May 19th

Question 1

Patient with undescended testis are at risk for developing what testicular cancer(s)?

Answer 1

Dysgerminoma or gonadoblastoma

Question 2

When do you see P aeruginosa associated osteomyelitis?

Answer 2

Foot puncture wound and IV drug abusers

Question 3

Large mediastinal mass with elevated AFP and Beta-hCG

Answer 3

Nonseminomatous germ cell tumor

Question 4

What are the oxygen sats and EPO levels in PV?

Answer 4

Normal oxygen sats and low EPO levels

Question 5

What is the treatment for PV?

Answer 5

Phlebotomy and hydroxyurea if high risk of thrombosis

Question 6

Probability of being free of a disease if the test result is negative

Answer 6

NPV

Question 7

Patients with CAP who require hospitalization on the medical floor require treatment with what?

Answer 7

Fluoroquinolone or beta-lactam plus macrolide

Question 8

What is the CURB-65 criteria?

Answer 8

Determines hospitalization; confusion, urea > 20, RR >30, BP (<90 or <60), age 65 and up; one point for each; 1-2 intermediate mortality = IP treatment; 3-4 high = ICU

Question 9

What are the s/sx of malignant hypertension?

Answer 9

Severe HTN with retinal hemorrhages, exudates or papilledema; can develop malignant nephrosclerosis (ARF, hematuria, proteinuria) but not required for the diagnosis

Question 10

Use dependence in regards to antiarrhythmic drugs is seen in what class of antiarrhythmic drugs?

Answer 10

Class IC - eg flecainide and propafenone

Question 11

What is the treatment for anal fissures?

Answer 11

Stool softeners, sitz bath, topical anesthetics and vasodilators (eg nifedipine, NTG)

Question 12

Narcolepsy is associated with low CSF levels of what?

Answer 12

Orexia-A/hypocretin-1

Question 13

What is the diagnostic criteria of ascitic fluid for SBP?

Answer 13

> 250 PMNs, protein <1 g, SAAG >1.1, positive Cx

Question 14

What are the symptoms of digoxin toxicity?

Answer 14

Anorexia, N/V, abd pain, confusion, fatigue, weakness, color vision alterations

Question 15

What cardiac meds can increase digoxin levels?

Answer 15

Amiodorone, propefenone, quinidine, verapamil

Question 16

Loss to follow up creates potential for what type of bias?

Answer 16

Selection bias (aka attrition bias)

Question 17

Subject is reluctant to report an exposure due to stigma about the exposure (eg sex, drugs) leads to what type of bias?

Answer 17

Reporting bias

Question 18

What is surveillance bias?

Answer 18

Exposure group undergoes increased monitoring relative to the general population; can lead to increased disease diagnoses

Question 19

How is stool osmotic gap calculated?

Answer 19

Plasma osmolality - 2x (stool sodium + stool potassium)

Question 20

What is a torus palatinus?

Answer 20

Benign bony growth located midline suture of the hard palate; congenital

Question 21

Immunocompromised patient with fever, pleuritic CP, hemoptysis and nodules with ground glass opacities on CT scan

Answer 21

Invasive aspergillosis; “halo sign”

Question 22

Kallmann syndrome is what type of inheritance pattern?

Answer 22

X linked recessive

Question 23

Macrocytic anemia, craniofacial anomalies, triphalangeal thumbs

Answer 23

Think Diamond-Blackfan anemia

Question 24

Microcytic anemia non-responsive to iron supplementation in Mediterranean origin

Answer 24

Beta-thalassemia

Question 25

What medications are commonly used to treat acute bipolar depression?

Answer 25

Quetiapine, lurasidone and lamotrigine;

Question 26

What murmur is heard in HOCM?

Answer 26

Crescendo-decrescendo systolic murmur heard best at the apex or LLSB

Question 27

Early decrescendo diastolic murmur heard best on LSB (3rd/4th intercostal space)

Answer 27

AR

Question 28

How are uric acid stones treated?

Answer 28

Hydration, alkalinization of urine, low purine diet; use oral potassium citrate to alkalinize the urine

Question 29

How is TTP diagnosed? What is the treatment?

Answer 29

Hemolytic anemia + thrombocytopenia; get blood smear (see schistocytes, helmet cells); treatment: plasma exchange; glucocorticoids; can use rituximab

Question 30

How is a liver abscess with E histolytica treated?

Answer 30

PO metronidazole; luminal agent (ie paromomycin) required to eradicate intestinal colonization; no need to drain abscess

Question 31

How is a hydatid cyst dueto Echinoccus treated?

Answer 31

Aspiration with albendazole

Question 32

How does Ehrlichiosis present?

Answer 32

Fever, HA, myalgias, leukopenia and thrombocytopenia

Question 33

How does babesiosis present?

Answer 33

Anemia with intravascular hemolysis, thrombocytopenia, see maltese cross on blood smear (diagnostic)

Question 34

How is babesiosis treated?

Answer 34

Atovaquone + azithromycin or quinine plus clindamycin (severe illness)

Question 35

What is the treatment for QT prolongation?

Answer 35

Beta blockers + pacemaker if symptomatic (lightheadedness, palpitations)

Question 36

How is hoarding disorder treated?

Answer 36

CBT (maybe SSRI could be used, no great evidence)

Question 37

Boot shaped heart (upturning of the cardiac apex)

Answer 37

Tetraology of fallot

Question 38

What is the treatment for bacillary angiomatosis?

Answer 38

Doxycycline or erythromycin

Question 39

Nephrotic syndrome with dense deposits within glomerular basement membrane that stain positive for C3 but not immunoglobulins

Answer 39

Type II membranoproliferative disease caused by IgG antibodies to C3 convertase, leading to persistent activation of alternative complement pathway

Question 40

What is treatment for Parkinson disease psychosis?

Answer 40

Quetiapine, clozapin, pimavanserin; haloperidol and risperidone should be avoided (worsen EPSE)

Question 41

Uncal herniation results in loss of what nerve?

Answer 41

Ipsilateral oculomotor nerve

Question 42

How is cryptococcal meningitis treated?

Answer 42

Amphotericin B and flucytosine

Question 43

How is cancer-related anorexia/cachexia syndrome treated?

Answer 43

Progesterone analogues or corticosteroids

Question 44

What components of spirometry measure respiratory muscle strength?

Answer 44

FCV and negative inspiratory force

Question 45

What is Trousseau’s syndrome? What is its significance?

Answer 45

Migratory superficial thrombophlebitis; seen in visceral (pancreatic) cancers

Question 46

Pronator drift is associated with a lesion where?

Answer 46

Pyramidal/corticospinal tract

Question 47

New mother holding her infant with outstretched thumb now complains of pain with passive stretching of flex thumb in palm

Answer 47

De Quervain tenosynovitis

Question 48

What is the treatment for PMS/PMDD?

Answer 48

SSRIs firstline; OCPs can help