6

Question 1

^pulmonary artery pressure, ^right atrial pressure, normal PCWP, think ?

Answer 1

PE
^PA and RA pressures reflect right heart failure, normal PCWP reflects normal left heart function so etiology is pulmonary
MI (and tamponade) would result in ^PCWP as well as ^PA and RA pressures (LHF–>RHF)

Question 2

if dx solid testicular mass + U/S suggestive of tumor, what to do next?

Answer 2

radical orchiectomy (+ cord removal)
additional sx, radiation, chemo may be necessary

Question 3

demeclocycline vs desmopressin

Answer 3

demeclocycline used in SIADH
desmopressin (ADH analog) for central DI
HCTZ for nephrogenic DI

Question 4

PCV13 vs PCV23

Answer 4

PCV13 then PCV23 for adults 65+

PCV23 for adults younger than 65 who are smokers or have chronic conditions (DM, liver disease, HD, lung disease)

Question 5

in Wilson’s, copper deposits in what organs?

how does it present?

Answer 5

liver, basal ganglia, cornia
kids/adolescents: liver disease
y. adults: neuropsych (tremor, rigidity, depression, paranoia, catatonia)

Question 6

what coagulopathic changes seen in SLE?

Answer 6

prolonged PTT due to lupus anticoagulant (anti-phospholipid antibody)
+/- prolonged PT

Question 7

why do patients with supravalvular aortic stenosis experience chest pain?

Answer 7

the outflow obstruction leads to LVH–>^myocardial O2 demand esp. during exercise–>subendocardial ischemia

Question 8

1st line treatment for essential tremor

Answer 8

propranolol

alternates: primidone, topiramate

Question 9

tick bite, febrile illness with systemic symptoms, leukopenia +/- thrombocytopenia and ^LFTs think ?
treatment?

Answer 9

Ehrlichiosis
(rash is uncommon unlike Lyme)
doxycycline

Question 10

Alzheimer’s vs Dementia with Lewy bodies

Answer 10

AD: early findings: memory and visuospatial impairments, cognitive impairments, language difficulties
late: neuropsych, dyspraxia, lack of insight, non cognitive neuro deficits, incontinence
DLB: parkinsonism, fluctuating cognitive decline, visual hallucinations, extrapyr. symptoms THEN visuospatial and memory deficits

Question 11

fever, cough, abdominal pain, diarrhea, night sweats, weight loss, splenomegaly, ^alk phos in an HIV+ pt with CD4 less than 50, think ?
how to tx?

Answer 11

MAC, disseminated
azithromycin or clarithromycin
(give ppx when CD4 less than 50)

Question 12

drowsiness, confusion, dry mouth, dilated pupils, blurred vision, reduced bowel sounds, urinary retention, think what OD? how to tx?

Answer 12

diphenhydramine (Benadryl) 1st 2 symptoms: antihistaminergic, others: anticholinergic
tx with physostigmine: cholinesterase inhibitor

Question 13

pronator drift tests for what dysfunction

Answer 13

UMN or pyramidal/corticospinal tract disease affecting the UEs

vs. Romberg’s which tests proprioception
vs. dysdiadochokinesia, ataxia, and intention tremor of cerebellar dysfunction

Question 14

plantar warts are caused by what infection

Answer 14

HPV

most commonly in y. adults or immunocompromised individuals

Question 15

molluscum contagiosum is caused by what infection

seen in whom?

Answer 15

poxvirus
single or multiple skin-colored papule with central umbilicus
prolonged course in immunocompromised i.e. HIV+ pts (consider testing if large, numerous, or widespread), also seen in children

Question 16

ARDS dx: PaO2/FiO2 ratio and what does it imply

Answer 16

PaO2/FiO2 ratio less than 300; implies hypoxemia on supplemental O2 (i.e. ratio of 60 if PaO2 60 on 100% O2)
other dx criteria: resp distress 1 wk of insult, b/l lung opacities (edema) not due to CHF/overload

Question 17

ARDS management

Answer 17

mechanical ventilation with low tidal volume, high PEEP, and permissive hypercapnia

Question 18

vitamin A toxicity manifests as ?

Answer 18

dry skin, headache, blurry vision, may see abdominal pain and hypercalcemia

Question 19

milk-alkali syndrome caused by ?

symptoms and findings?

Answer 19

excessive intake of Ca2+ and absorbable alkali
n/v/c, polyuria, polydipsia, neuropsych symptoms
^Ca2+, metabolic alkalosis, AKI, suppressed PTH

Question 20

MRI of brain showing multiple, well-circumscribed lesion with vasogenic edema at the gray/white matter junction, think ?

Answer 20

metastasis to brain (lung most common)

vs. Primary CNS lymphoma: single periventricular lesion

Question 21

proximal muscle weakness, dysphagia, and elevated CK, think ?
tx?

Answer 21

polymyositis

prednisone, MTX, azathioprine

Question 22

signs of right ventricular failure

Answer 22

^JVP, right ventricular 3rd heart sound, tricuspid regurg murmur, hepatomegaly w. pulsatile liver, LE edema, ascites +/- pleural effusions

Question 23

how to treat pregnant and lactating patients with Lyme disease

Answer 23

amoxicillin

doxy: teeth discoloration and retardation of skeletal development in fetuses/children

Question 24

abx not required for Lyme ppx if the tick has been attached for less than ?

Answer 24

36 hrs (1.5 days)

Question 25

abx not required for Lyme ppx if the tick has been attached for less than ?

Answer 25

36 hrs (1.5 days)

Question 26

if vitamin B12 is treated with folate and thiamine...

Answer 26

megaloblastosis and anemia will be corrected but leads to rapid progression of neurological symptoms (loss of proprioception, vibration, memory deficits, irritability, dementia)

Question 27

SEs of MTX

Answer 27

macrocytic anemia, nausea, stomatitis, rash, hepatotoxicity, intersitial lung disease, alopecia, fever

Question 28

SEs of MTX

Answer 28

macrocytic anemia, nausea, stomatitis, rash, hepatotoxicity, intersitial lung disease, alopecia, fever

Question 29

treatment of hemophilia

Answer 29

``` factor VII (A) or IX (B) desmopressin for mild hemophilia A ```

Question 30

female athlete triad

Answer 30

oligomenorrhea, osteoporosis, and decreased caloric intake

Question 31

sympathetic ophthalmia

Answer 31

"spared eye injury" immune-mediated inflammation of one eye after penetrating injury to other eye; typically anterior uveitis due to uncovering of "hidden antigens"

Question 32

higher titers of ? are associated with increased risk of miscarriage

Answer 32

``` antithyroid peroxidase (anti-TPO) antibodies (associated with Hashimoto's) in both euthyroid and hypothyroid women ```

Question 33

antibodies against TSH receptors cause what in the thyroid gland ?

Answer 33

atrophy (not enlargement) | less common cause of hypothyroidism (than anti-TPO)

Question 34

distortion of straight lines on visual exam, think ?

Answer 34

``` macular degeneration (most common cause of blindness in industrialized nations) can also see drusen deposits ```

Question 35

what skin lesion can be treated with dapsone

Answer 35

dermatitis herpetiformis | also gluten-free disease (celiac)

Question 36

TTP labs | treatment ?

Answer 36

``` hemolytic anemia (^LDH, decreased haptoglobin) with schistocytes, thrombocytopenia (^bleeding time, normal PT/PTT), sometimes renal failure, neuro manifestations, fever (FATRN) ADAMS13 deficiency tx: plasma exchange ```

Question 37

parapneumonic effusions labs

Answer 37

pleural fluid with v. low pH (less than 7.2) and glucose (less than 60)

Question 38

how to calculate attributable risk

Answer 38

``` ARP = (risk in exposed - risk in unexposed) / risk in exposed ARP = (RR - 1)/RR ```

Question 39

how to calculate attributable risk

Answer 39

``` ARP = (risk in exposed - risk in unexposed) / risk in exposed ARP = (RR - 1)/RR ```

Question 40

study with 2+ variables that are studied independently

Answer 40

factorial design

Question 41

grouping of different data points into similar categories

Answer 41

cluster analysis

Question 42

acute respiratory failure, dry cough, fever in immunocompromised individual (i.e. on chronic steroids) + ^LDH think ?

Answer 42

PJP, course is more indolent in those with HIV

Question 43

ptosis, down and out, diplopia with normal pupillary response think ?

Answer 43

ischemic oculomotor palsy (affects inner somatic fibers, spares outer PS fiber) poorly controlled DM

Question 44

"cape" distribution of pain/temp sensory loss + areflexic weakness in UEs think ?

Answer 44

syringomyelia: fluid filled cavity within the cervical and thoracic spinal cord associated with Arnold Chiari malformation type 1 1st affects SpTT in anterior commissure (pain/temp) dorsal column not affected (preserved prop/vibr) anterior horn affected later: LMN signs, weakness

Question 45

why do you get "hypocalcemic" during alkalosis

Answer 45

less H+ bound to albumin, so more Ca2+ binds resulting in less unbound (ionized) calcium which is the physiologically active form, so can manifest as hypocalcemia

Question 46

numbness pain btw 3/4th toes with clicking sensation when squeezing the metatarsal joints

Answer 46

morton neuroma

Question 47

afib can result from ? due atrial strain from increased right atrial pressure

Answer 47

PE

Question 48

triad of disseminated gonococcal infection

Answer 48

polyarthralgias, tenosynovitis, vesiculopustular skin lesions

Question 49

oral and genital ulcers +/- skin and ocular involvement

Answer 49

Behcet syndrome multisystem inflammatory condition thrombosis most common cause of death

Question 50

what treatment for Graves can worsen ophthalmopathy

Answer 50

``` radioactive iodine (RAI) due to raising titers of thyrotropin receptor antibodies (TRAB) on retro-orbital fibroblasts and adipocytes tx: glucocorticoids and antithyroid drugs ```

Question 51

features of lacunar stroke

Answer 51

``` pure motor hemiparesis pure sensory stroke ataxic hemiparesis dysarthria-clumsy hand syndrome + absence of cortical signs ```