13

Question 1

Difference between prospective cohort vs cross sectional studies

Answer 1

Prospective cohort compares disease incidence

Cross sectional compares disease prevalence

Question 2

Patients with celiac sprue who presents with GI sx (watery diarrhea) despite adherence to gluten free diet most likely has what disease?

Answer 2

Intestinal T cell lymphoma

Question 3

oliguria, hypotension, elevated BUN and creatinine in hospitalized patient. Ddx?

Answer 3

Acute tubular necrosis (muddy brown cast, high FeNA)

Question 4

Steps in evaluating impaired gastric emptying

Answer 4

1. first rule out mechanical obstruction; upper endoscopy
2. if nondiagnostic, and malignancy is a concern, obtain CT or MRI
3. then perform tests for gastric dysmotility, like scintigraphic gastric emptying tests

Question 5

Treatment for pregnant TB infected patients

Answer 5

9 months of isoniazid, ethambutol, rifampin

unless drug resistant, avoid pyrazinamide due to teratogenicity

Question 6

Causes of acute painless vision loss

Answer 6

• central retinal artery occlusion: sudden, cherry red spot, hx of amaurosis fugax, pale fundus
• central retinal vein occlusion: subacute, retinal hemorrhage, optic disc edema (“blood and thunder”)
• retinal detachment: floaters, fundus with vitreous hemorrhage, marked elevation of retina
• vitreous hemorrhage: decreased red reflex, hemorrhage on funduscopy, bed rest with elevation

Question 7

Characteristic lesions of cutaneous cryptococcus, confirmatory test?

Answer 7

small, reddish brown papules with central umbilication (like molluscum contagiosum)
- biopsy

Question 8

Common fractures when you fall on an outstretched hand

Answer 8

colles fracture (distal radius)- at risk for acute CTS
scaphoid fracture
ulnar styloid fracture

Question 9

Treatment of bacterial vaginosis (fishy odor, homongenous vaginal discharge)

Answer 9

oral metronidazole or clindamycin

Question 10

Which diseases are related to multiple skin tags? dermatitis herpertiformis?

Answer 10

• skin tags: insulin resistance, pregnancy, crohn’s dz (perinanal)
• derm. herp: celiac disease

Question 11

catatonia treatment

Answer 11

-benzo, ECT

Question 12

Management of pts with acute ischemic stroke who received TPA

Answer 12

• keep bp <185/105

- do not give antiplatelets, anticoagulation, invasive therapy in the first 24 hours

Question 13

Initial diagnostic test of dermatomyositis (proximal muscle weakness, helitrope rash, gottron’s papules, elevated muscle enzymes)? must needed screening test?

Answer 13

• ANA testing
• serum antibodies; anti Ro, La, anti Jo
• cancer screening test needed as it is associated with malignancy

Question 14

Management of breast mass in women under 30 and above 30?

Answer 14

• <30: ultrasound +/- mammogram–> complicated cyst? then core biopsy, if not, elective needle aspiration1
• > 30: mammogram +/- ultrasound–> malignancy? then core biopsy

Question 15

Autoimmune hepatitis (young to middle aged women, elevated AST/ALT and normal everything else) diagnosis test?

Answer 15

ANA, anti smooth muscle ab

Question 16

opioid withdrawal management

Answer 16

• opioid antagonist: methadone, buprenorphine (preferred under supervised setting)
• nonopioid: clonidine, antiemetics, antidiarrheals, benzos

Question 17

clinical presentation of nondominant parietal lesion vs dominant parietal lesion

Answer 17

• nondominant (right): construction apraxia—confusion, difficulty drawing lines, dressing issues
• dominant (left): Gerstmann syndrome—acalculia, finger agnosia, agraphia, left right confusion

Question 18

strongest known risk factor for breast cancer in male

Answer 18

klinefelter’s syndrome

Question 19

first line treatment of severe bipolar mania in pregnant patients

Answer 19

haldol

Question 20

Pernicious anemia shows what in gastric endoscopy?

Answer 20

• glandular atrophy
• intestinal metaplasia
• inflammation

Question 21

best diagnostic test for sickle cell anemia

Answer 21

hemoglobin electrophoresis

Question 22

Most common complication of cat scratch disease

Answer 22

suppuration of lymph nodes

Question 23

Most common cause of pediatric pneumonia and treatment

Answer 23

• preschool or focal lung findings: strep pneumo, high dose amoxicillin
• older or b/l lung findings: mycoplasma, azithro

Question 24

Primary prevention of esophageal varices? Management of acute esophageal bleeding?

Answer 24

• nonselective beta blockers- propanolol, nadolol

- banding with endoscopy at first attempt, at recurrence, try again. Then if that fails, try TIPS

Question 25

Clinical presentation of acute mesenteric ischemia

Answer 25

• acute abdominal pain where physical exam does not match severity of pain.
• metabolic acidosis

Question 26

presentation of esophageal perforation/boerhaave’s syndrome

Answer 26

• acute chest pain with repeated vomiting
• tear in distal third of esophagus, leads to pleural effusion
• pneumomediastinum, pneumothorax can be seen

Question 27

trimethoprim, methotrexate, and phenytoin can cause what kind of anemia through which mechanism? Tx?

Answer 27

• macrocytic anemia by inhibiting DHFR

- need folinic acid, not folic acid, as folinic acid is more potent

Question 28

What can prevent febrile nonhemolytic transfusion reaction (occurs 1-6 hours after transfusion)

Answer 28

leukoreduction

** washing cells is for IgA deficiency

Question 29

Most common complication of patients admitted with acute variceal bleeding, what ppx treatment is needed?

Answer 29

sbp

need fluoroquinolone agent for 7-10 days

Question 30

Which medication group contributes most to pulmonary edema?

Answer 30

pioglitazone/thiazolidinedione group

Question 31

Management of unilateral bloody/serous discharge

Answer 31

mammogram +/- ultrasound

surgical eval

Question 32

When is biopsy indicated for actinic keratosis lesions that may progress to SCC?

Answer 32

>1cm diameter
painful
indurated
ulcerated
grows rapidly