May 1st

Question 1

What is the presentation of staphylococcal toxic shock syndrome?

Answer 1

Risks: tampon use, nasal packing, surgical/postpartum wound infection; fever >102, hypotension, DIFFUSE MACULAR RASH INVOLVING PALMS AND SOLES, desquamation 1-3 weeks after disease onset, vomiting and diarrhea, AMS

Question 2

What is the treatment for staph toxic shock syndrome?

Answer 2

Fluids, removal of foreign body, antibiotics (eg clindamycin plus vanco)

Question 3

What is seen on electron microscopy in minimal change disease?

Answer 3

Effacement of foot processes of podocytes

Question 4

What is the treatment for MCD?

Answer 4

Corticosteroids

Question 5

In a posterior shoulder dislocation, how is the shoulder usually positioned?

Answer 5

Held in adduction and internal rotation; see visible flattening of anterior shoulder

Question 6

When do you see posterior shoulder dislocations clinically?

Answer 6

Seizures of electrocution injury

Question 7

What is the MOA of tamoxifen?

Answer 7

Estrogen receptor antagonist at the breast, estrogen agonist in the uterus (leading to endometrial proliferation - associated with polyps in premenopausal women and hyperplasia/cancer in postmenopausal women); has some estrogen-like activity at the bone (increase bone mineral density)

Question 8

What are the risk factors for placenta accreta?

Answer 8

Prior C section, h/o dilation and curettage, maternal age >35

Question 9

What are the two types of etiology in stress incontinence?

Answer 9

Decreased urethral sphincter tone, urethral hypermobility

Question 10

What is the first line treatment for stress incontinence?

Answer 10

Kegel exercises

Question 11

Infant with small-for-gestational age with cataracts and PDA (continuous machine like murmur)

Answer 11

Think congenital rubella syndrome; can also see sensorineural hearing loss

Question 12

What is the treatment for measles?

Answer 12

Supportive and vitamin A for hospitalized patients

Question 13

Child with macrocytic anemia, low retic count, and congenital anomalies (webbed neck, cleft lip, shielded chest, and triphalangeal thumbs)

Answer 13

Diamond Blackfan anemia

Question 14

What is seen on Hgb electrophoresis in Diamond Blackfan anemia?

Answer 14

Increased fetal Hgb

Question 15

What is the treatment for social anxiety disorder?

Answer 15

CBT + SSRI (propranolol for performance only social anxiety disorder)

Question 16

Guillain Barre effects what portion of the neuromuscular pathway?

Answer 16

Peripheral nerves

Question 17

Why is erythromycin contraindicated in neonates?

Answer 17

Can lead to pyloric stenosis

Question 18

What is post-exposure prophylaxis for pertussis?

Answer 18

Macrolide ( eg azithromycin)

Question 19

Normal anion gap acidosis and FTT with alkalotic urine

Answer 19

Think RTA type 1 (distal)

Question 20

Fanconi syndrome is associated with what type of RTA?

Answer 20

Type 2

Question 21

What is a normal Hgb electrophoresis pattern?

Answer 21

99% Hgb A, 0 % Hgb S and <1 % Hgb F

Question 22

What is seen on Hgb electrophoresis in Sickle cell disease?

Answer 22

0% Hgb A, 85-90% Hgb S and 5-15% Hgb F

Question 23

What is seen on Hgb electrophoresis in sickle cell trait?

Answer 23

50-60% Hgb A, 35-45% Hgb S, <2% Hgb F

Question 24

What is seen on Hgb electrophoresis in a patient with Sickle cell disease and is on hydroxyurea?

Answer 24

Hydroxyurea increased Hgb F, resulting in Hgb F % >15 on electrophoresis

Question 25

Hydroxyurea causes what kind of blood dyscrasis?

Answer 25

Can result in macrocytic anemia, and myelosuppression (neutropenia)

Question 26

APGAR score of what requires intervention?

Answer 26

Less than 7

Question 27

How does gonococcal conjunctivitis present in a neonate?

Answer 27

Usually persents at age 2-5 days with eyelid swelling and mucopurulent discharge and chemosis

Question 28

What is the gold standard for diagnosing gonococcal conjunctivitis?

Answer 28

Culture on thayer-martin agar

Question 29

What is treatment for gonococcal conjunctivitis?

Answer 29

Single dose IM 3rd gen cephalosporin

Question 30

Why is topical erythromycin ointment administered to neonates?

Answer 30

Prophylaxis for gonococcal conjunctivitis

Question 31

What is the preentation of chlamydial conjunctivitis in neonates?

Answer 31

Presents 5-14 days, mild eyelid swelling with watery serosang discharge

Question 32

What is the treatment for chlamydial conjunctivitis?

Answer 32

PO macrolide

Question 33

What are teh adverse effects of MTX?

Answer 33

Nausea, stomatitis, rash, hepatotoxicity, ILD, alopecia, fever, MACROCYTIC ANEMIA, and severe: pancytopenia

Question 34

What is the MOA of MTX?

Answer 34

Inhibits dihydrofolate reductase

Question 35

What is seen on liver biopsy in Reye syndrome?

Answer 35

Microvesicular fatty infiltration

Question 36

What is the empiric treatment for suspected bacterial meningitis?

Answer 36

3rd gen cephalosporin (ceftriaxone) and vancomycin

Question 37

Patient presents with pulmonary abscess and recurrent cutaneous abscesses with organism-filled neutrophils

Answer 37

Chronic granulomatous disease

Question 38

What is chronic granulomatous disease?

Answer 38

Immunodeficiency caused by mutation that prevents phagocytic oxidative burst - impairs intracellular killing

Question 39

Patients with chronic granulomatous disease are particularly susceptible to what types of organisms?

Answer 39

Catalase-positive

Question 40

How is chronic granulomatous disease diagnosed?

Answer 40

Test neutrophil function - eg dihydrorhodamine 123 or nitroblue tetrazolium test

Question 41

In breastfeeding failure jaundice, hyperbilirubinemia is due to what?

Answer 41

Increased enterohepatic circulation of bilirubin, resulting in increased unconjugated bilirubin

Question 42

What is the threshold for phototherapy in a full-term healthy 4-day old infant with elevated bilirubin?

Answer 42

Total bil >/= 20