Step3 11

Question 1

Clinical features of OCD

Answer 1

Obsessions:
Persistent, intrusive unwanted thoughts, anxiety-producing

Compulsion
Take up of your time
Do not “solve” the obsession

Question 2

Treatment for OCD

Answer 2

Cognitive-behavioral therapy

SSRI

Question 3

Genetics of X linked dominant disorders

Answer 3

All females offsprings of affected men have the condition

Question 4

Genetics of X linked recessive disorder

Answer 4

50% of male offspring of female carrier have the disease

50% of female offspring of a female carrier are carriers

WOMEN NEVER HAVE THE DISEASE

Question 5

Genetics of mitochondrial disorders

Answer 5

All offsprings from affected mothers have the condition

Only daughters pass it along

Question 6

What is MELAS

Answer 6

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes

Stroke-like episodes: hemiparesis, vision abnormalities (due to mitochondrial dysfunction, not corresponding to artery distribution)
Seizure
Muscle weakness
Hearing loss
Lactic acidosis

Question 7

When do you see hemosiderin-laden macrophages in pulmonary lavage

Answer 7

Diffuse alveolar hemorrhagic sd.

Anti-GMB
Granulomatosis with polyangiitis
Other systemic vasculitides

Question 8

What do you use a high-resolution chest CT scan for

Answer 8

Diagnosis of interstitial lung disease

Question 9

Diagnostic study for bronchial obstruction

Answer 9

Bronchoscopy… can take biopsy

Question 10

What happens if you use too much topical antibiotic

Answer 10

Acute contact dermatitis

Question 11

Medication that can worsen prostatic hyperplasia

Answer 11

Antihistamines can worsen prostatic hyperplasia

Question 12

Periodic breathing

Answer 12

<6 months of age

Cycles of:
5-10 sec of breathing pauses
10-15 sec of shallow rapid breathing
Return to normal breath

Reassure parents

Question 13

Giardiasis clinical presentation

Answer 13

Loose, fatty, foul-smelling stools
Abdominal cramps
Flatulence
Weight loss

Chronic:
Malabsorption (eg. lactose intolerance)
Profound weight loss
Vitamin deficiency

Question 14

Management of Giardiasis

Answer 14

Hands hygiene with soap and water
ATB for symptomatic/positive test patients (Tinidazole)
Avoid use of recreational water bodies if symptomatic

Question 15

Secondary cause of hypertension

<20 years of age

Answer 15

Renal parenchymal disease

Coarctation of the aorta

Question 16

Secondary cause of Hypertension

21-39

Answer 16

Hypo/hyper thyroidsm

Fibromuscular dysplasia

Renal Parenchymal disease

Question 17

Secondary cause of renal hypertension

40-64

Answer 17

Hyper/Hypo thyroidism

Sleep apnea

Hyperaldosteronism

Question 18

Secondary cause of renal hypertension

> 65

Answer 18

Renal artery stenosis

CKD

Question 19

Labs in PCOS

Answer 19

Elevated testosterone
Elevated estrogen
Increased LH/FSH ratio

Question 20

Comorbidities in PCOS

Answer 20

Endometrial hyperplasia/cancer

Metabolic syndrome

Obstructive sleep apnea

Non-alcoholic steatohepatitis

Question 21

Treatment of PCOS

Answer 21

Weight loss
Oral contraceptive for menstrual regulation
Letrozole for ovulation induction

Question 22

Meniere disease triad

Answer 22

Vertigo
Hearing loss
Tinnitus

Question 23

Treatment for Herpes zoster

Answer 23

Oral valacyclovir 3 times a day for 7 days
Oral acyclovir 5 times a day for 7 days
IV acyclovir for severe infection or immunocompromised

If >72hrs from the onset of symptoms… just analgesia and zinc oxide-based cream

Question 24

Exposure to VZV in health care personnel

Answer 24

If immune (vaccine or had disease), do nothing

If not immune: give vaccine <5 days from exposure (varicella vaccine, not herpes zoster vaccine)

If immunocompromised or pregnant: immunoglobulin +/- antiviral medication

Mask and glove if patient has disseminate zoster infection

Question 25

Pain management in Herpes Zoster

Answer 25

Acute (<30days): NSAID, analgesic Subacute ( 1-4 months): NSAID, analgesic Postherpetic neuralgia (>4months): TCAs, gabapentin, pregabalin

Question 26

Cough-variant asthma

Answer 26

Cough is the predominant symptom May not have wheezing or SOB Treat as regular asthma

Question 27

Interpretation of V/Q test

Answer 27

Low pretest + low V/Q prob: PE excluded Normal V/Q + any pretest prob: PE excluded High Pretest + high V/Q prob: PE confirmed Any other combination: do more studies

Question 28

Wells criteria for Pulmonary embolism

Answer 28

+3 Clinical signs of DVT Other diagnoses less likely +1.5 Hx of DVT Recent immobilization HR >100 +1 Hemoptysis Cancer >4 PE likely 4 or less PE less likely

Question 29

REMEMBER

Answer 29

Allergic reaction to contrast is a contraindication for studies

Question 30

Increased risk of breast cancer in men

Answer 30

Fx with BRCA mutations (think if hx of breast and ovarian cancer in the family) Klinnefelter sd (extra X chromosome) Other condition with elevated estrogen to androgen ratio: hepatic dysfunction, marihuana, obesity (very small risk)