step 3 8

Question 1

toxo management

Answer 1

pyrimethamine + sulfadiazine x 2 weeks

if no decreased lesion size at 2 weeks repeat CT, brain biopsy for lymphoma.

Question 2

cryptococcus CD4 cutoff

Answer 2

less than 50

Question 3

PML CD4 count

Answer 3

50

Question 4

M avium CD4 count

Answer 4

50

Question 5

endocarditis diagnosis

Answer 5

duke’s criteria, 2 major, 1 major and 3 minor, or 5 minor criteria

Question 6

endocarditis RF’s

Answer 6

Prosthetic heart valve, IVDU, dental procedure causing bleeding, previous endocarditis, cardiac surgery

Question 7

most common bugs in endocarditis

Answer 7

staph and strep

Question 8

cardiac defects that need prophylaxis

Answer 8

prosthetic valves
unrepaired cyanotic heart disease
previous endocarditis

Question 9

procedures that need prophylaxis

Answer 9

dental procedures that cause bleeding
respiratory tract surgery
surgery of infected skin

Question 10

drugs to use for procedural prophylaxis

Answer 10

amoxicillin for oral procedures, cephalexin for skin procedures

Question 11

leptospirosis presentation

Answer 11

fever, abdominal pain, muscle aches

Question 12

leptospirosis treatment

Answer 12

CTX, penicillin

Question 13

tularemia presentation

Answer 13

ulcer at site of contact + lymphadenopathy + conjunctivitis

Question 14

where cysticercosis lives

Answer 14

mexico, SA, Eastern Europe, India

Question 15

DM diagnosis

Answer 15

2 fasting glucose greater than 126
1 random glucose greater than 200 with symptoms
Abnormal OGTT
HgbA1c greater than 6.5%

Question 16

long-acting insuline

Answer 16

glargine (lantus)
detemir
NPH

Question 17

short acting insulin drugs

Answer 17

aspart
lispro
glulisine

Question 18

treatment of diabetic retinopathy

Answer 18

laser photocoagulation

Question 19

thyroid storm treatment

Answer 19

Iodine
methimazole
Dexamethasone
Propranolol

Question 20

solitary thyroid nodule management

Answer 20

TSH/T4 → if normal then FNA (could be cancer)→

Question 21

hypercalcemia presentation

Answer 21

stones, fractures from osteoporosis, confusion, constipation and abdominal pain
(“stones, bones, psychic moans, and GI groans”)

Question 22

hypocalcemia causes

Answer 22

surgery, hypomagnesemia, vitamin D deficiency, acute hyperphosphatemia, fat malabsorption, PTH resistance (rare)

Question 23

affect of dexamethasone suppression test on ACTH production etiologies

Answer 23

will suppress pituitary tumors but not others

Question 24

cushing syndrome is just

Answer 24

hypercortisolism

Question 25

hypercortisolism management

Answer 25

Confirm hypercortisolism:
1 mg overnight dexamethasone suppression given overnight
If abnormal, rule out false positives with 24-hour urine cortisol.
Identify source:
1) ACTH
If low → origin is adrenal gland → scan with CT or MRI → if found consult surgery
If high → origin is pituitary gland or ectopic production
2) High-dose dexamethasone test:
if suppressed → pituitary source → MRI or CT → if negative need inferior petrosal sinus sampling
if not suppressed → ectopic (cancer making ACTH) → scan chest for lung cancer or carcinoid → if found, consult surgery

Question 26

hyperaldosteronism clinical feature

Answer 26

hypokalemia + metaboic alkalosis (high bicarb)

Question 27

pheochromocytoma diagnosis system

Answer 27

urine and plasma metanephrine and catecholamines → CT/MRI of adrenals to confirm → may need MIBG scan to detect metastatic disease (which can’t be treated with surgery)

Question 28

treatment of klinefelter’s

Answer 28

testosterone

Question 29

FEV1 cut-off for diagnosis of asthma and RAD

Answer 29

greater than 12 percent

Question 30

any shortness of breath on CCS orders

Answer 30

oxygen
continuous oximeter
CXR
ABG

Question 31

acute asthma exacerbation treatment

Answer 31

Albuterol treatment
Methylprednisolone bolus
Inhaled ipratropium
Oxygen
Magnesium
ABG
if acidotic transfer to ICU and repeat
if persistent on repeat, intubate and put on ventilator

Question 32

sarcoidosis workup

Answer 32

CXR → biopsy (looking for noncaseating granulomas)

Question 33

most common CXR finding in PE

Answer 33

atelectasis (tissue not being perfused)

Question 34

most common findings in PE on ECG

Answer 34

sinus tachycardia

nonspecific ST-T wave changes

Question 35

tests to order on pleural fluid

Answer 35

gram stain and culture
acid-fast stain
total protein
LDH
glucose
cell count w/ differential
pH

Question 36

central respiratory stimulants

Answer 36

acetazolamide

medroxyprogesterone

Question 37

ARDS diagnostic criteria

Answer 37

pO2/FiO2 less than 200

Question 38

most common bugs in healthcare associated pneumonia

Answer 38

gram-negative bacilli

Question 39

TB workup

Answer 39

check for previous PPD → if none, PPD –> CXR →
if findings suggestive of latent infection → check for previous TB treatment, then INH x 9 months
if findings suggestive of active infection → confirm with sputum culture + acid-fast stain
*on step 3 go straight to CXR

Question 40

NHL treatment

Answer 40

CHOP, cyclophosphamide, hudroxyadriamycin, oncovin, prednisone

Question 41

HOdgkins treatment

Answer 41

ABVD, adriamycin, bleomycin, vinbkastine, dacarbazine

Question 42

Chemo nausea treatment if qt prolonged

Answer 42

Aprepitant, rolapitant, netupitant

Question 43

RA pleural effusion characteristic

Answer 43

very low glucose level

Question 44

rheumatoid arthritis management

Answer 44

NSAIDs
Steroid bridge to DMARD
DMARD ASAP (Methotrexate)
If failed add anti-TNF + make sure they’ve been tested for hepatitis B and TB
Exacerbation → steroids

Question 45

ankylosing spondylitis management

Answer 45

NSAIDs
Infliximab/adalimumab
Sulfasalazine
Secukinumab

Question 46

reactive arthritis clinical features

Answer 46

history of urethritis or GI infection + conjunctivitis + arthritis

Question 47

anti-Ro + anti-SSA in pregnancy confer increased risk for..

Answer 47

heart block

Question 48

most common drugs causing drug-induced SLE

Answer 48

hydralazine, procainamide, isoniazid

Question 49

sideroblastic anemia treatment

Answer 49

pyridoxine