Rosh Review/Week 1

Question 1

When should adults get pneumococcal vaccine and how should it be administered?

Answer 1

age 65 if no risk factors
any age with these risk factors: smoking, immunocompromised, cochlear implant, alcohol use disorder

PSV13 then wait a year then PPSV 23

pneumococcal is inactivated vaccine

Question 2

when do you do US for AAA

Answer 2

65-75 male smoker

Question 3

don’t use metformin when

Answer 3

renal insufficiency - creatinine over 1.4 (F) and 1.5 (M)

also CHF, certain radiographic contrast studies, acidosis, and seriously ill people

Question 4

alternative recommendation to metformin if contraindications present

Answer 4

short acting sulfonurea glipizide

Question 5

“Cross eyed”

Answer 5

stabismus

Question 6

exotropia

Answer 6

one eye looks ahead and the other looks laterally

Question 7

esotropia

Answer 7

one eye looks ahead and the other looks medially

Question 8

aniscoria

Answer 8

different sized pupils

Question 9

what can stabismus lead to

Answer 9

exotropia, esotropia, aniscoria

Question 10

ectropion

Answer 10

outward turning of lower eyelid

Question 11

what tests for stabismus

Answer 11

cover-uncover

light reflex test

Question 12

someone gets in a motorcycle accident with gravel stuck in cut - what kind of tetanus booster do they get

Answer 12

tdap - if no tetanus shot in past 5 years

Question 13

tx for ITP

Answer 13

Glucocorticoids, IVIG and immunosuppressive therapy is used to help patients achieve and maintain safe platelet counts.

Question 14

new onset thrombocytopenia with no preceding illnesses or med changes is usually

Answer 14

ITP - idiopathic thrombocytopenic purpura *can have purpura but don’t have to and low platelets will be only blood finding

Question 15

tx of cataracts

Answer 15

phacoemulsification of the opacified lens followed by implantation of an artificial lens.

Question 16

tx of severe frostbite

Answer 16

place hand in circulating warm water - 90-102 degrees

Question 17

typical symptoms of sarcoidosis - what will this person look like

Answer 17

black female (40s)
dyspnea, dry cough, painless lymphadenopathy, maculopapular lesions on face, bilateral hilar lymphadenopathy

Question 18

tx for sarcoidosis

Answer 18

oral steroids

Question 19

Immediate treatment for severe symptomatic hypercalcemia is

Answer 19

volume repletion with normal saline. Long-term therapy of hypercalcemia of malignancy involves treatment with bisphosphonates, which may cause osteonecrosis of the jaw. Hypercalcemia of malignancy (driven by PTH related peptide) is most commonly seen as a consequence of squamous cell, renal, breast, or bladder cancer. Hypercalcemia may also be caused by hematologic malignancies via the upregulation of cytokines and vitamin D, as well as via local osteolysis, which is seen in breast cancer and multiple myeloma. In hypercalcemia of malignancy, bisphosphonates are the cornerstone of long-term therapy. Bisphosphonates inhibit osteoclastic activity, reducing both the formation and the resorption of hydroxyapatite. They are used in malignancy-associated hypercalcemia as well as Paget’s disease of the bone and postmenopausal osteoporosis. Important toxicities to remember are corrosive esophagitis nausea, diarrhea, and osteonecrosis of the jaw.

Question 20

bulging tympanic membrane

Answer 20

acute otitis media

Question 21

first line for acute otitis media

Answer 21

HIGH dose amoxicillin

Question 22

most common cause of viral stomach bug

Answer 22

salmonella

Question 23

retrocele location of appendix - what sign

Answer 23

psoas sign

Question 24

tx for patent ductus arteriosis

Answer 24

ligation

Question 25

machinery like murmur

Answer 25

PDA

Question 26

most common head sign of child abuse

Answer 26

retinal hemorrhages

Question 27

what do you do when a healthy 15 month old child is exposed to a contact who has been diagnosed with the flu in the last 24 hours?

Answer 27

give tamiflu (osletamivir)

Question 28

4Hs: hemorrhages (petechiae, bleeding gums), hyperkeratosis (rough skin, loose teeth), Hypochondriasis (irritability, emotional changes), hematologic abnormalities (easy bruising) = what type of vitamin def

Answer 28

C results from "tea and toast" diet of elderly

Question 29

A: Night vision loss, dry skin, growth retardation, Bitot spots on the conjunctiva B1 (Thiamine): Alcoholism, malnutrition, Wernicke-Korsakoff syndrome B2 (Riboflavin): Cheilosis, corneal vascularization (the 2 Cs of B2) B3 (Niacin): Dermatitis, dementia, diarrhea, corn-based diet (Pellagra) B6 (Pyridoxine): Sideroblastic anemia, convulsions, peripheral neuropathy, INH use B12 (Cobalamin): Megaloblastic anemia + neurological symptoms, hypersegmented neutrophils C (Ascorbic acid): Scurvy (↑ bleeding, anemia, loose teeth) D: Rickets (children), osteomalacia, tetany E: Anemia, peripheral neuropathy, ataxia K: ↑ bleeding, ↑ PTT, ↑ PT

Answer 29

just for reference

Question 30

tricuspid valve stenosis most likely caused by

Answer 30

rheumatic fever

Question 31

epiglottitis tx

Answer 31

iv antibx and admission

Question 32

apple core sign on x ray =

Answer 32

colorectal cancer

Question 33

necrotizing fasciitis tx

Answer 33

vanco and clinda

Question 34

4 things you will see on xray with osteoarthritis

Answer 34

narrowed joint space osteophytes sclerosis subchondral cysts

Question 35

difference between rickets and osteomalacia

Answer 35

rickets - kids | osteomalacia - epiphysis have closed

Question 36

tx of hemodynamically stable a fib and wolff-parkinson-white syndrome

Answer 36

ibutilide

Question 37

widened mediastinum on chest xray =

Answer 37

aortic dissection

Question 38

avascular necrosis of femoral head intermittent limp worse after activity

Answer 38

leg calves perthes disease

Question 39

dry cough, bilateral hilar adenopathy, subcutaneous nodules

Answer 39

sarcoidosis

Question 40

tetany - hypercalcemia or hypocalcemia

Answer 40

hypocalcemia

Question 41

what bacteria is responsible for traveler's diarrhea and how do you treat it?

Answer 41

entertoxigenic e coli supportive care + 3 days of cipro and maybe antimotility agents

Question 42

how does traveler's diarrhea present

Answer 42

watery diarrhea with abdominal cramping

Question 43

overuse of albuterol inhaler results in what electrolyte abnormality

Answer 43

hypokalemia

Question 44

if a child drinks more than 16 oz of milk a day, what are they at an increased risk for

Answer 44

iron deficiency anemia

Question 45

compartment syndrome is most commonly assoc with what

Answer 45

long bone fractures

Question 46

what is a kerion?

Answer 46

delayed hypersensitivity reaction to tinea capitis; can lead to scarring alopecia

Question 47

how do ischemic colitis patients present?

Answer 47

mild to severe cramping with acute onset on left side of abdomen, older, rectal bleeding or bloody diarrhea in the first 24 hours, thickening of bowel wall on CT with free peritoneal fluid

Question 48

if pt presents with hair loss consistent with telogen effluvium, which blood test should you run

Answer 48

serum ferritin - may be iron deficient

Question 49

rubeola symptoms

Answer 49

rash that moves from face to trunk, fever. cough, coryza, conjunctivitis, Koplik spots *pinpoint greyish spots with surrounding red inflammation in lateral buccal mucosa" - pathognomonic

Question 50

hypocortisolism (addison's disease) = what other two electrolyte abnormalities

Answer 50

hyponatremia and hyperkalemia due to aldosterone levels being affected (Na+ not be absorbed correctly and potassium not be excreted properly)

Question 51

which type of medication is used to prevent variceal hemorrhage?

Answer 51

non selective beta blockers

Question 52

symptoms of ectopic pregnancy

Answer 52

bleeding in first trimester, abdominal pain, amenorrhea

Question 53

what enzyme is elevated in compartment syndrome

Answer 53

creatine kinase

Question 54

what should be avoided when children present with bloody diarrhea and no stool culture confirmation

Answer 54

DO NOT GIVE ANTIBIOTICS DUE TO INCREASED RISK FOR HUS

Question 55

contraindication to tetanus shot

Answer 55

encephalopathy after previous tetanus shot