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Question 1

pt presents with blood sugar over 600 and AMS. what will be elevated lab-wise? will they have increased ketones?

Answer 1

this is hyperglycemic hyperosmolar state, will see:

• serum osmolality will be increased (greater than 320)
• there will be no increased ketones

Question 2

diagnosis and treatment of sporotrichosis

Answer 2

dx: cigar shaped yaest
tx: itraconozole

Question 3

kid with port wine stain and seizures. what is another problem he probably has?

Answer 3

sturge weber syndrome; can cause leptomeningeal vascular malformations frequently occur in the occipital lobes of the brain and can cause homonymous hemianopia

Question 4

pt with refractory depression develops hypertension. what med is he taking?

Answer 4

MAOI (phenelzine, tranylcypromide, isocarboxazid) combines with an SSRI or tyramine-containing foods

Question 5

alport syndrome

Answer 5

• x-linked recessive
• collagen iV defect
• sensorineural hearing loss, ocular abnormalities, hematuria

Question 6

subacute granulomatous thyroiditis (de Quervains)

Answer 6

• painful
• following viral illness
• hyper then hypo thyroid
• tx is supportive
• full recovery

Question 7

pt presents with NSTEMI. most appropriate test after EKG is?

Answer 7

percutaneous coronary angiography

Question 8

pt presents with very high calcium levels. best initial step?

Answer 8

hydration with normal saline–>furosemide. if that doesnt work, then do dialysis.

Question 9

child with CF presnet with acute SOB and diarrhea. what other sx should you look for ?

Answer 9

signs of DM; polydypsia, polyuria

Question 10

pt with gallstones presents with fever, RUQ pain, and jaundice (charcots triad). dx?

Answer 10

acute cholangitis

Question 11

labs in acute cholangitis?

Answer 11

leukocytosis, conjugated hyperbilirubinemia, elevated alk phos, elevted GGT

Question 12

initial study of choice for acute cholangitis?

Question 13

gold standard study of choice for acute cholangitis?

Answer 13

IV fluids and abx–>ERCP

Question 14

contraindications to BB ?

Answer 14

right sided MI, bradycardia, low BP, 2-3rd degree heart block, bronchospasm

Question 15

when do you use levofloxacin for CAP?

Answer 15

when the pt has comorbid conditions or has used ABX within the past 90 days

can also use amoxilxillin-clavulonate+doxycycline combo

Question 16

treatement of outpatient CAP in pt who has no comorbidities or has not used ABX in the last 90 days?

Answer 16

macrolide or doxycycline

Question 17

you see a cerebellar pontine tumor on MRI. what is it and what effects will it have?

Answer 17

vestibular schwannoma

• ipsilateral sensoruneural hearing loss, tinnitus, vertigo
• headache, facial palsy, sensory loss over the face (same side as lesion)

Question 18

what kind of microbe is Propionibacterium acnes**?

Answer 18

anaerobic, gram positive bacillus

Question 19

which conditions cause pleural effusions with <30mg/dl of glucose (very low) in the pleural fluid?

Answer 19

• rheumatoid arthritis
• empyema
• malignancy

Question 20

what are the most common causes of pleural effusion with milky, white appearance (chylothorax)?

Answer 20

• lymphoma
• trauma caused by thoracic surgery

Question 21

bloody effusions are common in pleural effusion caused by what conditions?

Answer 21

• pulmonary embolism
• malignancy

Question 22

most specific test for CREST syndrome?

Answer 22

anti-centromere antibody

Question 23

most specific test for drug induced lupus?

Answer 23

anti-histone antibodies

Question 24

most specific test for diffuse scleroderma?

Answer 24

anti-topoisomerase antibodies

Question 25

most sensitive test for SLE? most specific?

Answer 25

sensitive= anti-nuclear antibodies specific=anti-ds-DNA antibodies and anti-Smith antibodies

Question 26

most specific test for primary biliary cholangitis?

Answer 26

anti-mitochondrial antibodies

Question 27

most specific test for autoimmune hepatitis?

Answer 27

anti-smooth muscle antibodies

Question 28

most common causes of **prosthetic valve endocarditis** **_within one year_** of surgery

Answer 28

* staph epidermidis * staph aureus

Question 29

most common causes of **prosthetic valve** endocarditis **_more than 1 year after_** surgery

Answer 29

strep viridans

Question 30

most common cuases of **native valve** endocarditis

Answer 30

* strep species * strep viridans * strep gallolyticus (colon cancer) * enterococci

Question 31

pt has liver disease and renal failure. why?

Answer 31

hepatorenal syndrome; due to **renal artery vasoconstriction.** get liver transplant

Question 32

pt presents with sx of cancer (usually colon or endometrial) and has a hx of numerous family members wiht various cancers. dx?

Answer 32

hereditary nonpolyposis colorectal cancer (lynch syndrome)

Question 33

the sx in central cord syndrome are mostly due to damage to which tract?

Answer 33

lateral spinothalamic (pain and temperature)

Question 34

ECG findings in hypocalcemia?

Answer 34

prolonged QT interval

Question 35

ECG findings in hypokalemia

Answer 35

flattening of the T wave

Question 36

ECG findings in pericarditis

Answer 36

* diffuse ST elevation * PR depression * low voltage QRS

Question 37

ECG findings in hypercalcemia?

Answer 37

shortened QT interval

Question 38

gold standard influenza test (highest sensitivity)

Answer 38

polymerase chain reaction

Question 39

what do cysteine kidney stones look like and how are they diagnosed?

Answer 39

hexagonal; 24 hour urine collection

Question 40

most **sensitive** test for CDIFF?

Answer 40

C diff toxin PCR

Question 41

describe the signs and sx of polio

Answer 41

* presents shortly after a febrile illness * asymmetrical muscle weakness * flaccid paralysis * absent deep tendon reflexes