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24 hour urine cortisol greater than what

value suggests a Cushing problem?

Greater than 100 mg/dl

Along with homocysteine, what levels can

be elevated with vitamin B12 deficiency?

Methylmalonic acid levels

Anaphlyaxis reaction is an example of

which type of hypersensitivity reaction?

Type 1 hypersensitivity

Anti-smooth muscle antibodies are

associated with which condition?

Autoimmune hepatitis

Ascitic fluid containing polymorphonuclear

leukocytes (PMNs) greater than this number
indicates spontaneous bacterial peritonitis (SBP)?

Greater than 250/mm3

ATP7B mutation is associated

with which condition?

Wilson's Disease

Back pain that improves with leaning

forward is the the classic presentation of
what musculoskeletal condition?

Spinal stenosis

Before starting patient on TNF-alpha

inhibitors, what test should be performed?

Purified protein derivative

(PPD) tuberculin skin test

Besides a traumatic tap, what condition is

often associated with red blood cells in the
cerebrospinal fluid on lumbar puncture?

Besides elevated MCV, what else can be

elevated with folate deficiency?

HSV encephalitis

Homocysteine levels

Besides rhabdomyolysis, what three major

conditions will produce blood in the urine
without seeing RBCs in urine?

Contamination with povidine, vitamin C

excess, Paroxsysmal nocturnal
hemoglobinuria (PNH)

Best next step after pt has tried NSAIDs /

OCPs for primary dymenorrhea but
symptoms persist >3 months?

Ultrasound to rule out uterine

abnormalities like fibroids

Bilateral lateral rectus palsy is often seen

with what vascular condition?

Cavernous sinus thrombosis

Blister cells or bite cells on peripheral

smear are most often seen with what

Glucose 6 phosphate
dehydrogenase deficiency (G6PD)

Blood pressure greater than or equal to what

value is a contraindication for t-PA therapy
in patients with ischemic stroke?

Systolic blood pressure greater than

185mmHg or Diastolic blood pressure greater
than 110mmHg

Boceprevir and Telaprevir are new hepatitis

C agents that can only be used against which
HCV genotype?

HCV genotype 1

Breast cancer along with sarcomas,

leukemia, lymphoma, brain tumors and
adrenal cancer defines which syndrome?

Li-Fraumeni Syndrome

Digestion of which toxin from reef fish can

cause for peri-oral parasthesias to occur?

Ciguatera toxin

During exercise, what is the formula used to

determine the maximum heart rate an
individual should achieve?

(220 - age in years) X 85%

Excessive ingestion of licorice can lead to

which electrolyte abnormality?


Finasteride, used to assist patients with benign prostatic

hyperplasia , acts on which enzyme to inhibit conversion
of testosterone to dihydrotestosterone?

5 alpha reductase

Foamy macrophages on PAS stain on a small

bowel biopsy is seen in what condition?

Whipple's Disease

Greater than what value is the white blood

cell (WBC) count expected to be in cases of
septic arthritis?

More than 50,000/uL

How do residual lung volumes and DLCO

change with kyphosis compared to normal

DLCO remains normal while residual lung

volumes are increased compared to normal

How do you differentiate chronic hepatitis B

infection from the carrier state?

Check liver function tests. Increased in

chronic state and normal in carrier state

How many days after aminoglycoside use

can acute tubular necrosis arise?

4-5 days

If a diabetic patient requires insulin therapy and

has normal renal function, how many units/kg is
the recommended daily insulin requirement?

0.5 units/kg

If patient with inflammatory bowel disease is

found to have dysplasia on colonoscopy, what
is the next step in management?


If pts with osteoarthritis present with

morning stiffness, what length of time should
it not exceed?

30 minutes

In hemochromatosis, which condition, if

developed, is irreversible?

Hypogonadism which can lead

to infertility

In males, a creatinine level of this or

higher is a contraindication to giving

1.5 mg/dl or higher

In patient with antibodies to pre-synaptic

acetylcholine receptors, are reflexes
increased or decreased?

Decreased (condition is EatonLambert Syndrome)

Individuals who have both Addison's Disease

and Hashimoto thyroiditis are known to have
what syndrome?

Schimdt's Syndrome (autoimmune

polyglandular type II)

Long term use of NSAIDS increases,

decreases, or has no effect on the risk of
developing colon cancer?


Long-term use of which potent antibiotic

requires performing regular eye exams?


Loss of passive flexion of the foot when the

calf is squeezed with achilles tendon tears is
known as what test?

Positive Thompson test

Muddy brown casts in a urinalysis is a

clue towards which renal process?

Acute tubular necrosis (ATN)

Name four commonly prescribed

medications that can cause aseptic

TMP-SMX (TrimethoprimSulfamethoxazole), IVIG (Immunoglobulin),

NSAIDS, Carbamazepine

Name the four main causes of

microcytic anemia.

Thalassemia, Iron deficiency, Anemia of

chronic disease, Sideroblastic anemia
(mnemonic TICS)

Name the supplement: Sleep aid also used

for stress/anxiety relief. If combined with
EtOH, can oversedate.


Name the supplement: Used against

dementia. Can increase the risk of bleeding.

Ginkgo Biloba

Name the supplement: Used against the

common cold. Can cause nausea, rash and


Name the supplement: Used as an antidepressant. Can potentially induces

cytochrome P450 drug metabolism.

St. John's Wort

Name the supplement: Used for benign

prostatic hyperplasia. Can cause headaches
and/or abdominal pain/nausea.

Saw Palmetto

Name three conditions that are very often

associated with hypogammaglobulinemia

CLL, nephrotic syndrome,


NSAIDS are known to cause allergic interstitial nephritis

without eosinophils. What other class of medication is
known to cause allergic interstitial nephritis without
eosinophils about 33% of the time?

Proton pump inhibitors (PPI)

An obese individual with headaches is found to have a

high opening pressure during lumbar pressure. What
is the best medication for this pt's likely condition?

Acetazolamide (Carbonic
anhydrase inhibitor)

Of the MCP, PIP, and DIP joint, which of the

following is least likely to be involved with
rhematoid arthritis?

DIP joint

Of the three major forms of hepatitis,

which does not currently have a vaccine
against it?

Hepatitis C

On a DEXA scan, what T score

will indicate osteoporosis?

T score of less than -2.5

On fundoscopic examination, which

condition is associated with cherry red spots
of the macula?

Retinal artery occlusion

On the morning of surgery, what change

should be made to long standing insulin in
diabetic patients?

Give half the dose of long

acting insulin

Optic chiasm compression will

lead to what eye abnormality?

Bitemporal hemianopsia

Patient develops a pneumonia soon after

recovering from the flu. What organism is
most often associated in this scenario?

Staphylococcus aureus

Patient is found to have a Pelger-Huet

anomaly and hyposegmented neutrophils.
What condition does this patient likely have?

Myelodysplastic syndrome

Patient is found to have left homonymous

quadrantanopia. Where is the lesion?

Right optic radiation

Patient is found to have positive antibodies

to soluble liver antigen (SLA). What
condition does this patient likely have?

Autoimmune hepatitis (which also

has anti-smooth muscle antibodies)

Patient who uses cocaine and has a weak

handshake. What is the likely diagnosis?

Inclusion body myositis

Patient with polymyositis is on high dose

steroids. CPK levels are improving but
weakness worsening. What to do?

Taper down on the steroids

Patient with rheumatoid arthritis on leflunomide

decides she wants to get pregnant. What is the best
next step in management?

Give cholestyramine for 9-11


Peripheral blood showing smudge cells is

most specifically associated with what

Chronic Lymphocytic
Leukemia (CLL)

Post renal transplant lymphoma is most

often associated with which organism?

Epstein Barr Virus (EBV)

Post-gallbladder removal, patient has right

upper abdominal pain and still has elevated
LFTs. Next step in management?

Check manometery studies to rule

out sphincter of oddi function

Proxmimal bicarbonate reabsorption is

seen in which renal tubular acidosis type?

Renal tubular acidosis type 2

Strong family history of premature heart

disease + patient has a low HDL. What level
is likely to be elevated?

Lipoprotein a or Lp(a)

Sweet's Syndrome can be associated

with what type of malignancy?

Acute myelogenous leukemia

Trastuzumab is used for what positive

marker in patients with breast cancer?

HER2/neu positive

Treatment of MALT requires

eradication of what organism?

Heliobacter Pylori (H. pylori)

Two fasting blood sugars greater than

what # will diagnose diabetes mellitus?

125 mg/dl

What antibody can be associated in

individuals who have Crohn's Disease?

Anti-Saccharomyces cerevisiae
antibodies (ASCA)

What are the CD markers for a Reed

Sternberg cell in Hodgkin's lymphoma?

CD15 and CD30

What are the most common vitamin

K dependent clotting factors?

Factors II, VII, IX, and X

What are the MRI T1 (increased/decreased)

and T2 (increased/decreased) signal changes
seen in patients with multiple sclerosis?

Decreased T1 and Increased


What are the organisms that

may lead to struvite stones?

Urea-splitting bacteria (Proteus,

Klebsiella, or Pseudomonas)

What are the possible agents for treating

hypertension in pregnant women?

Hydralazine, Labetalol, Alpha


What are the reflexes you would expect in an

individual who has antibodies to post
synaptic acetylcholine receptors?


What are the triad of diseases in multiple

endocrine neoplasia (MEN) type I?

Parathyroid, pituitary, and pancreatic-remember them as the 3P's of MEN I

What are the two most common HLA markers

associated with a condition that has positive
antibodies to tissue transglutaminase?

What are the two most common nerve

root impingements in lower back pain?

What area of the brain is affected with the

diagnosis featuring bradykinesia, cogwheel
rigidity, postural instability and resting tremor?

HLA DQ-2 and HLA DQ-8

L5 and S1

Substantia nigra (likely diagnosis is

Parkinson's disease)

What blood test is the initial screening

test for suspected systemic mastocytosis?

What cardiac condition has a loud holosystolic

murmur w/ palpable thrill along left sternal
border over 3rd or 4th intercostal space?

Serum tryptase level

Ventricular septal defect


What class of anti-depressants can be used

for patients who are suffering from urge

TCAs (Tricyclic antidepressants)

What class of medication is the first-line

treatment of renal crisis in scleroderma?

ACE inhibitors

What condition does a patient likely have if on

physical exam you hear a loud systolic ejection
murmur at the right 2nd intercostal space?

Aortic stenosis

What condition is known as "spotless

Rocky Mountain spotted fever"?


What condition is often associated with

antibodies positive to glutamic acid

Type 1 Diabetes Mellitus

What condition is often associated with

hypersegmented neutrophils?

Vitamin B12 deficiency

What condition is often associated

with pigeon or bat droppings?


What degree of stenosis is an indication

for carotid endarterectomy in female

70-99% stenosis

What degree of stenosis is an indication for

carotid endarterectomy in male patients who
are symptomatic? And asymptomatic?

50-99% in symptomatic. 6099% in asymptomatic.

What enteropathic organism is most often

associated with Guillain-Barre Syndrome

Campylobacter jejuni

What environmental exposure can lead to

acute vitamin B12 deficiency?

Nitrous oxide

What group of testicular cancer is

not sensitive to radiation therapy?

Non-seminomas (eg. teratoma, embryonal

carcinoma, choriocarcinoma, yolk sac tumor)

What hematologic condition is often

associated with restless leg syndrome?

Iron deficiency anemia

What hematological condition is caused by

a membrane defect of spectrin deficiency?

Hereditary spherocytosis

What HLA marker can often be

associated with ankylosing spondylitis?


What is a very common organism for

UTIs in young, pregnant women?

Staphylococcus saprophyticus

What is Charcot's triad?

Fever, Right upper quadrant

abdominal pain, and Jaundice

What is the anti-depressant category of

choice in patients with bulemia?


What is the antibiotic of choice for mild

Clostridium difficile colitis? Severe?

PO or IV metronidazole for mild.

PO vancomycin for severe.

What is the best management in an

individual who has overdosed on TCAs and
has widened QRS on EKG?


What is the best next step in a patient with

aspirin allergy who will be undergoing
elective coronary angioplasty?

Aspirin desensitization. Pts undergoing

elective angioplasty should be pre-treated
with aspirin and clopidogrel.

What is the best screening

blood test for acromegaly?

Insulin growth factor 1 (IGF-1)

What is the best treatment for penicillinallergic, pregnant female with UTI?


What is the best way to prevent foot ulcers

from occuring in diabetic patients?

Perform monofilament testing

What is the earliest lab value to increase

after repleting iron in patients with iron
deficiency anemia?

Reticulocyte count

What is the enzyme that converts

testosterone to estradiol?


What is the fundoscopic exam finding often

seen with idiopathic intracranial
hypertension (Pseudotumor cerebri)?


What is the goal hemoglobin level in

patients with end stage renal disease?

11-12 g/dl (higher than this can increase

risk of embolism or strokes)

What is the goal uric acid level to prevent

further attacks in patients with gout?

Less than 6mg/dl

What is the gold standard for diagnosing

small intestinal bacterial overgrowth?

Endoscopy with jejunal


What is the gold standard imaging

modality for diagnosing kidney stones?

Noncontrast spiral CT

What is the ideal LDL goal in CAD

patients or CAD equvialent patients?

Less than 70 mg/dl

What is the inheritance pattern for

Hereditary Hemorrhagic Telangiectasia

Autosomal dominant. HHT is also known

as Osler-Weber-Randau syndrome

What is the initial diagnostic test to check in

an individual you suspect of having

Creatine phosphokinase (CPK)

or Creatinine kinase (CK)

What is the initial diagnostic test to check in

an individual you suspect to have temporal

Erythrocyte sedimentation
rate (ESR)

What is the laboratory screening

test for chronic alcohol abuse?

Carbohydrate free transferrin

level elevated

What is the leading cause of death in

patients with systemic lupus erythematosus?

Cardiovascular disease

What is the leading cause of sudden

cardiac death in young athletes?

Hypertrophic cardiomyopathy

What is the main anti-depressant to be

avoided in patients with seizure disorder?


What is the main pulmonary function test

that helps differentiate obstructive from
restrictive lung disease?

Total lung capacity (TLC)

What is the main vector of Lyme

Disease in North America?

Ixodes scapularis

What is the MOST common

cause of aseptic meningitis?

Enterovirus (more than


What is the most common cause of

pneumonia in HIV patients?

Streptococcus pneumoniae

What is the most common cause of septic

arthritis in inviduals greater than 40 years of

Staph aureus

What is the most common electrolyte

abnormality associated with tamoxifen use?


What is the most common extra-articular

manifestation of rheumatoid arthritis?

Rheumatoid nodules

What is the most common presenting

symptom of an individual with acute
altitude sickness?


What is the most common

subytpe of thyroid cancer?

Papillary thyroid cancer

(papillary carcinoma)

What is the most common symptom of

Hereditary Hemorrhagic Telangiectasia

Epistaxis (nose bleeding)

What is the most common type of

glomerulonephritis throughout the world?

IgA Nephropathy

What is the most commonly used agent in

the treatment of Familial Mediterranean


What is the most important prognostic

factor in a patient with breast cancer?

Lymph node positivity

What is the most likely diagnosis in a patient

on hemodialysis with skin ulcerations and an
elevated calcium-phosphate product?


What is the most likely diagnosis in diabetic

pt with diarrhea, weight loss, flatulence and
vitamin A, D, B12 deficiencies?

Small intestinal bacterial


What is the most likely organism that

causes post partum endometritis?

Group B Streptococcus
(Streptococcus agalactiae)

What is the most sensitive method of

diagnosing avascular necrosis?


What is the most specific test for

diagnosing rheumatoid arthritis?

Anti-citrullinated protein
(anti-CCP) antibody

What is the name of the sign in which RLQ

pain is elicited with LLQ palpation in a
patient suspected of having appendicitis?

Positive Rovsing sign

What is the number of dermatomes over which a

patient with Herpes Zoster virus requires both
contact and airborne precautions?

What is the rash that is commonly

associated with celiac disease?

What is the recommendation for initial

colonoscopy after inflammatory bowel disease
diagnosis and follow up colonoscopies?

Two dermatomes

Dermatitis herpetiformis

8 years after diagnosis and

then every 1-2 years

What is the simplest test to differentiate

anemia of chronic disease from iron

Total iron-binding capacity


What is the syndrome that contains the

triad of ptosis, miosis, and anhidrosis?

Horner's Syndrome

What is the treatment of choice for unstable

pt with wide complex tachycardia?

Immediate synchronized
cardio version

What is the treatment of choice

of dermatitis herpetiformis?


What is the treatment of M3

form of AML?

All-Trans Retinoic Acid


What is the triad of symptoms you would

expect in a patient with normal pressure
hydrocephalus (NPH)?

Ataxia (wide based gait), dementia,

and urinary incontinence

What is the valvular abnormality that can

result from dissection of the ascending

Aortic regurgitation

What is the valvular condition most

commonly associated with pulsus tardus in
the carotids?

Aortic stenosis

What kidney stones are most

commonly missed on plain xrays?

Uric acid stones

What mutation is often associated

with polycythemia vera?

JAK2 mutation

What organism can cause febrile, hemolytic

anemia esp in pts who visited Nantucket or
Long Island area?

Babesia microti

What organism is known as the

"great mimicker" of appendicitis?

Yersinia enterocolitica

What organism is known to

cause Q fever?

Coxiella burnetti

What reflexes (increased/decreased) would

you expect with someone who is diagnosed
with West Nile Virus meningits?


What rheumatological condition can often

be associated with temporal arteritis?

Polymyalgia rheumatica

What thyroid test level tends to be

elevated in patients who have sick
euthyroid syndrome?

Reverse T3 (rT3)

What two antibiotics are most commonly

used for the treatment of diverticulitis?

Ciprofloxacin and

What two conditions are associated with

bisferiens pulse in the carotids?

Aortic regurgitation and

hypertrophic cardiomyopathy

What type of kidney stones are

often implicated in recurrent UTIs?

Struvite (Magnesium
ammonium phosphate) stones

What type of reflexes would you expect in

a patient who has uncontrolled


What vitamin deficiency can occur

with use of Isoniazid (INH)?

Vitamin B6 (Pyridoxine)

What vitamin or mineral deficiency is

associated with rash and alopecia in patients
on TPN feeding?

Zinc deficiency

What will be the folate and vitamin B12

levels in patients with Caribbean tropical

Normal folate, decreased

vitamin b12 levels

What would you expect pleural effusion

glucose level to be in individuals with
rheumatoid arthritis?

Less than 30 mg/dl

What would you expect the C3 complement levels

to be (increased/decreased/same) in a patient with
post-infectious glomerulonephritis?


Which agent used in the treatment of

rheumatoid arthritis requires frequent eye


Which antibody is associated with cold

agglutinin hemolytic anemia?


Which antibody is associated

with CREST syndrome?


Which antibody is most specifically

associated with type I diabetes?

Anti-glutamic acid

Which class of anti-depressants are

associated with widened QRS complex that
can be treated with bicarbonate?

Tricyclic antidepressants

Which class of anti-diabetic agents should be

avoided in patients who have underlying
congestive heart failure (CHF)?


Which class of antibiotics is most notoriously

contraindicated in individuals with
myasthenia gravis?


Which class of medication is used to prevent

vasospasm in patients with subarachnoid

Calcium channel blockers (eg.

nimodipine, nifedipine)

Which congestive heart failure medication is

used for symptomatic relief but does not
decrease mortality?

Furosemide (Lasix)

Which disease is associated with decreased

uroporphyringoen decarboxylase activity?

Porphyria cutanea tarda

Which extra-intestinal manifestions can

mirror inflammatory bowel disease?

Arthritis and Erythema


Which form of lung cancer is most often associated

with ectopic production of parathyroid hormonerelated peptide (PTHrp)?

Squamous cell carcinoma of

the lung

Which form of nephrotic syndrome is

most associated with heroin use?

Focal segmental

Which form of nephrotic syndrome is

often associated with lithium use?

Minimal change disease

Which gene test should be checked before

administering azaithioprine to prevent
dangerous bone marrow suppression?

TPMT gene test (thiopurine Smethyltransferase)

Which hepatitis B marker

indicates active replication?


Which hepatitis C treatment medication

may exacerbate autoimmune hepatitis?


Which hepatitis infection is the only

type that is a DNA virus?

Hepatitis B

Which herpes virus is associated

with Kaposi's sarcoma?

Human herpes virus 8

Which HIV medication is known to cause an

asymptomatic elevation in MCV?


Which HIV medication requires you to check

HLA B-5701 to prevent hypersensitivity


Which knee test can indicate that patient has

a lateral collateral ligament tear?

Positive varus test

Which marker is often

associated with ovarian cancer?

CA 125

Which marker is often associated

with pancreatic cancer?

CA 19-9

Which myeloproliferative disorder is

associated with BCR-ABL or t (9,22)

Chronic Myelogenous
Leukemia (CML)

Which organism can be associated with

Burkitt's Lymphoma and nasopharyngeal

Epstein-Barr Virus (EBV)

Which organism causes

Trench Fever?

Bartonella quintana

Which organism commonly causes

meningitis in infants and the elderly,
requiring treatment with ampicillin?

Listeria monocytogenes

Which organism is considered a

contaminant in the blood if no central venous
catheter is present?

Staphylococcus epidermidis

Which organism is known to

cause "desert rheumatism?"


Which organism is notoriously known to

cause hemolytic uremic syndrome (HUS)?

Escherichia coli O157:H7

Which organism is the most common

cause of diabetic foot ulcers?

Staphylococcus aureus

Which pain medication should be avoided

in patients who are taking SSRIs for

Tramadol (concurrent use of SSRI with

tramadol can cause serotonin syndrome)

Which renal disorder can present both as

nephritic and nephrotic syndrome?

glomerulonephritis (MPGN)

Which statin is the drug of

choice in HIV patients?


Which subtype of nephrotic syndrome is

most commonly associated with hepatitis B

Membranous nephropathy

Which two CD markers are often deficient in

individuals with paroxsysmal nocturnal
hemoglobinuria? (PNH)

CD55 and CD59

Which two hyperthyroid conditions will

cause low radioactive iodine uptake?

Thyroiditis and exogenous use of

thyroid medication

Which two murmurs decrease in intensity

with leg raising and squatting?

Hypertrophic obstructive cardiomyopathy

(HOCM) and Mitral valve prolapse (MVP)

Which two murmurs will decrease in

intensity with squatting, sitting or leg

Hypertrophic obstructive cardiomyopathy

and Mitral valve prolapse

Which type of anemia is a common

complication of chronic lymphocytic

Warm agglutinin autoimmune

hemolytic anemia

Which type of beta blockers are okay to

give to patients with hypertension and

Cardioselective beta blockers (metoprolol,

atenolol, bisoprolol, nebivolol)

Which type of cancer is least likely to

metastasize to the brain and usually
produces blastic bone lesions?

Prostate cancer

Which type of lung cancer can give a

paraneoplastic syndrome of gynecomastia?

Large cell carcinoma

Which type of renal tubular acidosis is

associated with defect in proximal
bicarbonate absorption?

Renal tubular acidosis type II

Which vitamin is used to

enhance iron absorption?

Vitamin C (Ascorbic acid)

Which vitamin toxicity may lead to

idiopathic intracranial hypertension
(Pseudotumor cerebri)?

Vitamin A

With allergic bronchopulmonary

aspergillosis (ABPA), what two labs will be

IgE and peripheral eosinophils

greater than 10 percent

With osteoarthritis, what would you expect

the ESR and CRP levels to be?

Normal (versus elevated in

rheumatoid arthritis)

With systemic lupus erythematosus exacerbation, what

would you expect the complement (high/low), antidsDNA (pos/neg) and ESR (high/low) levels to be?

Low complement, pos antidsDNA, high ESR

With terminal complement deficiency, to

which organism are patients most

Neisseria meningitis

Within what age range does USPSTF

recommend one-time screening for AAA in
men with a smoking history?

65 to 75 years