Miscellaneous

Question 1

Tx of chronic irritant contact dermatitis

Answer 1

Emollients, topical corticosteroid, avoid irritants

Question 2

40M goes hiking + linear vesicles on calf appearing days later. Dx? Hypersensitivity type?

Answer 2

contact dermatitis = type IV
hypersensitivity; linear vesicles = poison ivy/sumac

Question 3

38F gardens a lot + gets rash on face, arms, backs of hands. Dx?

Answer 3

contact dermatitis from sunscreen

Question 4

Long term oxygen improves survival in patients with COPD with what level syptoms

Answer 4

Significant chronic hypoxemia (oxygen saturation<=88% or arterial oxygen tension<=55 at rest, with normal exertion or during sleep

Question 5

Highly sensitive marker for heart failure in people without obesity

Answer 5

High BNP (>100)
(If BNP low in patient without obesity with dyspnea, likely not heart failure)
(Among obese patients with heart failure, BNP may be falsely low)

Question 6

Mononeuritis multiplex definition and presentation

Answer 6

Definition: Neuropathy associated with Granulomatosis with polyangiitis, Eosinophilic
granulomatosis with polyangiitis, Microscopic polyangiitis

Presentation: neuropathy of “one large nerve in many locations” – e.g., wrist drop + foot drop in same patient

Question 7

Acetazolamide MOA

Answer 7

Carbonic anhydrase inhibitor (enzyme that enables H2CO3 to HCO3- + H+) that acts within the tubular cells of the PCT

Question 8

Acetazolamide Classic use

Answer 8

Altitude sickness
Drug causes decreased reabsorption of HCO3- in the PCT which results in ­increased urinary pH and volume + decreased serum pH and volume

(In altitude sickness, patients hyperventilate (decreased CO2 thus increased pH) to take in more O2, but it takes a minimum of 12-24 hours for the kidney to decrease HCO3- reabsorption, so acetazolamide forces the decrease reabsorption by causing metabolic acidosis)

Question 9

Kidney compensation for metabolic acidosis with increased bicarbonate reabsorption and H excretion. The increased bicarbonate reabsorption leads to increased urinary x excretion. Most of the H excretion is in form of y or x.

Answer 9

X - Cl (chloride)
Y - ammonium (NH4)
Z - dihydrogen phosphate (H2PO4)

Question 10

Important drug interaction that can increase digoxin levels

Answer 10

Amiodarone

Question 11

Digoxin toxicity sxs acute and chronic

Answer 11

Acute: GI sxs (anorexia, nausea, vomitting, abdominal pain

Chronic: less pronounced GI and more Neuro and visual sxs (scotomas, color vision changes, blindness)

Question 12

PCWP is considered a reasonable surrogate for

Answer 12

LAP

Question 13

Allergic conjunctivitis (bilateral conjunctival injection, watery discharge, pruitis, eyelid edema) dx and tx?

Answer 13

Dx: clinical
Tx: topical antihistamines and mast cell stabilizers

Question 14

Elevated prolactin results in suppression of

Answer 14

GnRH (thus low LH and FSH; central hypogonadism)

Question 15

Tx prolactinioma

Answer 15

Dopamine agonists

Question 16

Major concern with prolactinoma in premenopausal women

Answer 16

Causes anovulation, amenorrhea/oligorrhea, infertility

This concern for bone loss (estrogen deficiency - osteoporosis)

Question 17

Free perforation of the GI tract can occur in setting of inflammation (diverticulitis) and presents with

Answer 17

Classic pain sequence:
Sudden severe pain (perforation)
Temporary Pain relief (decompression)
Generalized constant pain (Peritonitis)

Question 18

Free perforation of gi tract on abdominal imaging

Answer 18

Intraperitoneal free air

Question 19

Causes of non-caseating granuloma

Answer 19

Crohn + sarcoidosis

Question 20

Causes of caseating granuloma

Answer 20

TB