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Question 1

what complications are the first to occur in diabetes mellitus?

Answer 1

microvascular

• diabetic retinopathy
• nephropathy
• neuropathy

Question 2

______ marks the earliest manifestation of a microvascular complication associated with diabete mellitus

Answer 2

microalbuminuria

Question 4

what are the 4 ways to diagnose diabetes?

Answer 4

1. hemoglobin A1c of 6.5% or greater
2. fasting serum glucose over 126 mg/dL
3. serum glucose over 200 mg/dL two hours after 75g of oral glucose load
4. random serum glucose over 200mg/dL with classic diabetes sx

Question 5

which lab value will be abnormally elevated in hemophilia A (factor VIII deficiency)?

Answer 5

aPTT, defective intrinsic pathway

Question 6

first line treatment for persistent allergic rhinitis

Answer 6

intranasal corticosteroids

Question 7

list the major risk factors for suicide

Answer 7

• personal hx of suicide attempts
• sexual orientation
• famliy history of suicide attempts

Question 8

name some dopamine agonists used in treating Parkinsons

Answer 8

levodopa, pramipexole, ropinirole

Question 9

COMT inhibitors end in what suffix?

Answer 9

-capone

Question 10

MAO inhibitors end in what suffix?

Answer 10

-giline

Question 11

types of drugs used to treat Parkinsonian resting tremors?

Answer 11

anticholinergic medications (benztropine, trihexyphenidyl)

Question 12

what 3 things justify involuntary admittance to the psychiatric hospital?

Answer 12

1. harm to self
2. harm to others
3. unable to take care of self due to psychiatric illness

*if pt is able to do thses things, even if acutely delusional, just schedule regular visits outpatient

Question 13

who do you contact when you suspect child abuse?

Answer 13

• law enforcement
• Child Protective Services
• or Department of Children and Family Services

Question 14

pt with actively bleeding esophageal varices is undergoing EGD. best treatment?

Answer 14

treatment of choice for acute bleeding of esophageal varices during endoscopy is ligation

Question 15

is L5 felxed or extended in forward torsions?

Answer 15

L5 is neutral in forward torsions and follows type 1 mechanics

Question 16

pt with flu-like illness +lymphadenopathy+rash and you suspect acute HIV illness. what is the next step in diagnosing?

Answer 16

• first: HIV 1/2 antigen/antibody immunoassay
  
  • if negative, no further testing.
  • if positive, get HIV 1/2 antibody differentiation assay
• idk very confusing, OME says get viral load

Question 17

cranial technique to address acute otitis media and temporal bone dysfunction is _____

Answer 17

V spread technique

Question 18

what cranial dysfunction can lead to acute otitis media?

Answer 18

internal rotation of the temporal bone

Question 19

St. Johns wort (used for depression) is a known cyp P450 _____

Answer 19

inducer; increases the metabolism of warfarin causing decrease in INR

Question 20

goal INR for pts on anticoagulation for AFIB, PE, DVT

Answer 20

2-3

Question 21

goal INR for pts on anticoagulation with mechanical heart valves

Answer 21

2.5-3.5

Question 22

S-adenosyl methionine (SAMe) is used for depression and has an interaction with what drug?

Answer 22

SSRIs (can cause serotonin syndrome)

Question 23

pt with warfarin toxicity, active bleeding, and high INR . what should you give them?

Answer 23

fresh frozen plasma transfusion for immediate reversal (vitamin K alone will take hours to reach effect)

Question 25

pt with warfarin toxicity and INR higher than 5 with **no bleeding.** What do you give?

Answer 25

vitamin K

Question 26

pt is overconcerned with a mild sx despite numerous negative tests. dx?

Answer 26

illness anxiety disorder

Question 27

development of several unrelated sx without a clear medical explanation

Answer 27

somatic sx disorder

Question 28

pt with thyroid nodule and decreased TSH. next step?

Answer 28

decreased TSH= hyperthyroidism US, then thyroid scintigraphy (RAIU)

Question 29

pt with thyroid nodule and increased or normal TSH. next step?

Answer 29

increased TSH=hypothyroid (or euthyroid) US, then FNA if nodule is 1cm or larger if less than 1 cm, f/u US in 6-12 months

Question 30

where is the most common place to get an anal fissure?

Answer 30

posterior midline

Question 31

name the tumors commonly associated with MEN1 (MEN1 gene)

Answer 31

* hyperparathyroidism (usually first tumor to show up and most common) * pancreatic islet cell tumor * pituitsry tumor (prolactinoma)

Question 32

tumors commonly associated iwth MEN2A | (RET mutation)

Answer 32

2 Ps * hyper**p**arathyroidism * **p**heochromocytoma * medullary thyroid cancer (elevted calcitonin) (pts should undergo thyroidectomy in early childhood)

Question 33

tumors commonly associated with MEN2B

Answer 33

* _medullary thyroid carcinoma_ * _**p**heochromocytoma_ * mucosal neuromas * intestinal ganglioneuromas * marfanoid habitus * developmental abnormalities * skeletal deformities * megacolon

Question 34

colon cancer marker for recurrent disease

Answer 34

carcinoembryonic antigen (CEA)

Question 35

first test to get when bacterial meningitis is suspected?

Answer 35

blood cultures

Question 36

pt presents with bacterial meningitis and signs of increased intracranial pressure. workup order?

Answer 36

blood draw--\> steroids+abx--\>CT if CT normal, then do LP

Question 37

pt presents with bacterial meningitis and **NO** signs of increased intracranial pressure. workup order?

Answer 37

blood draw--\>LP--\> steroids+abx

Question 38

supraventricular arrythmia that is associated with pulmonary disease (long-standing asthma or COPD)

Answer 38

Multifocal atrial tachycardia; 3 or more P wave morphologies over 100 BPM

Question 39

treatment for asepctic bursitis

Answer 39

protdctive joint bracing and comservative management (RICE)

Question 40

lab values seen in hemochromatosis?

Answer 40

* elevated iron * elevated ferritin * decreased TIBC * confirm with liver bx and genetic testing

Question 41

what is **spodylolysis** and how do you diagnose it?

Answer 41

pars interarticularis fracture, occurs in young athletes with radiation to butt. diagnose with oblique lumbar radiograph

Question 42

what is **spodylolisthesis** and how do you diagnose it?

Answer 42

anterior displacement of a lumbar vertebral segment relative to the segment above or below dx with lateral radiography

Question 43

what is **spodylosis** and how do you diagnose it?

Answer 43

degenerative narrowing of the joints of the spine ("osteoarthritis of the spine")

Question 44

pt just had seizure and arm is internally rotated and abducted. injury?

Answer 44

posterior glenohumeral dislocation

Question 45

pt has abdominal pain after discharge for acute pancreatitis. what is it and what do you do next?

Answer 45

pancreatic pseudocyst; NPO and observation

Question 46

when do you need to give a pregnant pt betamethasone for fetal lung maturation?

Answer 46

if pt is delivering before 34 weeks

Question 47

pregnant pt comes in having seizure (eclampsia). what do you do?

Answer 47

airway management, IV mag sulfate, betamethasone, induction of vaginal delivery (you dont have to do a c-section)

Question 48

pt becomes acutely hypoxic during hospital stay. what test do you want to order to rule out ARDS vs cardiogenic pulmonary edema?

Answer 48

echocardiogram

Question 49

suspect pancreatic cancer in a patient. next step?

Answer 49

US

Question 50

most sensitive test for pancreatic CA? most specific?

Answer 50

sensitive=CT abdomen specific=ERCP

Question 51

pt treated for UTI, but doesnt get better. what next?

Answer 51

send urine for culture and sensitivities; complicated UTI could be pyelo

Question 53

murmurs that get **louder with inspiration** are on which side of the heart?

Answer 53

right side