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Question 1

septic shock management

Answer 1

• fluid resuscitation to CVP of 8-12

- vasopressors if MAP <65 after fluids

Question 2

What is immune reconstitution inflammatory syndrome?

Answer 2

paradoxical worsening of pre-existing infections in HIV positive individuals days to week after starting HAART treatment.
- self limited

Question 3

Secondary causes of restless leg syndrome?

Answer 3

• iron deficiency anemia
• diabetes
• uremia (ESRD, CKD)
• MS, parkinsons
• pregnancy
• drugs (antidepressants, metoclopramide)

Question 4

features of lumbar spinal stenosis?

Answer 4

• worsens with extension, improves with flexion
• pain decreases with sitting down
• diagnosed with MRI

Question 5

what is kappa statistic?

Answer 5

-inter rater reliability

Question 6

what is validity?

Answer 6

accuracy

Question 7

long term management of chronic hypoparathyroidism

Answer 7

• add a thiazide to increase serum calcium and decrease urinary calcium
• PTH increases renal calcium absorption

Question 8

PMDD/PMS treatment

Answer 8

• first line: SSRI
• 2nd line: another SSRI or estrogen-progesterone oral contraceptive
• benzo and other GnRH agonist may be effective but has SE

Question 9

Management of GBS

Answer 9

• intubation and mechanical respiration due to respiratory failure
• plasmapheresis and/or IVIG therapy

Question 10

criteria for ARDS

Answer 10

• new or worsening resp sx in past week or w/i 1 week of clinical insult
• b/l lung opacities consistent with pulm edema
• no signs of cardiac failure or fluid overload
• ECHo needed for definite exclusion
• PaO2/FiO2 ratio <300mmHg

Question 11

Sx and treatment of RA

Answer 11

• symmetric polyarthritis (MCP, PIP) with morning stiffness >30 min
• First line tx: NSAIDS
• DMARDS: antimalarials, sulfasalazine, methotrexate, azathioprine to slow down bone erosion
• RF only positive in 70-80% of ppl, it’s a CLINICAL ddx
• CCP another marker

Question 12

Sx of SLE

Answer 12

• migratory morning stiffness that lasts minutes
• manifestation in skin and kidneys and msk
• anti ds DNA

Question 13

Cardiogenic shock hemodynamic parameters

Answer 13

• low cardiac index (normal 2.8-4.2)
• elevated pulmonary capillary wedge pressure (normal 9)
• elevated SVR

Question 14

Signs of pulmonary artery hypertension, and best ddx test

Answer 14

• loud S2
• enlarged pulmonary arteries
• right axis deviation EKG
• raynaud’s phenomenon
• ECHO as initial test

Question 15

tx of PAH

Answer 15

• bosentan (endothelin inhibitor)
• epoprostenol and treprostinil (prostacyclin analogs)
• CCB
• sildenafil

Question 16

Management of cocaine induced chest pain

Answer 16

• first line: benzo to help with anxiety
• second line: phentolamine if benzo fails
• alternatives: nitroprusside, nitroglycerin
• avoid bb to avoid coronary vasospasm

Question 17

features and tx of primary dysmenorrhea

Answer 17

• presents in first 6-12 months of period, normal physical exam
• elevated levels of prostaglandin
• tx: first line is NSAIDs, then OCP

Question 18

HPV vaccination timeline and contraindications?

Answer 18

• first dose at age 11-12, 3 doses in 6 month period
• hx of prior sexual activity, previous HPV infection, immunosuppression, abnormal pap smear are NOT contraindications
• hypersensitivity to yeast IS contraindication

Question 19

features and treatment of primary billiary cirrhosis

Answer 19

• unexplained pruritis and elevated alk phos
• progressive cholestasis and liver failure
• HLD with xanthomas
• antimitochondrial antibodies
• tx: ursodeoxycholic acid and liver transplantation
• cx: osteoporosis, osteomalacia

Question 20

symptoms of serotonin syndrome

Answer 20

• mental status changes
• autonomic dysregulation
• neuromuscular hyperactivity (hyperrflexia, myoclonus, ocular clonus)
• cause: combined use of SSRI and MAOI (eg phenelzine); need 5 week wait period

Question 21

risk factors, sx and tx of candida endophthalmitis

Answer 21

• central venous catheter, TPN, broad spectrum abx, abd surgery, IV drug use, steroids, neutropenia
• ocular pain, scotomas, photophobia, fever
• vitrectomy and antifungal (amphotericin B or fluconazole)

Question 22

treatment and cx of beta thalassemia major

Answer 22

• hypertransfusion regimen

- iron overload and resultant organ damage

Question 23

Risk of hepatic adenoma with use of OCP in women

Answer 23

Stop OCP due to risks of sudden rupture with infra-abdominal bleeding and malignant transformation

Question 24

Features of Rocky Mountain spotted fever and treatment

Answer 24

5-7 days after tick bite, low fever, lethargy, myalgia, petechial rash in ankles and wrists, spreads to palm soles and body.

TX: doxy is first line, chloramphenicol is alt option.

clinical diagnosis, no need to wait for confirmatory test

Question 25

Treatment of salicylate overdose (metabolic acidosis)

Answer 25

Gastric lavage
Administration of activated charcoal
Alkalization of urine to enhance secretion

Question 26

Management of dyspepsia in:

1. pt with GERD sx
2. NSAID/cox2 use
3. no meds use, no alarm sx and above 55
4. no meds use but alarm sx

Answer 26

1. empiric tx, acid suppression
2. empiric tx, acid suppression, d/c meds
3. endoscopy
4. endoscopy

test for h.pylori only in high risk population (asia, eastern Europe, latinos)

Question 27

what is parinaud’s syndrome, and what tumor is it associated with?

Answer 27

• loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus, ataxia
• pineal tumor- some are germinomas, can produce HCG

Question 28

Side effects of amiodarone

Answer 28

• thyroid dysfunction–> thyrotoxicosis
• corneal deposits
• skin discolorations
• pulmonary fibrosis
• liver toxicity

Question 29

How does glucagonoma present?

Answer 29

pancreatic tumor associated with mild diabetes and classic skin rash that clears in the center, “necrolytic migratory erythema”

Question 30

Most common cause of hemoptysis?

Answer 30

Pulmonary infections

• bronchitis
• bronchiectasis (mucopurulent sputum production, recurrent infection)
• lung cancer
• PE