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1

lichen planus diagnostic test
(intense pruritic polygonal shaped violaceous papules in flexure surfaces (mostly wrist), buccal mucosa, or external genitalia)

punch biopsy

2

Treatment of polycystic ovarian disease

weight loss
if that fails, then clomiphene citrate

3

In absence of MPOA or advance directives, who should the staff contact?

highest priority surrogate decision maker
ethics committee only consulted when opinions are opposing

4

Horner's syndrome (miosis, ptosis and often anhidrosis) and unilateral headache, ddx and best diagnostic test

carotid artery dissection
CT angiography is first step, catheter angiography is gold standard, MRA alternative

5

Whats the best initial screening test for thyrotoxicosis for pregnant ladies?

TSH
total T4 and T3/free T4 T3 not as reliable as they are higher than normal, has to be adjusted

6

When is amiodarone preferred as antiarrythmic drug in paroxysmal afib patients?

structural heart disease (LVH, CHF)
normal heart: flecainide

7

Diagnosis and treatment for epistaxis, petechiae, worse with use of aspirin, normal platelet count.

VWF
- ristocetin cofactor assay, VWF level (carries factor VIII in blood)
- first line tx: desmopressin/DDAVP
- next best step: factor VIII replacement (has both vwf and factor VIII)

8

Drugs that increase TBG and decrease free T4 may need higher doses of thyroxine replacement. Which drugs?

estrogen
tamoxifen
raloxifene
methadone, heroine

9

Drugs that decrease TBG and increase free T4 may need lesser doses of thyroxine replacement. Which drugs?

steroids
androgens
danazol

10

hydrothorax, a common cause of transudative pleural effusion in patients with cirrhosis and ascites and is located on the right. Treatment?

- sodium restriction, diuretics
- TIPS as second line

11

E.coli and GBS are common bugs in neonates (<28 days), strep pneumo and neisseria (>28 days). Broad spectrum abx needed immediately. Which ones?

- ampicillin and gentamicin or cefotaxime
- ceftriaxone or cefotaxime, +/- vanc based on meningeal involvement

12

Infant botulism from environmental dust containing spores. Treatment?

Human derived botulinum toxin

13

Following viral pericarditis/cardiac surgery, pt presents with right heart failure, peripheral edema, ascites, elevated JVP, hepatojugular reflex, Kussmaul's sign, pericardial knock, pericardial calcifications on chest radiograph. Ddx?

Constrictive pericarditis

14

Saw palmetto's use and SE

benign prostate hyperplasia
risk of bleeding

15

Most common complication of lumbar myelomeningocele

bladder dysfunction

16

Which smoking cessation meds should be avoided in pts with depression or SI? seizures?

avoid varenicline for unstable psych sx
avoid buproprion for seizures

17

abrupt onset of butterfly rash, sharp demarcation, painful, red, edematous. ddx? common bug?

erysipelas
group a strep

18

postpartum endometritis treatment?

clindamycin and gentamicin
* metronidazole is contraindicated in breastfeeding mothers

19

maculopapular rash that spreads from face caudally, acute arthritis, thrombocytopenia, and encephalitis, fever, lymphadenopathy of posterior cervical and suboccipital nodes. Ddx?

Rubella

20

Cough, conjunctivitis, coryza, blue white koplik spots, starts on face and spreads caudally. Ddx?

Measles/ Rubeola

21

Causes of post operative hypoxemia

immediate: airway obstruction/edema, residual meds effect
early: bronchospasm (wheezing)
1-5 days: pneumonia
2-5 days: atelectasis
3 days to over a week: PE

22

Which electrolyte imbalance post op causes hyperactive deep tendon reflexes

hypocalcemia

23

Management and treatment of seborrheic keratosis

if symptomatic and cosmetically disfiguring, then can do curettage/shave excision
otherwise, no treatment needed

24

Whats the best contraceptive method for pts with sickle cell disease?

progestin only methods (intrauterine device), as it decreases amount of menses
estrogen containing methods promote thromboembolism
copper IUD has severe bleeding and dysmenorrhea first year

25

type of poisoning in improperly stored seafood that causes palpitations, abdominal cramps, diarrhea, oral burning, headache.

scombroid poisoning

26

ocular melanoma, most sensitive diagnostic test and treatment

US
asx w/ small lesions - observe and reassess
large lesions- radiation therapy

27

Most important factor in prognosis in COPD patients

FEV1
FEV1 <40% is severe COPD

28

Brief shooting back pain, positive straight raising test in 60, worsens with bending and straining. Ddx?

nerve root irritation

29

Possible explanations of positive ELISA-anti-HCV antibodies? What test is needed for confirmation of HCV?

- persistent Hep C infx
- cleared infection
- false positive result
- HCV RNA is a high specificity test

30

Treatment for latent TB

- first line: isoniazid for 9 months for both children and adults
- second line: rifampin 6 months in children, 4 in adults