Set 3

Question 1

Ash leaf spots, cardiac and kidney tumors, seizures / developmental delay?

Answer 1

Tuberous Sclerosis (mutation in 2 tumor suppressor genes)

Question 2

Lens dissociaton associated with (2)

Answer 2

homocysteinuria = downward
Marfan's = upward

Question 3

AMS, ataxia, nystagmus and conjugate gaze palsy

Answer 3

Wernicke’s encephalopathy (B1 thiamine def)

Question 4

Pathogenesis of statin-induced myopathy

Answer 4

inhibits intracellular coenzyme Q10 synthesis

Question 5

Pathogenesis of RHF in COPD patient

Answer 5

pulmonary HTN from chronic hypoxemia –> constriction of pulmonary arterial system

Question 6

What do prolonged QRS vs. prolonged QT indicate?

Answer 6

QRS = bradyarrhythmia (BBB)
QT = tachyarrhythmia (subtype of Vtach)

Question 7

Tx Dressler’s Syndrome

Answer 7

NSAIDs > > corticosteroids

Question 8

Banana bag

Answer 8

Thiamine 1st then dextrose, naloxone and O2

Question 9

2 causes of pulsus paradoxus

Answer 9

I.e. drop in SBP >10 during Inspiration
1. Cardiac tamponade
2. Severe asthma/COPD
(during inspiration blood pools in the lungs –> decreased LV preload –> decreased CO)

Question 10

Complications of Strep Pharyngitis vs. Impetigo?

Answer 10

Strep pharyngitis can lead to PSGN, rheumatic fever, scarlet fever
Impetigo can only cause PSGN

Question 11

ST depression V1 and V2

Answer 11

Posterior wall MI

Question 12

Dx, Tx heat stroke

Answer 12

T >105F

Tx evaporative cooling (water spray / fans)

Question 13

Tx Raynauds

Answer 13

Nifedipine (dihydropyridine CCB)

Question 14

2 major causes of pseudotumor cerebri?

Answer 14

Vit. A toxicity (isotretinoin or prolonged tetracylcine use), OCPs

Question 15

Tx depression WITH insomnia

Answer 15

Trazadone

Question 16

Exudative (increased protein) effusion withOUT evidence of infection

Answer 16

Malignancy –> BCA or Lung MC

Question 17

2 cardiac problems where Mg sulfate is the Tx

Answer 17

Torsades and digoxin OD

Question 18

Pathogenesis of hyperprolactinemia

Answer 18

decreased DA in hypothalamus/tuberoinfundibular pathway –> LOSS of normal inhibition on PRL release from ANTERIOR pituitary. Hence, see increased PRL in patients on antipsychotics (DA antagonists)

Question 19

Immune response elicited by Pneumoccocal polyvalent (subunit) vaccine

Answer 19

B cell only b/c polysaccharides* can’t be presented to T cells (peptides and proteins can be though)

Question 20

Decreased grip –> nerve injured

Answer 20

ulnar –> INTEROSSEOUS muscles

Question 21

Tx asystole or PEA

Answer 21

CPR –> epinephrine

DO NOT SHOCK unless in vfib or pulseless vtach

Question 22

HTN, hematuria and abd mass in a young person, think? associated with? (2)

Answer 22

PKD (autosomal dominant)

a/w cerebral aneurysms and strokes

Question 23

3 DA pathways and ass. conditions

Answer 23

mesolimbic - excitatory - schizophrenia (incr. DA)
tuberoinfundibular - inhibitory - hyperPRL (decr. DA)
nigrostriatal - inhibitory - parkinsonism (decr. DA)

Question 24

JVD, Kussmaul’s sign, hypotension, clear lung fields and NORMAL heart sounds (not muffled)? Tx?

Answer 24

RHF (vs. cardiac tamponade w/ muffled heart sounds).

Tx = IVF to sustain preload and BP, avoid nitro or diuretics

Question 25

What is injured with fx of supracondylar region of humerus?

Answer 25

median nerve and/or brachial artery

Question 26

Child with syncope and hearing impairment? Tx?

Answer 26

QT prolongation syndrome - often + FHx | Tx BB +/- pacemaker if sx

Question 27

Tx DCM

Answer 27

BB or CCB

Question 28

decreased radial pulses that disappear with deep inspiration?

Answer 28

pulsu paradoxus --> cardiac tamponade

Question 29

RF for AAA, oeprative criteria

Answer 29

RF = age >60, SMOKING, fhx, atherosclerosis (****NOT HTN which is RF for aortic dissection) Operate if >5.5cm, symptomatic or rapidly expanding

Question 30

Tx duration of lithium for bipolar disorder

Answer 30

1x = 1yr | 3+ x = for LIFE

Question 31

Left arm is swollen pale but pulses are present, Dx? Tx? Etiology?

Answer 31

Subclavian vein thrombosis 2/2 indwelling central line dx = duplex US Tx remove line +/- anticoagulation

Question 32

CD4 level prophylaxis guidelines

Answer 32

<50 = azithromycin for MAC

Question 33

Narrow complex tachycardia

Answer 33

SVT

Question 34

infant with persistent wheezing not responsive to inhaled bronchodilators or steroids

Answer 34

vascular ring causing upper airway compression

Question 35

Patient with CHF or Afib develops N/V/D, vision changes, AMS and decreased appetite? 3 causes

Answer 35

digitoxin toxicity (precipitated by renal injury, dehydration or hypokalemia)

Question 36

murmurs that increase with inspiration

Answer 36

Right heart murmurs bc negative intrathoracic pressure pulls blood into the RA

Question 37

stones, bones, grones, psychic overtones

Answer 37

Hypercalcemia (primary hyperparathyroidism, malignancy)

Question 38

Episodic palpitations, weakness, hypotension and tachycardia? Tx?

Answer 38

PSVT | Tx = vagal maneuvers, cold-water immersion, adenosine

Question 39

4 CHD equivalents? When to start statins?

Answer 39

DM, Sx carotid artery ds, PAD, AAA | Start ASA and statin at ANY LDL level (goal <100)

Question 40

Loud S1 and mid-diastolic rumble murmur

Answer 40

MS

Question 41

F/u of pap smear LSIL

Answer 41

``` adolescent = repeat in 12mo premenopause = colpo + bx postmenopause = reflex HPV +/- colpo ```

Question 42

<4yo with HIGH fever +/- febrile sz with a trunkal rash that spreads outward (maculopapular)

Answer 42

Roseola infantum/6th ds = HHV6

Question 43

Tx decompensated CHF

Answer 43

nitro + loop diuretics

Question 44

Female with normal development until 6mo then decline with hand-wringing

Answer 44

Rett disorder

Question 45

Transient monocular vision loss

Answer 45

amaurosis fugax = retinal embolism (MCC carotid artery plaque)

Question 46

anemia, thrombocytopenia and increased WBC (lymphs)? Tx?

Answer 46

CLL --> rituximab (cd20 Ab)

Question 47

dizziness, palpitations, trembling and profuse sweating during exercise

Answer 47

hypoglycemia inducing sympathetic system | angina has CP* duh

Question 48

Tx enuresis

Answer 48

non-med measures --> desmopressin --> imipramine

Question 49

Bullous pemphigoid vs. pemphigus vulgaris

Answer 49

``` BP = tense blisters involving groin PV = fragile blisters involving oral mucosa* ```

Question 50

2 complications of SAH

Answer 50

cerebral salt wasting --> increased ADH and BNP secretion causes hyponatremia SIADH - also hyponatremia