step 3 4

Question 1

Hypomagnesium differential

Answer 1

medication side effect (Diuretics, gentamicin, amphotericin, cisplatin), alcohol withdrawal, pancreatitis, parathyroid surgery

Question 2

metabolic alkalosis differential

Answer 2

Primary: contraction alkalosis, cushing/conn syndromes, hypokalemia, milk-alkali syndrome, vomiting
CLEVER PD
C – contraction (dehydration)
L – liquorice (diuretic), laxative abuse
E – endocrine (Conn’s, Cushing’s)
V – vomiting, GI loss (villous adenoma)
E – excess alkali (antacids)
R – renal (Bartter’s), severe K depletion
P – post hypercapnia
D – diuretics

Question 3

hypokalemia metabolic alkalosis pathophys

Answer 3

potassium ions shift out to correct hypokalemia, which causes hydrogen ions to shift into the cell

Question 4

episodic HTN think

Answer 4

pheochromocytoma

Question 5

screening intervention that has the biggest effect on mortality

Answer 5

mammography

Question 6

ER, PR postive breast cancer needs…

Answer 6

tamoxifen

Question 7

when you need adjuvant chemo for breast cancer

Answer 7

positive axillary nodes or tumor is greater than 1 cm in size
patient is still menstruating

Question 8

tamoxifen SEs

Answer 8

DVT
Hot flashes
Endometrial cancer

Question 9

aromatase inhibitors mechanism-side effects

Answer 9

estrogen antagonist, osteoporosis

Question 10

use of trastuzumab in breast cancer

Answer 10

HER-2/NEU positive metastatic disease

Question 11

screening for single family member with colon cancer

Answer 11

at age 40 or 10 years earlier than age at which family member contracted cancer

Question 12

screening for HNPCC, three family members, two generations, one premature

Answer 12

colonoscopy at age 25, then every 1-2 years

Question 13

screening for FAP, Gardner’s syndrome, Peutz-Jeghers, Turcot’s syndrome

Answer 13

screening sigmoidoscopy at age 12, then every 1-2 years

Question 14

lung cancer screening indication

Answer 14

30 pack year plus + age 55-75 + has not quite in past 15 years

Question 15

contraindications to lung cancer resection

Answer 15

bilateral disease
mets
malignant pleural effusion
involvement of aorta, vena cava, heart
lesions within 1-2 cm of carina

Question 16

cervical cancer screening

Answer 16

21-29, q3 years until 29, then pap + HPV (cotesting) q5 years until 65

Question 17

pap smear results management

Answer 17

abnormal pap with low-grade or high grade dysplasia → colposcopy and biopsy
pap with atypical squamous cells of undetermined significance → HPV testing
HPV-positive pap → colposcopy

Question 18

official recommendation for PSA

Answer 18

don’t offer, but if asked and patient is under 75, PSA + DRE

Question 19

prostate cancer management

Answer 19

if localized – surgery + external radiation or implanted radioactive pellets
if metastatic – hormonal, not chemo, andogen blockade with flutamide and leuprolide or goserelin

Question 20

management of cord compression in prostate cancer patient

Answer 20

flutamide

Question 21

ovarian cancer treatment

Answer 21

surgical debulking then chemo

Question 22

step 3 answer to scrotal lump

Answer 22

inguinal orchiectomy of affected testicle

Question 23

testicular cancer treatment and staging

Answer 23

Stage with CT abdomen-pelvis

Treat local disease with radiation and metastatic with chemo

Question 24

rocephin generic name

Answer 24

CTX

Question 25

severe sepsis management

Answer 25

If still hypotensive after first pressor add vasopressin at 0.4 kg/hr If still hypotensive → add stress-dose steroids, hydrocortisone 500 mg q6h, increase to 2g monitor response to pressors with flow track or CVP monitoring

Question 26

AC abbreviation

Answer 26

before meals

Question 27

septic shock criteria

Answer 27

Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and Lactate greater than or equal to 2 mmol/L

Question 28

when to be concerned about pseudomonas

Answer 28

1) nosocomial bacteremia, 2) wound 3) urinary tract infections 4) recent hospitalization 5) ventilator

Question 29

drugs covering anaerobes

Answer 29

Beta-lactam/beta-lactamase inhibitors such as ampicillin/sulbactam and piperacillin/tazobactam have excellent anaerobic coverage. When treating suspected or proven anaerobic infections with these drugs, addition of other agents such as metronidazole and clindamycin.

Question 30

e coli features

Answer 30

E. coli is a Gram-negative, facultative anaerobic (that makes ATP by aerobic respiration if oxygen is present, but is capable of switching to fermentation or anaerobic respiration if oxygen is absent)

Question 31

qSOFA criteria and interpretation

Answer 31

AMS RR greater than 22 SBP less than 100 - positive if 2 or greater

Question 32

solumedrol generic name

Answer 32

methylprednisolone

Question 33

retroperitoneal structures

Answer 33

``` urinary adrenal glands kidneys ureter circulatory aorta inferior vena cava pancreas rectum and anal canal Secondarily retroperitoneal, meaning the structures initially were suspended in mesentery and later migrated behind the peritoneum during development[3] the duodenum, except for the proximal first segment, which is intraperitoneal[4] ascending and descending portions of the colon ```

Question 34

top 5 causes of chronic caugh

Answer 34

postnasal drip asthma gastroesophageal reflux disease (GERD) chronic bronchitis, treatment with ACE inhibitors

Question 35

three key features of PTSD

Answer 35

1) re-experiencing of the traumatic event (dreams, flashbacks, or intrusive recollections) 2) avoidance of stimuli 3) increased arousal (anxiety, sleep disturbances, hypervigilance, emotional lability, or impulsiveness)

Question 36

other causes of depression

Answer 36

hypothyroidism, Parkinson’s, meds (beta blockers, steroids, antipsychotics, substance abuse

Question 37

rapid cycling bipolar diagnosis

Answer 37

bipolar with at least 4 episodes of mania per year

Question 38

rapid cycling bipolar treatment

Answer 38

stop all antidepressants, stimulants, caffeine, benzos, and alcohol

Question 39

first line for bipolar

Answer 39

lithium, lamotrigine, risperidone

Question 40

cyclothymia treatment

Answer 40

psychotherapy, if impaired function then start divalproex

Question 41

postpartum psychosis symptoms

Answer 41

psychotic symptoms, severe depressive symptoms

Question 42

suicide management

Answer 42

PEC and hospitalize → get sitter to accompany patient and do not leave unsupervised psychotherapy + SSRI security tray IF acute severe risk of self-harm → ECT

Question 43

ECT indications

Answer 43

MDD unresponsive to meds High risk for immediate suicide Contraindications to using antidepressants Good response to ECT in the past

Question 44

SSRI system

Answer 44

switch to another SSRI if no response within 8 weeks IF single episode → treat for 6 months, then taper and discontinue IF multiple episodes → long term therapy

Question 45

how to tailor antidepressants

Answer 45

IF poor appetite, weight loss, or insomnia → mirtazapine IF weight gain or concern for sexual side effects → bupropion IF severe insomnia → trazodone IF chronic neuropathic pain → amitriptyline

Question 46

lithium toxicity presentation

Answer 46

disorientation, tremors, nausea, vomiting

Question 47

NMS management

Answer 47

discontinue antipsychotic → ICU transfer → give bromocriptine + dantrolene or diazepam

Question 48

serotonin syndrome management

Answer 48

IVF Cyproheptadine Benzodiazepine

Question 49

causes of MAOI-induced hypertensive crisis

Answer 49

MAOI + antihistamines, nasal decongestants, consumption of tyramine-rich foods

Question 50

depression system

Answer 50

Diagnose → Rule out other causes (hypothyroidism, Parkinson’s, meds (beta blockers, steroids, antipsychotics, substance abuse)) → determine risk factors for suicide → tailor antidepressant

Question 51

other somatic symptom disorder

Answer 51

Maintain a single physician as primary caretaker. Individual psychotherapy. Do not hospitalize.