Questions

Question 1

What is the next best step after establishing the diagnosis of myasthenia gravis?

Answer 1

Chest X-ray to r/o thymoma

Question 2

Who always gets a statin accoring to current guidelines?

Answer 2

Diabetic ages 40-75

Question 3

Shiny tongue with vitalligo

Answer 3

Pernicious anemia– Ab against intrinsic factor

Question 4

HIV pts with a CD4 of <50 require prophylaxis for what infection? With What Abx?

Answer 4

Mycobaterium Avium Complex (MAC)

Azithromycin

Question 5

Loss of the gallbladder ducts is commonly seen in what disorder?

Answer 5

Primary biliary cirrhosis

Chemotherapy

GVHD

CMV

Hodgkin disease

Question 6

Treatment for ethylene glycol poisoning

Answer 6

Ethanol or fomepazole (alcohol dehydrogenase inhibitor)

Question 7

Explain type II HIT

Answer 7

Type II HIT is the result of heparin binding to platelet factor 4.

The heparin-PF4 complex then binds IgG. This leads to activation of platlets and sequestion of the patelets by the spleen.

This causes thrombosis and thrombocytopenia

Question 8

Most common cause of PNA in nursing homes

Answer 8

S. pneumonia

Question 9

Equation to calculate osmolar gap

Answer 9

2xNa + BUN/2.8 + Glucose/18

Question 10

How much fluid given to burn patient

Answer 10

4mL per 1% burn

(rule of 9s)

Question 11

Most common EKG abnormality seen in hypothermia

Answer 11

J point elevation

Question 12

Common side effect of hydroxychloroquine

Answer 12

retinopathy

Question 13

Causes of AKI with acyclovir treatment

Answer 13

Acyclovire when given IV can chrystallize in the urine causing obstructive uropathy

Question 14

Give this to treat epiglottitis…what to give close contacts

Answer 14

Ceftriaxone

give close contacts Rifampin

Question 15

Gray highly vascular membrane on the pharynx of a sick child…dx? Tx?

Answer 15

Diptheria

Tx with antitoxin

Question 16

Signs of vitamin B2 (riboflavin) deficiency

Answer 16

Chelosis

Question 17

Arrythmia most specific for digoxin tox

Answer 17

atrial tachycardia with AV block

Question 18

Combination of nephrotic syndrome, hepatomegaly, palpable kidneys and ventricular hypertrophy is suggestive of…

Answer 18

Secondary amyoldosis (AA)

tx: colchicine

Question 19

Vitamin B3 (niacin) deficiency

Answer 19

4D’s

Dermatitis

Diarrhea

Dementia

Death

Question 20

Which type of dementia is associated with alterations in level of consciousness and EPS

Answer 20

Lew body dementia

Question 21

Calculation to adjust Ca for albumin

Answer 21

Serum Ca - ( 0.8 (4 - albumin))

Question 22

Mnemonic to remember gravity and parity

Answer 22

F-PAL

Full term

Pre term

Abortions

Living Children

Question 23

Most commonly induced HIV nephropathy

Answer 23

Focal segmental glomerulosclerosis

Question 24

Commone side effect of statin

Answer 24

elevated transaminases

Myositis

Question 25

Side effects of niacin

Answer 25

elevated glucose, uric acid and pruritis

Question 26

Side effects of fibrates

Answer 26

Elevated rate of myositis when used with statins

Question 27

Side effects of cholestyramine

Answer 27

flatus and abdominal cramping

Question 28

Common side effects of CCB

Answer 28

Edema Constipation

Question 29

ST elevation in V2-V4 corresponds to ischemia here

Answer 29

Anterior wall MI= high mortality

Question 30

Which leads correspond to inferior wall MI?

Answer 30

ST elevations in II, III, aVF

Question 31

Ho long does CK-MB stay elevated in a patient post MI? Why is this important to know?

Answer 31

1-2d It is most specific for re-infarction because Tropnins stay elevated for 10-14d

Question 32

Describe the S4

Answer 32

Late **diastolic** murmur heard when an atria contracts against a stiffened ventricle

Question 33

Describe S3

Answer 33

Low frequency Early Diastole, just after the S2 in early diastole Normal in young people Indicates elevated ventricular diastolic filling pressures may be first clinica sign of CHF

Question 34

Initial teo drug therapy in CHF

Answer 34

ACEi or ARB with a diuretic (loop) Spironolactone is given for anti-aldosterone effect not diuretic effect

Question 35

What treatments are shown to have a mortality benefit in systolic dysfunction?

Answer 35

ACEi/ARB B-blocker Spironolactone Hydralazine/nitrate implatable defib

Question 36

This drug shows clear benefit in CHF with diastolic dysfunction

Answer 36

B-blocker

Question 37

Best INITIAL therapy for CHF with pulmonary edema

Answer 37

Loop diuretic

Question 38

All left sided murmurs will increase on expiration except for these two

Answer 38

HOCM Mitral valve prolapse

Question 39

Pulsations in the nail bed, BP in legs 40mmHg higher than arms, and a wide pulse pressure are all signs of this

Answer 39

Aortic regurgitation

Question 40

Which manuveurs improve MVP murmur? Why?

Answer 40

Anything that increases LVEDV becuase the valve will be more stretched out and less likely to "snap" backwards

Question 41

Most commom cause of hypertrophic cardiomyopathy

Answer 41

Hypertention

Question 42

Erythematous papules and plaques that are present on the face, extremities and perineum in patients with glucagonomas

Answer 42

Necrolytic migratory erythema

Question 43

Treatment of choice for uncomplicated cystitis in a female

Answer 43

Nitrofurantoin or tmp/smx

Question 44

Treatment of choice for complicated UTI in female

Answer 44

Fluroqinnolones

Question 45

Abx of choice for a neonate \<1yo for pertussis prophylaxis

Answer 45

Azithromycin NOT erythromycin due to pyloric stenosis

Question 46

Best choice Abx for human bite patient

Answer 46

Amoxicillin-clavulanate

Question 47

Isloated alk phos incidentally discovered in elderly patient. Most like Dx?

Answer 47

Paget disease of bone

Question 48

Early 20s African American female with slow onset dry scaly skin diffusely with horns and plaques

Answer 48

Icthyosis Vulgaris

Question 49

Hosimoto patients are at high risk for this malinancy

Answer 49

Thyroid lymphoma-- rapidly enlarging gland with donut sign Needs core bopsy for dx

Question 50

Discuss CAH

Answer 50

Question 51

Durring which week is external eversion indicated in a patient with a breech presentation?

Answer 51

Not until the 37th week

Question 52

An HIV patient presents with non-specific symtoms of malaise, fever, cough, abdominal pain and aches. Their alkphos is elevated. CD4 is \<50. Most likely Dx? What prophylactic drug would have prevented this?

Answer 52

MAC- Disseminated mycobaterium complex Axitromycin would have prevented