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Question 1

Which heart disease are IV drug users at increased risk of? How does it sound?

Answer 1

RIGHT sided (tricuspid) endocarditis. Faint murmur that increases with inspiration and is heard in the lower sternal border.

Question 2

What is the management of LV dysfunction leading to acute pulmonary edema?

Answer 2

Dobutamine which is a positive inotrope and reduced preload relieving the lungs.

Question 3

What drug should be added to TMP/SMX in a patient with toxoplasmosis? What is the next step after cure?

Answer 3

Folinic acid. Lower dose for chronic suppression therapy.

Question 4

What is the treatment for afib patietns who are hemodynamically stable?

Answer 4

Control the rate with digoxin, betablocker, CCB etc

Question 5

What is the presentation of spontaneous bacterial peritonitis? What is the next step in management?

Answer 5

Ascites, mild diffuse abdominal pain, altered mental status and low grade fever. Take ascitic fluid, blood and urine culture before starting therapy.

Question 6

What is the post op complication between days 8-15? on day 7?

Answer 6

Drug fever or deep abscess. Do a CT scan

Wound infection so do a PE exam.

Question 7

What does intracranial hypertension present with? What type of herniation can occur?

Answer 7

Cushings triad (HTN, bradycardia, depressed respiration). Transtentorial herniation (uncal hernation) which compresses oculomotor nerve, posterior cerebral artery (occipital lobe), brainstem.

Question 8

When is CVS sampling done?

Answer 8

at 10 - 13 weeks in advanced maternal age

Question 9

What are EKG findings and symptoms in hyperkalemia?

Answer 9

Peaked T waves, widened QRS, short QT, prolonged PR. Muscle weakness and pain

Question 10

What is myelophthisic anemia?

Answer 10

Abnormal hematopoetic or non hematopoetic cells in bone marrow leading to fragmented and nucleated cells. Suspect in cancer.

Question 11

What is the tone of the bladder in overflow incontinence?

Answer 11

Hypotonicicty

Question 12

When is target cells seen and what is the next step?

Answer 12

In thalassemia, iron deficiency, hemoglobin mutations, chronic liver disease. Do hemoglobin studies if microcytic and target cells

Question 13

What is the CT findings of chronic subdural hematoma?

Answer 13

Hyperdense crescentric mass

Question 14

What is the most common cause of brain abscess formation in meningitis? What other lab values are observed?

Answer 14

Citrobacter koseri. Elevated whites, elevated protein, low glucose

Question 15

What is PTHrp associated with? What is the next step in the workup?

Answer 15

SCC of the lung. Chest radiograph followed by biopisy

Question 16

What causes angioedema? What medication causes itr? WHat medications dont work? What is the best initial test?

Answer 16

C1 esterase inhibitor. ACE inhibitor. GLucocorticoids. C2 and C4 complements are decreased. C1 esterase also decreased.

Question 17

What are the three types of hereditary angioedema?

Answer 17

Type 1 - decreased levels of C1INH, Type II - normal levels but decreased function of C1INH, Type III - no detectable abnormality in C1INH

Question 18

What is the treatment for acute angioedema?

Answer 18

FFP and Ecallantide

Question 19

What is the long term treatment for angioedema? What compound accumulates during angioedema?

Answer 19

Androgens (Danazole and Stanazole). Bradykinin

Question 20

What is the treatment for urticaria?

Answer 20

Antihistamines (Hydroxyzine, diohenhydramine, fexofenadine, loratidine, cetirizine or ranitidine) and second line are leukotreine receptor antagonists (Montelukast and zafirlukast)

Question 21

What is the presentation of CVID? Which cell types are deficient? What is patient at increased risk for?

Answer 21

Bronchitis, PNA, sinusitis, Otitis media. Can also have Giardiasis and Sprue like intestinal malabsorption. Reduced B cell output (Igs but normal number of B cells) and normal T cells. Normal amount of lymphoid tissue. Increased risk of lymphoma

Question 22

What tests are used to test for CVID? Treatment?

Answer 22

Immunoglobulin level decreased and antigen levels. Use antibiotics for each infection, Regular IVIG

Question 23

What is the presentation of Brutons?

Answer 23

Low B cells in number and in number of lymphoid tissue unlike CVID. Normal T cells. Antibiotics and long term IVIG administration.

Question 24

What is the long term treatment for SCID?

Answer 24

Bone marrow transplant that can be curative

Question 25

What is the presentation of IgA deficiency?

Answer 25

Recurrent sinopulmonary infection, atopic disease, anaphylaxis to blood transfusion when blood donor has normal levels of IgA, sprue like condition, increased risk of vitiligo, thyroiditis

Question 26

What is the treatment of IgA deficiency?

Answer 26

Treat infections, wash blookds. IVIG will not work.

Question 27

What are the T and B levels in Wiskott-Aldrich Syndrome? Treatment?

Answer 27

Normal T cells and normal B cells but decline with age. T lymphocytes markedly deficienct in blood and lymph nodes. BM transplantation is only definitive treatment

Question 28

What is the hallmark of CGD?

Answer 28

Lymph nodes leaking purulent material, apthous ulcers. Look for infections with odd combination of Staph, Burkholderia, Nocardia, Aspergillus. NADPH oxidase

Question 29

When can you not use dipyridamole in a stress test in patients who can't exercise?

Answer 29

It provokes bronchospasm so avoid in asthmatics.

Question 30

What meds should be used for TB meningitis?

Answer 30

RIPE + Corticosteroids (for mortality benefit)

Question 31

What are the risk factors for SCC of the head and neck?

Answer 31

Alcohol, tobacco, HPV (16, 18, 30)

Question 32

WHat is the type of speech that is delayed at getting to the final point but will eventually do so? same but doesn't get to the final point?

Answer 32

Circumstantiality. Tangentiality.

Question 33

What is the presentation and treatment of ethyl glycol poisoning?

Answer 33

CNS depression, nephrotoxicity, metabolic acidosis. Fomepizole, Ethanol, or dialysis.

Question 34

What is the most serious complication of acute pancreatitis? What is the next step?

Answer 34

Necrosis of pancreas. Pancratic aspiration to rule out super infection followed by surgical debridement is that is the case.

Question 35

Which lung cancer is the most sensitive to chemotherapy?

Answer 35

Small cell lung cancer

Question 36

Which primitive reflexes are the first to develop and disappear? Approximate dates/months?

Answer 36

Palmar grasp (28 weeks to 3 months) and rooting reflex (32 weeks to 1st month)

Question 37

What is the presentation of CMV retinitis?

Answer 37

Retinal spots, flame hemorrhages and retinal detachment. Do a dilated fundoscopic exam and treat with IV foscarnet or gancyclovir,

Question 38

What is absolutely required for rheumatic fever diagnosis?

Answer 38

Evidence of Group A Strep infection (antiDNASE B, antistreptolysin O, antihyalrunodinase)

Question 39

What are Wiskott-Aldrich patients at increased risk of?

Answer 39

Lymphoma and ALL

Question 40

What meds do you use for the treatment of HF?

Answer 40

ACEi/ARB and aldosterone antagonists (regress hypertrophy

Question 41

What are skin findings in UC?

Answer 41

Erythema nodosum (panniculitis that is symmetric, tender, erythematous, subQ nodules) and pyoderma gangrenosum

Question 42

What are the findings of dermatomyositis? Which markers are elevated?

Answer 42

Heliotrope rash, gottron papules, proximal muscle weakness, shawl sign, ANA and Anti jo antibodies

Question 43

What is the pathophysiology behind analphylactoid reactions?

Answer 43

Direct mast cell degranulation, e.g exposure to IV contrast. No sensitization involved.

Question 44

What are the metabolic derangements in rhabdomyolysis?

Answer 44

HyPOphospatemia and hyperkalemia

Question 45

What are the symptoms and treatment for legionella PNA?

Answer 45

PNA with mental confusion and diarrhea. Treat with ceftriaxone plus macrolide or a fluoroquinolone while waiting for results.

Question 46

Which cancer is the most common cause of mortality in both men and women?

Answer 46

Lung cancer followed by PC and BC in men and women respectively. Common by incidence in men is Prostate Lung Colorectal and women is Breast Lung Colorectal

Question 47

What do you have to do before giving acetozolamide for pseudotumor cerebri?

Answer 47

Diagnose first with MRI

Question 48

What are the symptoms of spinal epidural abscess? Which organism is implicated?

Answer 48

Focal back pain, motor weakness, sensory changes, incontinence, and paralysis. Staph aureus.

Question 49

What type of stones should you suspect in a patietn with high urine pH? What are the stones made of?

Answer 49

Struvite. Ammonium, Magnesium, Phosphate plus Calcium carbonate apatite

Question 50

What medication is safe for post stroke patient with insomnia ?

Answer 50

Trazadone

Question 51

Which antibodies are present in mixed connective tissue disease?

Answer 51

Anti U1 ribonucleoprotein (U1-RNP)

Question 52

What is the steps in evaluating bloody pleural effusion?

Answer 52

Cytology followed by CT to determine location of tumor

Question 53

What is the treatment of Herpes Zoster with post herpetic neuralgia?

Answer 53

Acyclovir + Tricyclic antidepressant (Desipramine preferably)

Question 54

What features are unique to Crohns and not UC?

Answer 54

Perianal disease, strictures, fistulas, ileal lesions, skip lesion, transmural involvement