Step3 6

Question 1

Location of lesion in a patient with constructional and dressing apraxia

Answer 1

Non dominant parietal lobe

Question 2

Area of supply of the left anterior descending

Answer 2

Apex

Anterior 2/3 of the septum

Anterior wall of the left ventricle

Question 3

Laboratory test for invasive fungal infections

Answer 3

Beta D-glucan

Question 4

Etiology of Otitis media + conjunctivitis

Answer 4

Usually non-typeable H. influenzae

Question 5

Common cause of otitis media

Answer 5

S. pneumonia

Nontypeable H. influenzae

Moraxella

Question 6

Management of otitis media

Answer 6

Amoxicillin

Amoxiclav

Penicillin allergic:
azytrho or clinda

Question 7

Treatment for bronchiolitis

Answer 7

Supportive care

Question 8

Prevention of RSV

Answer 8

Palivizumab for selected infants
<29 weeks
Chronic lung disease of prematurity
Hemodynamically significant heart disease

Question 9

Complications of Bronchiolitis

Answer 9

Apnea
Respiratory failure

Older infants:
Recurrent wheezing

Question 10

Antipseudomonal antibiotics

Answer 10

Cefepime / Ceftazidime
Amikacin / Tobramycin (aminoglicoside)
Carbapenem
Aztreonam
Colistin
Certain fluoroquinolones (eg. cipro)
Piperazilin-tazobactoan
Tricarcilin-clav.

Question 11

Other symptoms (4) and laboratory results (7) that might be present in Kawasaki disease

Answer 11

Arthritis, scrotal swelling, pericarditis, and gallbladder inflammation

Labs:
Steril pyuria on clean catch (catheterization bypasses the urethral origin of the pyuria)
Thrombocytosis, Elevated WBC, decreased hemoglobin
Elevated LFTs
Hypoalbuminemia
Hyponatremia
(PCR/ESR)

Question 12

Treatment of Kawasaki disease

Answer 12

High dose aspirin during the acute phase

IV immunoglobulin

Question 13

Precautions to take after immunoglobulin therapy

Answer 13

Differ live vaccines for at 11 months

Question 14

Lifestyle modification effect in hypertension

DASH diet

Answer 14

Drops 12 mmHg

Question 15

Lifestyle modification effect in hypertension

Weight loss

Answer 15

6mmHg per 10 kg of weight loss

Target: BMI <25

Question 16

Lifestyle modification effect in hypertension

Low Sodium Diet

Answer 16

< 1.5 - 2.3 g/day

Response vary

5-8 mmHg

Question 17

Lifestyle modification effect in hypertension

Alcohol intake

Answer 17

<2 drink/day for men and <1 for women

5 mmHg

Question 18

Lifestyle modification effect in hypertension

Exercise

Answer 18

> 30min a day >5 days a week

7mmHg

Question 19

Lobular carcinoma in situ

Diagnosis
Management
Surgery

Answer 19

Usually incidental

Needle biopsy ====> exicional biopsy

No radiation or chemo recommended because this is not malignant

May add tamoxifen or raloxifen

Patients may request mastectomy

Question 20

Management of Ductal Carcinoma In situ

Answer 20

Lumpectomy +/- radiation

Endocrine therapy for 5 years in ER/PR +

Question 21

Management of invasive breast cancer

Answer 21

With NEGATIVE lymph nodes:
Lumpectomy, breast-conserving surgery, and radiation may be considered depending on tumor size
Chemo to shrink tumor before surgery, adjuvant chemo, hormone therapy

With POSITIVE lymph nodes:
Breast-conserving surgery or modified radical mastectomy, axillary disection, adjuvant chemo, and endocrine therapy

Question 22

Paget disease of the bone

Clinical presentation
Management

Answer 22

Bone pain
Thicken cortex of the bone and sclerotic lesion on Xray
Hypercalciuria
Heart failure

Studies:
Bone scan: increased uptake

If symptomatic (pain or neuro symptoms) or affects weight bearing bones (eg. femur), treat with bisphosphonate

Question 23

Pathophysiology of hypercalcemia in Paget

Answer 23

Due to immobilization because of many painful lesions but not because of disease itself

Question 24

Hyperthyroidism in elderly patients

Answer 24

Apathetic hyperthyroidism:
Lethargy, apathy, decreased appetite. weight loss

Can present with A. fib without tachy due to medications or conductivity issues related to age

Question 25

Cardiovascular effects of hyperthyroidism

Answer 25

Hypertension Tachycardia Widened pulse pressure (increased cardiac output with decreased systemic vascular resistance) A. fib

Question 26

Prognosis in COPD

Answer 26

FEV1 and age After adjusting for age, FEV1 is the most important predictive factor for prognosis

Question 27

Diagnostic features of Dementia with Lewi Bodies Core (4)

Answer 27

Fluctuating cognition REM sleep disorders Visual hallucinations Parkinsonism

Question 28

Diagnostic features of Dementia with Lewi Bodies Suggestive (2)

Answer 28

Severe antipsychotic sensitivity SPECT or PET low dopamine transporter uptake in the basal ganglia

Question 29

Diagnostic features of Dementia with Lewi Bodies Supportive (5)

Answer 29

``` Repeated falls Syncope or near syncope Delusions Autonomic dysfunction Depression or anxiety ```

Question 30

Pharmachologic treatment for dementia with lewi bodies

Answer 30

Cholinestares inhibitors for cognitive impairment. Donepezil Levodopa/carvidopa for parkinsonism Melatonin for REM sleep behavior disorder Antipsychotics for hallucinations (use low potency, second-generation eg. quetiapine, cloanzapine, )

Question 31

Predictors of 30 days mortalitye in PE CLINICAL (8)

Answer 31

``` Hypotension (Sistolic bp <90) Tachycardia (>110) Hypoxemia (O2 sat <90%) Tachypnea (>30) Hypothermia (36) Age >80 Altered mental status Cancer ```

Question 32

Predictors of 30 days mortality in PE IMAGING

Answer 32

Right ventricular dysfuntion on eco or CT

Question 33

Predictors of 30 days mortality in PE LABORATORY

Answer 33

Elevation of troponin or BNP