbalance in the ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), often seen in anovulation (no ovulation).

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Anovulation (No Ovulation)

Lack of ovulation, the release of an egg from the ovary.

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Follicle Cyst

A fluid-filled sac in the ovary that develops when a follicle doesn't release the egg.

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LH (Luteinizing Hormone)

Hormone that stimulates androgen production in the ovaries (females) and testes (males).

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FSH (Follicle Stimulating Hormone)

Hormone that stimulates egg/sperm production and follicle development.

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PCOS Treatment (High BMI)

Weight loss is the first and most important treatment step for PCOS patients with high BMI.

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PCOS Treatment (No Pregnancy)

Oral Contraceptives (OCPs) are often used for PCOS treatment when pregnancy is not desired.

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PCOS Treatment (Desire of Pregnancy)

Clomiphene is often used when pregnancy is desired, in addition to other methods.

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PCOS and Endometrial Cancer

PCOS increases the risk of endometrial cancer due to unopposed estrogen effects.

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Prostate Cancer Treatment

Flutamide followed by Leuprolide is a common treatment sequence for prostate cancer.

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Acute Gout Treatment

Indomethacin (NSAID) is the preferred initial treatment of acute gout on the USMLE.

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Chronic Gout Treatment

Allopurinol or Febuxostat are used to reduce gout attacks in the long term.

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Probenecid

A medication that increases the excretion of uric acid. Avoid with a history of uric acid stones or overproduction.

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Rasburicase/Peglotsidase

Urate oxidase analogues that break down uric acid directly.

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Lesch-Nyhan Syndrome

X-linked genetic disorder causing self-mutilation and high uric acid levels.

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HGPRT Deficiency

The enzyme deficiency that causes Lesch-Nyhan Syndrome.

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Pseudogout

Joint inflammation due to calcium pyrophosphate deposition.

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Pseudogout Causes

Primary hyperparathyroidism and hemochromatosis are common causes of pseudogout.

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Hemochromatosis

A genetic disorder causing iron overload, leading to various complications.

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Von Willebrand Disease (vWD) presentation

vWD always involves both a platelet problem and a clotting factor problem. Platelet problems cause mild bleeding (epistaxis, bruising), while clotting factor problems cause more serious bleeding (menorrhagia, excessive bleeding after procedures).

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vWF secondary function

vWF stabilizes Factor VIII in the blood, preventing its rapid breakdown.

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vWD treatment

Desmopressin increases the release of vWF from the body's stores, improving clotting.

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Vitamin K deficiency heme parameters

Vitamin K deficiency leads to increased PT (Prothrombin Time) and aPTT (Activated Partial Thromboplastin Time), but normal bleeding time.

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Adult Vitamin K deficiency cause

In adults, chronic antibiotic use often disrupts the gut flora, hindering Vitamin K production, leading to deficiency.

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Sickle Cell Cause

Sickle cell disease is caused by a mutation from glutamic acid to valine on the beta-globin chain.

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Sickle Cell inheritance pattern

Sickle cell disease is inherited in an autosomal recessive pattern.

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Sickle Cell Nephrotic Syndrome

Nephrotic syndrome in sickle cell patients often manifests as Focal Segmental Glomerulosclerosis (FSGS).

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Sickle Cell dark urine

Dark urine in sickle cell patients can be a sign of Renal Papillary Necrosis.

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Agranulocytosis presentation

Agranulocytosis (neutropenia) usually presents clinically with mouth ulcers and fever.

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Febrile neutropenia treatment

Treatment for febrile neutropenia (neutropenic fever) involves immediate use of broad-spectrum intravenous antibiotics.

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Ganciclovir use

Ganciclovir is an antiviral drug used to treat Cytomegalovirus (CMV) infections.

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PTU and methimazole use

PTU and methimazole are antithyroid drugs used to treat hyperthyroidism (like Graves' disease).

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Ticlopidine role

Ticlopidine is an antiplatelet medication that blocks ADP receptors (specifically ADP2Y12).

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Strongest indication for anticoagulation

A strong indication for anticoagulation is the presence of prosthetic heart valves or other implanted prosthetic materials.

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Activated Macrophages

Activated macrophages produce 1-alpha hydroxylase, an enzyme that activates vitamin D3.

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Sarcoidosis Calcium

Increased calcium in sarcoidosis leads to decreased calcium in the feces because vitamin D3 increases small bowel absorption.

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Sarcoidosis Treatment

Steroids are the treatment for sarcoidosis.

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Asthma Outpatient Treatment

Outpatient asthma treatment starts with SABA, then low-dose ICS, escalating to maximize ICS, then LABA, and considers other drugs (mast cell stabilizers, anti-leukotrienes), using oral steroids as a last resort.

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Asthma Inhaler Ineffective

If a child's asthma is not controlled with only SABA inhalers, the next best step is adding ICS (fluticasone).

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Asthma Recurrence Prevention

Oral steroids are the most effective way to reduce the risk of asthma recurrence, although not the immediate next step.

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Goodpasture Syndrome Symptoms

Goodpasture syndrome is characterized by hematuria and hemoptysis (coughing up blood).

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Goodpasture Antibodies

Anti-GBM antibodies (targeting collagen IV) are present in Goodpasture syndrome.

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Goodpasture Diagnosis

Diagnosis includes detecting anti-GBM antibodies and confirming with a renal biopsy showing linear immunofluorescence.

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Wegener's Granulomatosis Symptoms

Wegener's granulomatosis presents with hematuria, hemoptysis, and symptoms related to inflammation of the head (mastoiditis, sinusitis, etc.).

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Wegener's Granulomatosis New Name

The new name for Wegener's granulomatosis is granulomatosis with polyangiitis.

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Wegener's Granulomatosis Diagnosis

The diagnosis involves detecting c-ANCA antibodies (anti-PR3), which target a specific protein.

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Churg-Strauss Syndrome

Churg-Strauss syndrome presents with asthma and eosinophilia.

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Churg-Strauss New Name

The new name for Churg-Strauss syndrome is eosinophilic granulomatosis with polyangiitis.

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Churg-Strauss Diagnosis

Diagnosis includes identifying p-ANCA antibodies (anti-MPO) targeting a specific enzyme.

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Microscopic Polyangiitis

Microscopic polyangiitis is diagnosed when hematuria is present in isolation and p-ANCA antibodies are detected in the blood.

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Rapidly Progressive Glomerulonephritis

Severe renal disease in Wegener's, Goodpasture's, or Microscopic Polyangiitis leads to rapidly progressive glomerulonephritis.

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Gallstone Pancreatitis Symptoms

Gallstone pancreatitis presents with high ALP, high direct bilirubin, and high amylase or lipase.

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Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction is suspected when a patient has high ALP, high direct bilirubin, high amylase or lipase AND a prior cholecystectomy.

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Choledocholithiasis with Cholecystectomy

Choledocholithiasis (a retained stone within the bile duct) is suspected after a cholecystectomy when a patient shows the high liver enzymes and high pancreatic enzymes, but no previous history of gallstones.

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Pancreatic Cancer Diagnosis

Suspected pancreatic cancer is diagnosed with a CT scan of the abdomen with contrast.

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Cholangiocarcinoma

Cholangiocarcinoma is suspected when a patient has high liver enzymes and high pancreatic enzymes, a history of cholecystectomy, and a negative CT scan.

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Primary Biliary Cirrhosis (PBC)

PBC is a disease characterized by high ALP, high direct bilirubin, high cholesterol, and diffuse pruritus.

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PBC Diagnosis

Anti-mitochondrial antibodies (AMAs) are tested first for suspected PBC diagnosis; a liver biopsy is needed for confirmation.

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Post-Operative Bile Leak

Post-operative bile leak is suspected when a patient has fever, abdominal pain, and recent gallbladder surgery.

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Choledochal Cyst

A choledochal cyst is a cystic lesion in the bile duct.

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Chronic Mucocutaneous Candidiasis (MCC)

MCC is a condition where a person has a history of skin infections.

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Severe Combined Immunodeficiency (SCID)

SCID is a condition marked by multiple bacterial, fungal, and viral infections since birth or early childhood.

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Bruton's Agammaglobulinemia

Bruton's agammaglobulinemia results in a patient presenting with bacterial infections after 6 months of age.

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SLE

Systemic Lupus Erythematosus; an autoimmune disease affecting multiple organs and systems.

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SLE flare

An exacerbation of SLE symptoms, often triggered by infections or stress.

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Lupus nephritis (DPGN)

Kidney inflammation (nephritis) seen in SLE; a specific type is diffuse proliferative glomerulonephritis.

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DPGN histology

Kidney tissue showing wire-looping capillary pattern; a microscopic characteristic.

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SLE treatment (flare)

Corticosteroids are often used to treat an SLE flare.

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SLE Treatment (nephritis)

Mycophenolate mofetil is used to treat lupus nephritis.

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Discoid Lupus Tx

Hydroxychloroquine is the preferred treatment for discoid lupus.

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Specific SLE Abs

Anti-Smith antibodies are considered more specific than anti-dsDNA in SLE.

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Acute SLE flare Abs

Anti-dsDNA antibodies often increase during acute SLE flares, along with decreased C3.

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Drug-induced lupus Abs

Anti-histone antibodies are common in drug-induced lupus (DIL).

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Drugs causing DIL

Minocycline, Hydralazine, INH, Procainamide, and Penicillamine.

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Viral-induced aplastic anemia

A condition where a viral infection causes a decrease in all blood cell lines due to bone marrow failure.

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Dx viral aplastic anemia

Bone marrow aspiration helps diagnose viral-induced aplastic anemia.

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ITP (Immune thrombocytopenic purpura)

A condition where antibodies cause destruction of platelets, leading to low platelet count.

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ITP mechanism

Antibodies target GpIIb/IIIa on platelets, causing their destruction.

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ITP Dx

Low platelet count is the key diagnostic finding.

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ITP Tx

Steroids, IVIG, and splenectomy are possible treatments.

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Hereditary spherocytosis

An inherited condition causing spherical red blood cells that have a shorter lifespan.

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Bleeding time

A measure of platelet function.

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PT and aPTT

Tests assessing the clotting cascade involving clotting factors.

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Hemophilia

A group of inherited bleeding disorders, primarily due to clotting factor deficiencies (x-linked recessive)

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Hemophilia A

Inherited bleeding disorder due to factor VIII deficiency (X-linked recessive).

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Hemophilia B

Inherited bleeding disorder due to factor IX deficiency (X-linked recessive).

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Hemophilia Tx

Desmopressin (for Hemophilia A) or Factor replacement (VIII or IX) for both A & B.

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von Willebrand Disease (vWD)

Inherited bleeding disorder due to vWF deficiency or dysfunction.

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vWD inheritance

Autosomal dominant inheritance pattern.

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vWF function

vWF is a critical protein for platelet function and clotting.

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vWD labs

Bleeding time elevated; normal or slightly elevated PT, and aPTT elevated about half the time;

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Aspirin Toxicity (early)

Within 20 minutes, causes respiratory alkalosis (low CO2, high pH, normal O2, normal bicarb).

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Aspirin Toxicity (late)

After 20 minutes, causes a mixed metabolic acidosis-respiratory alkalosis (low CO2, low pH, normal O2, low bicarb).

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Aspirin Toxicity Tx

Bicarbonate to increase aspirin urinary excretion.

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TCA Toxicity Tx

Sodium bicarbonate dissociates TCA from sodium channels.

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Normal Calcium

8.4-10.2 mEq/L

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Mild Hypercalcemia Tx

Normal saline (0.9% NaCl) if asymptomatic (10.2-12 mg/dL).

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Moderate Hypercalcemia Tx

Normal saline + bisphosphonate (if symptomatic) (12-14 mg/dL).

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Severe Hypercalcemia Tx

Normal saline + bisphosphonate (immediately) (14+ mg/dL).

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Hypercalcemia + Polyuria

Suggests nephrogenic diabetes insipidus.

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Hypercalcemia + Confusion

Can cause delirium (mental confusion).

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Low Ca/K unresponsive to suppl.

Often indicates low magnesium.

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Wernicke Encephalopathy

B1 (thiamine) deficiency causing ataxia, confusion, ophthalmoplegia.

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Korsakoff Psychosis

Late-stage Wernicke encephalopathy with retrograde amnesia and confabulation.

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Stress Incontinence

Urine leakage during increased pressure (coughing, laughing).

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Stress Incontinence Tx

Kegel exercises; mid-urethral sling if insufficient.

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Urge Incontinence

Sudden, strong urge to urinate followed by leakage.

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Urge Incontinence Tx

Oxybutynin (muscarinic antagonist) or mirabegron (beta-3 agonist).

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Pre-renal Failure

Kidney issues due to low blood volume (hypovolemia).

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Age recommendations for vaccines

Vaccines are given at specific ages to infants and children up to adulthood, taking into consideration factors like pregnancy and immunodeficiency

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HepB vaccine at birth

Hepatitis B vaccine is given to newborns, even if the mother's status is unknown

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HPV vaccine age range

9-45 years old for persons who are not pregnant or immunocompromised

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Pneumonia vaccine for the elderly

PCV13 followed by PPSV23 6-12 months later for persons aged 65 or older

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MMR vaccine schedule

First dose at 12-15 months and second dose at 4-6 years

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Varicella vaccine schedule

A single dose between 12-18 months

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Asplenia or Sickle Cell Disease vaccines

PCV13, PPSV23, and Hib for individuals with these conditions

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Pancreatitis pseudoabscess

Circular lesion in the pancreas; treated with ERCP to drain internally.

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Emphysema - Bullous changes

Expanded lungs or hyperlucency on CXR indicates emphysema.

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Centri-acinar emphysema cause

Smoking is a significant cause of this type of emphysema.

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Pan-acinar emphysema cause

Alpha-1 antitrypsin deficiency is a cause of this type of emphysema.

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CREST syndrome lung complication

Can cause pulmonary fibrosis and hypertension.

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Restrictive lung disease FEV1/FVC

Normal or increased FEV1/FVC ratio.

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Obstructive lung disease FEV1/FVC

Decreased FEV1/FVC ratio.

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Activated Macrophages produce

1-alpha hydroxylase that activates vitamin D3

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Sarcoidosis Calcium & Feces

Increased calcium in sarcoidosis causes decreased calcium in feces due to increased small bowel absorption from vitamin D3.

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Sarcoidosis Treatment

Steroids

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Asthma Outpatient Tx

Starts with SABA, then low-dose ICS, maximizes ICS, then LABA, may include other drugs (mast cell stabilizers, anti-leukotrienes), and oral steroids as last resort

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Asthma Inhaler Ineffective

Next best step after ineffective SABA inhaler is adding ICS (fluticasone).

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Asthma Recurrence Prevention

Oral steroids are most effective for reducing asthma recurrence, but not the next best immediate step

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Goodpasture Syndrome Symptoms

Hematuria (blood in urine) and hemoptysis (coughing blood).

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Goodpasture Antibodies

Anti-GBM antibodies (anti-collagen IV).

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Goodpasture Diagnosis

Detecting anti-GBM antibodies and renal biopsy showing linear immunofluorescence is confirmatory.

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Wegener's Granulomatosis – Symptoms

Hematuria, hemoptysis (blood in sputum), and head inflammatory symptoms (mastoiditis, sinusitis, otitis, nasal septal perforation).

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Wegener's Granulomatosis – New Name

Granulomatosis with polyangiitis.

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Wegener's Granulomatosis Diagnosis

Identifying c-ANCA antibodies (anti-PR3 antibodies).

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Churg-Strauss Syndrome – Symptoms

Asthma and eosinophilia (high white blood cell count).

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Churg-Strauss – New Name

Eosinophilic granulomatosis with polyangiitis.

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Churg-Strauss Diagnosis

Identifying p-ANCA antibodies (anti-MPO).

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Microscopic Polyangiitis

Detected with isolated hematuria and p-ANCA antibodies.

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Rapidly Progressive Glomerulonephritis

Severe kidney disease in Wegener's, Goodpasture's, and Microscopic Polyangiitis causing a type of glomerulonephritis(crescentic).

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Choledocholithiasis (After Cholecystectomy)

High ALP, high direct bilirubin, normal amylase or lipase after gallbladder removal in patients with recent cholecystectomy.

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Pancreatic Cancer Diagnosis

CT scan of the abdomen with contrast.

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Gallstone Pancreatitis

High ALP, high direct bilirubin, high amylase or lipase (or both).

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Sphincter of Oddi Dysfunction

High ALP, high direct bilirubin, high amylase or lipase, with prior cholecystectomy.

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vWD presentation

Always includes both a platelet problem and a clotting factor problem.

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Platelet problem in vWD

Causes mild bleeding like epistaxis, bruising, and petechiae.

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Clotting factor problem in vWD

Causes more serious bleeding like menorrhagia and excessive bleeding with procedures.

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vWF secondary function

vWF stabilizes Factor VIII.

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vWD treatment

Desmopressin increases vWF release.

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Vitamin K deficiency heme parameters

Increased PT and aPTT, normal bleeding time.

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Adult Vitamin K deficiency cause

Chronic antibiotic use disrupts gut flora.

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Sickle Cell cause

Glutamic acid to valine mutation on beta-globin.

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Sickle Cell inheritance

Autosomal recessive.

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Sickle Cell Nephrotic Syndrome

FSGS (Focal Segmental Glomerulosclerosis).

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Sickle Cell dark urine

Renal papillary necrosis.

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Agranulocytosis presentation

Mouth ulcers + fever.

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Febrile neutropenia treatment

Immediate broad-spectrum IV antibiotics.

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Ganciclovir use

Treatment for CMV (cytomegalovirus).

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PTU & methimazole use

Treatment for Graves' disease (hyperthyroidism).

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Ticlopidine role

ADP2Y12 blocker, anti-platelet agent.

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Strongest indication for anticoagulation

Prosthetic heart valves or material.

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Insulin Resistance

Body cells don't respond normally to insulin, leading to high blood sugar.

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Abnormal GnRH Pulsation

Irregular release of GnRH (gonadotropin-releasing hormone), causing hormonal imbalances.

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Hirsutism in Anovulation

Excessive hair growth in women due to irregular ovulation/hormonal imbalance.

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High LH/FSH Ratio

Imbalance of LH (luteinizing hormone) and FSH (follicle-stimulating hormone).

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Anovulation

Lack of ovulation (egg release from the ovary).

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Follicle Cyst

Fluid-filled sac in the ovary, caused by a follicle not releasing an egg.

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LH Function

Stimulates androgen production in the ovaries (female) and testes (male).

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FSH Function

Stimulates egg/sperm production and follicle development.

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PCOS Treatment (High BMI)

Weight loss is crucial treatment for PCOS patients with high BMI.

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PCOS Treatment (No Pregnancy)

Oral contraceptives (OCPs) are often used for PCOS without a pregnancy desire.

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PCOS Treatment (Desire of Pregnancy)

Clomiphene is often used to support pregnancy, along with other methods for PCOS.

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PCOS and Endometrial Cancer

PCOS increases the risk of endometrial cancer due to unopposed estrogen.

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Prostate Cancer Treatment

Flutamide followed by Leuprolide is a common prostate cancer treatment sequence.

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Acute Gout Treatment

Indomethacin (NSAID) is the first choice for acute gout (USMLE).

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Chronic Gout Treatment

Allopurinol or Febuxostat (xanthine oxidase inhibitors) decrease gout recurrence.

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Probenecid

Increases uric acid excretion. Avoid in uric acid stone/overproduction history.

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Rasburicase/Peglotsidase

Urate oxidase analogues directly breaking down uric acid.

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Lesch-Nyhan Syndrome

X-linked genetic disorder causing self-harm and high uric acid.

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HGPRT Deficiency

Enzyme deficiency causing Lesch-Nyhan Syndrome.

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Pseudogout

Joint inflammation caused by calcium pyrophosphate deposition.

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Pseudogout Causes

Primary hyperparathyroidism and hemochromatosis are common causes.

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Hemochromatosis

Genetic disorder causing iron overload, with various health complications.

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Radial Traction (Airways)

The sticky force on the outside of the airways that prevents them from closing.

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Lung Apex-Base Changes (Sitting/Standing)

Both ventilation and perfusion increase from the apex to the base of the lungs when changing positions (sitting to standing).

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Otitis Media (OM) Most Common Cause

Streptococcus pneumoniae is the most common cause of otitis media..

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Otitis Media (OM) Treatment

Oral amoxicillin is the first-line treatment for otitis media.

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Recurrent Otitis Media (OM) Tx

Amoxicillin/clavulanate is used for recurrent otitis media.

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Tympanostomy Tubes (When)

Tympanostomy tubes are recommended for three or more OM episodes within 6 months, or four or more in a year.

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Otitis Externa (OE) Most Common Cause

Pseudomonas aeruginosa is the most common cause of otitis externa.

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Otitis Externa (OE) Tx

Topical ciprofloxacin + hydrocortisone drops are used to treat otitis externa.

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OE Prevention (water exposure)

Alcohol-acetic acid ear drops prevent otitis externa in those with frequent water exposure.

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Earwax Buildup Tx

Carbamide peroxide ear drops are used to treat earwax buildup.

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Anemia of Chronic Disease Lab Findings

Low hematocrit, low MCV, low transferrin, low TIBC, and normal or low transferrin saturation.

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Iron Deficiency Anemia Lab Findings

Low hematocrit, low MCV, high transferrin and TIBC, and super-low transferrin saturation.

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Iron Deficiency Anemia, RDW

Iron deficiency anemia often has an increased red blood cell distribution width (RDW).

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Thalassemia, RDW

Thalassemia typically has a low/low-normal red blood cell distribution width (RDW).

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Thalassemia Diagnostic Test

Hemoglobin electrophoresis is used to diagnose thalassemia.

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Thalassemia: Iron levels

Thalassemia is characterized by normal iron levels.

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Anemia of Chronic Disease, Pregnancy

In pregnancy, anemia of chronic disease often has normal iron and ferritin levels, even if the mother is taking iron supplements.

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Microcytic Anemia not improved by iron

Thalassemia is a microcytic anemia that doesn't respond to iron supplementation.

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Anemia of Chronic Disease, Renal Failure Tx

If renal failure is the cause of anemia of chronic disease, erythropoietin (EPO) is the treatment.

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Anemia of Chronic Disease, Non-Renal Tx

If renal failure isn't the cause, treat the underlying condition (e.g., IBD, RA, SLE).

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TIA/Stroke Risk Reduction (High BP, Smoker)

For high blood pressure and smokers with TIA, or stroke risk, lisinopril (blood pressure medication) is a recommended intervention to reduce risk of stroke (not smoking cessation alone).

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Normotensive Stroke Pt

Normotensive stroke patients are evaluated for atrial fibrillation.

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Hypertensive Stroke Pt

For hypertensive stroke patients, carotid duplex ultrasound is the next step.

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Normotensive Stroke Pt, Next Step

For normotensive stroke patients with a normal ECG, a Holter monitor is the next diagnostic step.

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High BMI Female, Irregular Cycles

High BMI females with irregular menstrual cycles likely have anovulation.

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Anovulation + Hirsutism

Anovulation accompanied by hirsutism suggests polycystic ovary syndrome (PCOS).

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Study Notes

Travel Diarrhea

  • Traveler diarrhea is often caused by ETEC, HL or HS toxins. Bloody diarrhea after poultry consumption is often Campylobacter jejuni or Salmonella.
  • Antibiotic use associated with diarrhea can cause C. difficile.
  • Fever of 104°F + abdominal distension with C.diff suggests toxic megacolon and warrants a laparotomy.
  • Treatment for C.diff is vancomycin, not metronidazole.
  • Bloody diarrhea and travel history could be Entamoeba histolytica.
  • Treatment is metronidazole + iodoquinol or paromomycin.
  • Close quarters, military, cruise ship or other similar environments + watery diarrhea could be Norwalk virus.
  • Children <5 years with watery diarrhea, Rotavirus is likely.

Bloody Diarrhea

  • Few organisms causing bloody diarrhea are Shigella.
  • Bloody diarrhea +appendicitis-like pain in a child might be Yersinia enterocolitica.
  • Bloody diarrhea + reactive arthritis in a adult could be related to Y. enterocolitica, Campylobacter, Shigella or Salmonella.
  • Diarrhea and Guillain-Barré syndrome might indicate Campylobacter infection.

Cardiac Ischemia

  • ECG stress test is first-line for evaluating suspected cardiac ischemia.
  • If baseline ECG shows abnormalities (e.g., BBB), an echo stress test may be necessary.
  • A dobutamine stress echo is indicated for those unable to exercise on an ECG stress test.

Pericarditis

  • Diffuse ST-segment elevations on ECG suggest pericarditis.
  • Pericarditis is often associated with central chest pain that is worsened when lying supine and improved when leaning forward.
  • Pericarditis following viral infection can lead to increased creatine kinase.
  • Posterior MI is suggested by ST-segment depressions in anterior ECG leads.
  • Pericardial effusion or tamponade presents with pulsus paradoxus (systolic blood pressure drop >10 mmHg with inspiration).
  • Beck's triad (hypotension; muffled heart sounds; jugular venous distension) strongly suggests pericardial tamponade.

Pneumonia

  • Pneumonia in CF patients <10 years is most commonly caused by S. aureus and >10yrs by Pseudomonas.
  • Pneumonia following influenza infection is commonly caused by S. aureus.
  • Pneumonia associated with rabbits is F. tularensis
  • Pneumonia associated with cattle is Coxiella (Q fever)
  • Pneumonia associated with birds is Chlamydia psittaci

Pulmonary Embolism

  • Leg swelling, pain, shortness of breath signifies pulmonary embolism potentially caused by deep vein thrombosis.
  • In pregnant women, V/Q scan instead of CT is required for PE diagnosis and management.
  • Someone already on warfarin (blood thinner) needs a spiral CT to confirm and an IVC filter for treatment.

Acid-base disturbances

  • Respiratory alkalosis (low CO2, high pH) is common in PE and asthma.
  • Aspirin toxicity also causes respiratory alkalosis during the initial 20 minutes.

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HY USMLE Review Part I PDF

Description

Test your knowledge on the causes, symptoms, and treatments of travel and bloody diarrhea. This quiz covers key pathogens, diagnostic criteria, and appropriate management strategies. Ideal for students of medicine or healthcare professionals.

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