GIM

Question 1

Unilateral then bilateral Purulent discharge without pain or visual disturbance. Dx?

Answer 1

Bacterial conjunctivitis

Question 2

Conjunctivitis associated with rash involving ophtho division of fifth cranial n, Dx?

Answer 2

Herpes zoster conjunctivitis

Question 3

Acute hyperpurulent ocular discharge in a sexually active adult. Dx?

Answer 3

Neisseria gonorrhea conjunctivitis

Question 4

Unilateral then bilateral conjunctivitis with Daytime watery or mucoid discharge. Dx?

Answer 4

Viral conjunctivitis

Question 5

Itching and tearing of the eyes, nasal congestion. Dx?

Answer 5

Allergic conjunctivitis

Question 6

Anaphylaxis reaction is an example of which type of hypersensitivity reaction?

Answer 6

Type 1 hypersensitivity reaction

Question 7

Back pain that improves with leaning forward is the classic presentation of what musculoskeletal condition?

Answer 7

Spinal stenosis

Question 8

Before starting a patient on TNF-alpha inhibitors, what test should be performed?

Answer 8

Purified protein derivative(PPD) tuberculin skin test

Question 9

Best next step after pt has tried NSAIDs /OCPs for primary dysmenorrhea but symptoms persist >3 months?

Answer 9

Ultrasound to rule out uterine abnormalities like fibroids

Question 10

Name the supplement: Sleep aid also used for stress/anxiety relief. If combined withEtOH, can oversedate.

Answer 10

Kava

Question 11

Finasteride, used to assist patients with benign prostatic hyperplasia, acts on which enzyme to inhibit conversion of testosterone to dihydrotestosterone?

Answer 11

5 alpha reductase

Question 12

Excessive ingestion of licorice can lead to which electrolyte abnormality?

Answer 12

Hypokalemia

Question 13

Name the supplement: Used against dementia. Can increase the risk of bleeding.

Answer 13

Ginkgo Biloba

Question 14

Name the supplement: Used for benign prostatic hyperplasia. Can cause headaches and/or abdominal pain/nausea.

Answer 14

Saw Palmetto

Question 15

Name the supplement: Used as an anti-depressant. Can potentially induce cytochrome P450 drug metabolism.

Answer 15

St. John’s Wort

Question 16

Name the supplement: Used against the common cold. Can cause nausea, rash and itchiness.

Answer 16

Echinacea

Question 17

Name three conditions that are very often associated with hypogammaglobulinemia

Answer 17

CLL, nephrotic syndrome, bronchiectasis

Question 18

On fundoscopic examination, which condition is associated with cherry red spots on the macula?

Answer 18

Retinal artery occlusion

Question 19

1-3% with 1 long bone fracture 33% with bilateral femur fractures - acute neurological abnormalities, hypoxemia and petechial rash. Dx?

Answer 19

Fat Embolism Syndrome

Question 20

On a DEXA scan, what T score will indicate osteoporosis?

Answer 20

T score of less than -2.5

Question 21

Digestion of which toxin from reef fish can cause for peri-oral paresthesias to occur?

Answer 21

Ciguatera toxin (found in barracuda, grouper, red snapper, moray eel, sea bass)

Question 22

Loss of passive flexion of the foot when the calf is squeezed with achilles tendon tears is known as what test?

Answer 22

Positive Thompson test

Question 23

During exercise, what is the formula used to determine the maximum heart rate an individual should achieve?

Answer 23

(220 - age in years) X 85%

Question 24

Rapid fire txt: Bipolar disorder

Answer 24

Mood stabilizers (eg, lithium, valproic acid, carbamazepine), atypical antipsychotics

Question 25

Rapid fire txt: Anorexia

Answer 25

Nutrition, psychotherapy, antidepressants not helpful (?olanzapine)

Question 26

Rapid fire txt: Alcohol withdrawal

Answer 26

Long-acting benzodiazepines | chlordiazepoxide, clonazepam, Diazepam

Question 27

Rapid fire txt: Alcoholism

Answer 27

Disulfiram, acamprosate, naltrexone, supportive care

Question 28

Rapid fire txt: Bulimia nervosa

Answer 28

CBT, SSRIs

Question 29

Rapid fire txt: ADHD

Answer 29

Methylphenidate, CBT, atomoxetine, guanfacine, clonidine

Question 30

Rapid fire txt: Depression

Answer 30

SSRIs or CBT

Question 31

What are the possible agents for treating hypertension in pregnant women?

Answer 31

Hydralazine, Labetalol, Alpha Methyldopa

Question 32

Rapid fire txt: Benign prostatic hyperplasia

Answer 32

α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors

Question 33

HLA-DR4assoc w/?

Answer 33

Diabetes mellitus type 1, rheumatoid arthritis, Addison disease

Question 34

Rapid fire txt: Ethylene glycol/methanol intoxication

Answer 34

Fomepizole (alcohol dehydrogenase inhibitor)

Question 35

Rapid fire txt: Drug of choice for anticoagulation during pregnancy

Answer 35

1st trimester: warfarin if <5mg, LMWH, UFH 2nd trimester: warfarin

Question 36

Rapid fire assoc: Mammary gland ("blue domed") cyst

Answer 36

Fibrocystic change of the breast

Question 37

Rapid fire txt: Buerger disease

Answer 37

Smoking cessation

Question 38

HLA-B27 assoc w/? 4 things

Answer 38

Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome)

Question 39

HLA-DR3assoc w/?

Answer 39

Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis, Addison disease

Question 40

Rapid fire assoc:"Thumb sign" on lateral neck x-ray

Answer 40

Epiglottitis (Haemophilus influenzae) Medical emergency

Question 41

What are the two most common nerve root impingements in lower back pain?

Answer 41

L5 and S1

Question 42

What blood test is the initial screening test for suspected systemic mastocytosis?

Answer 42

Serum tryptase level

Question 43

What environmental exposure can lead to acute vitamin B12 deficiency?

Answer 43

Nitrous oxide (Nitrous oxide inactivates vitamin B12.)

Question 44

What is the enzyme that converts testosterone to estradiol?

Answer 44

Aromatase

Question 45

What class of anti-depressants can be used for patients who are suffering from urge incontinence?

Answer 45

TCAs (Tricyclic anti-depressants)

Question 46

What is the anti-depressant category of choice in patients with bulimia?

Answer 46

SSRIs

Question 47

What is the fundoscopic exam finding often seen with idiopathic intracranial hypertension (Pseudotumor cerebri)?

Answer 47

Papilledema

Question 48

Which vitamin toxicity may lead to idiopathic intracranial hypertension(Pseudotumor cerebri)?

Answer 48

Vitamin A

Question 49

Which vitamin is used to enhance iron absorption?

Answer 49

Vitamin C (Ascorbic acid)

Question 50

Which pain medication should be avoided in patients who are taking SSRIs for depression?

Answer 50

Tramadol (concurrent use of SSRI with tramadol can cause serotonin syndrome)

Question 51

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Answer 51

Kartagener syndrome (dynein arm defect affecting cilia)

Question 52

Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

Answer 52

Osler-Weber-Rendu syndrome

Question 53

Which knee test can indicate that patient has a lateral collateral ligament tear?

Answer 53

Positive varus test

Question 54

Swollen gums, mucosal bleeding, poor wound healing, petechiae

Answer 54

Scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)

Question 55

Which statin is the drug of choice in HIV patients?

Answer 55

Pravastatin

Question 56

Rapid fire assoc: "Chocolate cyst" of ovary

Answer 56

Endometriosis (frequently involves both ovaries)

Question 57

What is the most common presenting symptom of an individual with acute altitude sickness?

Answer 57

Headaches

Question 58

What is the laboratory screening test for chronic alcohol abuse?

Answer 58

Carbohydrate free transferrin level elevated

Question 59

What is the most common symptom of Hereditary Hemorrhagic Telangiectasia(HHT)?

Answer 59

Epistaxis (nose bleeding)

Question 60

What is the most commonly used agent in the treatment of Familial Mediterranean Fever?

Answer 60

Colchicine

Question 61

What is the main anti-depressant to be avoided in patients with seizure disorder?

Answer 61

Bupropion

Question 62

Slow, progressive muscle weakness in boys

Answer 62

Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)

Question 63

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

Answer 63

Turner syndrome (45,XO)

Question 64

Dermatitis, dementia, diarrhea

Answer 64

Pellagra (niacin [vitamin B3] deficiency)

Question 65

Dilated cardiomyopathy, edema, alcoholism, or malnutrition

Answer 65

Wet beriberi (thiamine B1] deficiency)

Question 66

Enlarged, hard left supraclavicular node

Answer 66

Virchow node (abdominal metastasis)

Question 67

Episodic vertigo, tinnitus, hearing loss

Answer 67

Meniere disease

Question 68

Unilateral deep regular pain, nausea, vomiting, fixed non-reactive pupil, Shallow anterior chamber

Answer 68

Acute angle closure glaucoma

Question 69

Severe ocular pain that worsens with eye Movement and light exposure; A raised hyperemic lesion that may be localized or diffuse and obscures the underlying vasculature

Answer 69

Scleritis

Question 70

Red eye with scales and crusts around the eyelashes or dandruff like skin changes and greasy scales around the eyelashes

Answer 70

Blepharitis

Question 71

Non-painful red, flat, superficial lesion that allows visualization of the underlying vasculature

Answer 71

Episcleritis

Question 72

Facial muscle spasm upon tapping

Answer 72

Chvostek sign (hypocalcemia)

Question 73

Bluish line on gingiva

Answer 73

Burton line (lead poisoning)

Question 74

Bone pain, bone enlargement, arthritis

Answer 74

Paget disease of bone (increased osteoblastic and osteoclastic activity)

Question 75

What vitamin deficiency can occur with use of Isoniazid (INH)?

Answer 75

Vitamin B6 (Pyridoxine)

Question 76

What vitamin or mineral deficiency is associated with rash and alopecia in patients on TPN feeding?

Answer 76

Zinc deficiency

Question 77

What is the most likely diagnosis in diabetic pt with diarrhea, weight loss, flatulence and vitamin A, D, B12 deficiencies?

Answer 77

Small intestinal bacterial overgrowth

Question 78

What will be the folate and vitamin B12 Levels in patients with Caribbean tropical sprue?

Answer 78

Normal folate, decreased vitamin b12 levels

Question 79

What are the five major medications that can cause folate deficiency?

Answer 79

Phenytoin, MTX, tmp, sulfasalazine, metformin

Question 80

Aspirin exacerbated respiratory disease (triad asthma or samter syndrome) TX?

Answer 80

Aspirin desensitization

Question 81

Chronic non-allergic rhinitis (vasomotor rhinitis) tx?

Answer 81

Intranasal glucocorticoids, intranasal antihistamines, topical ipratropium bromide

Question 82

Absolute risk (event rate) equation?

Answer 82

Patients with event in group/Total patients in Group

Question 83

Relative risk equation?

Answer 83

Experimental event rate/ Control event rate

Question 84

Absolute risk reduction equation?

Answer 84

|ERR-CER|

Question 85

Relative risk reduction equation?

Answer 85

|ERR-CER|/CER

Question 86

NNT or NNH equation?

Answer 86

1/ARR

Question 87

Pos Likelihood ratio equation?

Answer 87

Sensitivity/(1-specificity)

Question 88

Neg Likelihood ratio equation?

Answer 88

(1-sensitivity)/specificity

Question 89

Pos likelihood ratio of 2,5,10 increase probability of dz by?

Answer 89

15, 30, 45%

Question 90

Neg likelihood ratio of 0.5, 0.2, 1 decrease probability of dz by?

Answer 90

15, 30, 45%

Question 91

Nasal polyposis, asthma, eosinophilia, mononeuritis, petechial skin lesions

Answer 91

Eosinophilic granulomatosis with polyangiitis

Question 92

Systemic illness with saddle nose deformity, nasal ulceration, chronic sinusitis

Answer 92

Granulomatosis with polyangiitis

Question 93

Young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, recurrent bronchitis

Answer 93

Cystic fibrosis

Question 94

Non-seasonal rhinitis with negative skin test. Dx?

Answer 94

Chronic non-allergic rhinitis (vasomotor rhinitis)

Question 95

Refractory congestion after chronic use of topical nasal decongestants

Answer 95

Rhinitis medicamentosa

Question 96

Nasal congestion in the last six or more weeks of pregnancy

Answer 96

Pregnancy rhinitis

Question 97

Rhinitis, nasal polyps, asthma, aspirin intolerance

Answer 97

Aspirin exacerbated respiratory disease (triad asthma or samter syndrome)

Question 98

Pain, photophobia, inflammation Confined to corneal limbus, corneal irregularity, pupillary irregularity

Answer 98

Keratitis or iridocyclitis (iritis, anterior uveitis)

Question 99

transient Impairment in anterograde memory. Self awareness, motor, And social skills are preserved

Answer 99

Transient global amnesia

Question 100

Urinary urgency and Increasing pelvic pain and pressure relief with voiding in women is due to what diagnosis? Usually patients have fibromyalgia

Answer 100

Interstitial cystitis

Question 101

What are three treatments for Interstitial cystitis? (Treatment is not curative and typically focuses on improving quality of life and avoidance of triggers)

Answer 101

Amitriptyline (use limited due to side effects), pentosan Polysulfate sodium, bladder instillation

Question 102

In patients with multiple sclerosis, eye pain w/central vision loss suggest what diagnosis? What is the treatment?

Answer 102

Optic neuritis, methylprednisolone (oral prednisone leads to higher rate of recurrence)

Question 103

What 4 main drugs interfere with folic acid metabolism?

Answer 103

Methotrexate, phenytoin, pyrimethamine, trimethoprim

Question 104

What are 1st line treatments for alcohol use disorder?

Answer 104

Naltrexone and acamprosate

Question 105

What are the 2 main contraindications for naltrexone?

Answer 105

Patients currently taking opioids and acute hepatitis or liver failure

Question 106

what serum lithium levels are indications for dialysis.

Answer 106

>4 or >2.5 with significant lithium toxicity (seizures, depressed mental status)

Question 107

Symptomatic vertebral compression fractures are managed how acutely? And if this fails, what's another option for txt?

Answer 107

NSAIDs, acetaminophen, opioids. Intranasal calcitonin if the others don't work

Question 108

What is the triad of serotonin syndrome?

Answer 108

Mental status change, autonomic hyperactivity (hyperreflexia), neuromuscular abnormalities. (Clonus)

Question 109

What are the findings in neuroleptic malignant syndrome?

Answer 109

Very high fever typically greater than 104ﾟ, delirium, lead pipe rigidity, autonomic instability