Set 4

Question 1

OCPs decrease the risk of what? Increase?

Answer 1

Decrease = Endometrial, ovarian
Increase = VTE, HTN

Question 2

Arrhythmia caused by digoxin toxicity

Answer 2

Atrial tachycardia w/ AV block (increased ectopy and increased vagal tone)

Question 3

Autism vs. Child Disintegrative Disorder

Answer 3

Autism ALWAYS manifests before 3yo
CDD displays normal development until ~2yo followed by LOSS of PREVIOUSLY acquired skills in 2+ areas (language, social, bowel/bladder, motor) with ENSUING autistic features

Question 4

Young healthy person suddenly dies, ddx?

Answer 4

HCM –> tx BB or CCB

QT prolongation snydrome –> tx BB +/- pacemaker if sx

Question 5

Jervell-Lange Nielson

Answer 5

torsades + hearing impairment + fhx

Question 6

Ca2+, Phos, vit D and PTH levels in secondary hyperPTH

Answer 6

Increased = Phos and PTH
decreased = vit d and Ca2+

Question 7

Tx DKA

Answer 7

IV NS or** 1/2NS+K (if hypokalemic BEFORE insulin, must use 1/2NS with K+ to make isotonic)
then insulin

Question 8

Trigeminal nerve palsy and limb ataxia, wheres the lesion?

Answer 8

lateral pons

Question 9

Dx, Tx hypertensive encephalopathy

Answer 9

BP > 180/120

Tx nitroprusside and labetolol

Question 10

Jugular venous tracing letters / meaning

Answer 10

a,c,x,v,y
a- atrial contraction
c- ventricular contraction
x down- RA relaxation
v- valve closed and RA filling
y down- blood flows from RA to RV

Question 11

2mo vaccinations (6)

Answer 11

Hep B(2), rotavirus, TDaP, Hib, Pneumococcal, Inactivated polio

Question 12

pure motor stroke

Answer 12

Lacunar infarct (posterior limb of IC)

Question 13

Tx CML

Answer 13

imatinib

Question 14

7 tocalytics

Answer 14

B-agonist --> terbutaline or ritodrine
MgS
nifedipine
indomethacin
nitroglycerin
oxytocin ANTagonist
progesterone

Question 15

Tx aortic regurg

Answer 15

decrease afterload = nifedipine or ACEI

Question 16

Tx EPS

Answer 16

diphenhydramine, bezontropine or triheyphenidyl (anticholinergics)

Question 17

Bullae and ulcers w/ central necrosis in an immunocompromised patient

Answer 17

pseudomonas - erythema gangrenosum

Question 18

Tx depression with insomnia AND decreased appetite

Answer 18

mirtazapine (TCA) good in old folks

Question 19

contralateral paralysis and loss of touch/vibration/proprio and tongue deviating to the IPSilateral side, wheres the lesion?

Answer 19

Medial medullary syndrome

Question 20

Systolic murmur that disappears with squatting

Answer 20

MVP (squatting increases venous return)

Question 21

severe / refractory HTN and muscle weakness, dx? Tx?

Answer 21

Conn’s Syndrome aka Primary hyperaldosteronism (hypoK causes weakness)
Tx = spironolactone

Question 22

MCC death in MI patients

Answer 22

Vfib –> defibrillate

Question 23

ispilateral limb ataxia, contralateral eye deviation and paralysis, wheres the lesion?

Answer 23

Medial Pons

Question 24

Drugs for Tx of parkinson’s

Answer 24

DA agonists = levodopa/carbidopa, bromocryptine, amantadine
anticholinesterase = benztropine
MAO-B inhibitor = selegeline

Question 25

Loss of contralateral pain/temp, ipsilateral loss of face pain/temp, difficulty swalling, cerebellar ataxia and horner's syndrome

Answer 25

Lateral medullary syndrome aka Wallenberg, 2/2 PICA stroke

Question 26

SE terbutaline

Answer 26

``` B1 = tachycardia / increased SV B2 = vasodilation and bronchodilation ```

Question 27

Narrow QRS with P waves buried in beggining of QRS (ie not discernable)? Tx?

Answer 27

AVNRT aka paroxysmal SVT (rentry causes simultaneous atrial and ventricular contraction) stable = carotid massage/valsalva, adenosine unstable = cardiovert

Question 28

TB pleural effusion vs. epyema

Answer 28

TB = VERY high protein (>4), LYMPHOCYTIC leukocytosis, glucose midly low empyeme = VERY low glucose, frank prurulence and PMN dominant leukocytosis

Question 29

3 MCC foot drop

Answer 29

peripheral neuropathy L5 radiculopathy common peroneal nerve damage (fibula neck fx)

Question 30

Tx chronic stable angina

Answer 30

1st BB then +/- CCB | Nitrates used acutely

Question 31

kid, holosystolic murmur at LLSB and apical diastolic murmur

Answer 31

VSD

Question 32

Effect of chronic steroid use on muscles

Answer 32

steroid-induced myopathy = painless* proximal muscle weakness LE before UE improves after d/c steroids

Question 33

systolic and diastolic abdominal bruit

Answer 33

think RAS

Question 34

bilateral hip, thigh buttock claudication, impotence, symmetric atrophy BLE

Answer 34

aortoiliac occusion causing chronic ischemia

Question 35

Second line mood stabilizers

Answer 35

carbemazepine or valproate

Question 36

Tx hypertriglyceridemia

Answer 36

fibrates (fenofibrate or gemfibrozil) = LPL stimulators that increase HDL, decrease TG

Question 37

Dx criteria ARDS

Answer 37

acute onset | PaO2/FiO2 <18

Question 38

lifestyle mods for decreasing HTN in order of effectiveness (5)

Answer 38

weight loss > DASH diet > low salt diet/exercise > decrease alcohol intake

Question 39

electrical alternans suggests

Answer 39

pericardial effusion

Question 40

Dx spontaneous bacterial peritonitis

Answer 40

paracentesis w/ >250PMN, protein >1, glucose <50, LDH greater than serum

Question 41

3 tests before starting Lithium

Answer 41

Creatinine, TSH/T4, BhCG

Question 42

Tx vtach

Answer 42

``` stable = amiodarone (2nd line lidocaine, procainamide) unstable = cardiovert ```

Question 43

nerve most often damaged in mastectomy / effect

Answer 43

long thoracic nerve --> winged scapula

Question 44

prominant x and y descents on JVP w/ early heart sounds following S2

Answer 44

``` constrictive pericarditis (TB if outside US, viral in US) early heart sound = pericardial knock ```

Question 45

Which type of bilirubin causes pruritus

Answer 45

direct (conjugated) bc conjugated bilirubin is water-soluble and thus floats freely in blood (unconjugated is bound to albumin)

Question 46

Live vaccines for HIV patients?

Answer 46

ONLY MMR and varicella if 200

Question 47

Medication given after gastric bypass

Answer 47

ursodeoxycholic acid x6mo to prevent gallstones 2/2 rapid weight loss inducing increased [bile]

Question 48

Hepatomegaly, CHF, DM and testicular atrophy

Answer 48

hemochromatosis

Question 49

Tx overflow incontinence

Answer 49

timed voids, double voids, intermittent cath or BETHANECHOL (cholinergic agonist)

Question 50

pericaridits in CKD patient? Tx?

Answer 50

``` uremic pericarditis (BUN>60) Tx hemodialysis ```