UW 2

Question 1

What heme effect is seen with pulmonary HTN

Answer 1

Polycythemia - from hypoxemia, stimulates EPO

Question 2

Pt with massive hemoptysis - management

Answer 2

1. Endotracheal tube
2. If bleeding persists - Bronchoscopy to localize bleeding site, provide suction to improve visualization, other interventions
   If can’t localize source - pulmonary arteriography

Question 3

When can external cephalic version be done

Answer 3

Bt 37 weeks and onset of labor if no CI

Question 4

CI to External cephalic version

Answer 4

Ruptured membranes
Hyperextended fetal head
Fetal/uterine abnormalities 
Non-reassuring fetal monitoring
Oligohydramnios
Multiple Gestatino

Question 5

TX for GoodPasture’s

Answer 5

Emergency Plasmapheresis

Question 6

Management for pts with renal insufficiency and need CT w contrast

Answer 6

Non-ionic contrast agents
IV hydration
Acetylcysteine

Question 7

Presentation of Meniere’s DZ

Answer 7

Vertigo
Ear fullness
Tinnitus
Low-frequency, sensorineural hearing loss
Vomiting, Postural instability
Nystagmus

Question 8

TX for Meniere’s

Answer 8

1. Strict, salt restricted diet 2-3 g/day
   Avoid alcohol, caffeine, nicotine
2. Meds - diuretics, antihistamines, anticholinergics

Question 9

CYP 450 Inhibitors

Effect on Warfarin

Answer 9

Increase Warfarin Effect = Increase bleeding
Acetaminophen, NSAIDs
Abx, antifungals (metronidazole)
Amiodarone
Cimetidine
Cranberry juice, Ginkgo, VIt E 
Omeprazole
Thyroid hormone
SSRIs

Question 10

CYP 450 Inducers

Effect on Warfarin

Answer 10

Decrease Warfarin effect = decrease efficacy, increase thrombosis
Carbamezapine
Ginseng
Green veggies = spinach
OCPs
Phenobarb
Rifampin
St.John's wort

Question 11

Presentation of VIPoma

Answer 11

Watery diarrhea
Hypo or achlorhydria b/c decreased gastric acid secretion
Flushing, lethargy, N/V
Muscle Weakness/Cramps

Question 12

Labs in VIPoma

Answer 12

Hypokalemia
Hypercalcemia
Hyperglycemia

Question 13

Dx for VIPoma

Answer 13

VIP level >75 pg/mL

Abdominal CT or MRI - localizes tumor in pancreas

Question 14

TX for VIPoma

Answer 14

IV hydration

Octreotide

Question 15

Where does carcinoid tumor occur

Answer 15

Small Intestine

Question 16

3 MCC of chronic cough

Answer 16

1. Upper-airway cough syndrome/postnasal drip
2. Asthma
3. GERD

Question 17

Pt w high risk pregnancy (HTN/preeclampsia) @ 32 weeks - Next step

Answer 17

NST weekly in 3rd trimester

Question 18

Difference bt breastfeeding failure jaundice and breast milk jaundice

Answer 18

Breastfeeding failure

• First week of life
• Decreased BR elimination
• Suboptimal feeding
• Dehydration

Breast Milk

• Age 3-5 days, peaks @2wks
• High B-glucuronidase in breast milk
• Normal exam

Question 19

TX for breastfeeding failure jaundice

Answer 19

1. Optimize lactation - increase feeding frequency

2. Supplement w cow’s milk based formula if insufficient amt

Question 20

Vaccinations for HIV pts at time of DX

Answer 20

Influenza
Hepatitis viruses
S.pneumonia
MMR in pts with CD4 > 200 + no AIDS defining lesion

Question 21

Live vaccines CI in HIV

Answer 21

BCG
Anthrax
Oral Typhoid
Intranasal Influenza
Oral Polio
Yellow fever

Question 22

Presentation of Bell’s Palsy

Answer 22

Sudden onset
Unilateral facial paralysis 
Affected side
- Inability to raise eyebrow/close eye
- drooping of mouth corner
-Disappearance of nasolabial fold
- Decreased tearing
- Hyperacusis
-Loss of taste sensatin anterior 2/3 tongue

Question 23

Where do Bell’s lesions occur

Answer 23

Lesion Below the Pons

Question 24

What does forehead muscle sparing in Bell’s pt indicate

Answer 24

Intracranial lesions

Brain imaging req’d

Question 25

Presentation of steroid-induced folliculitis/Steroid Acne

Answer 25

Monomorphous pink papules | Absence of comedones

Question 26

Granulosa cell tumors

Answer 26

Bimodal age distribution Excessive estrogen production Young - precocious puberty, 2 sexual traits, breast and external genitali hypertrophy, pubic hair growth, hyperplasia of uterus

Question 27

Dysgerminoma

Answer 27

Younger women/children Age 20 = avg Unilateral, cause torsion Does not secrete sex hormones

Question 28

Sertoli-Leydig cell tumor

Answer 28

Produce androgens | Defeminization -> masculinization

Question 29

Disseminated Histo presentation | CXR

Answer 29

``` Low grade fever, malaise, anorexia, wt loss LA Pancytopenia HSM Palatal ulcers CXR - hilar LA ```

Question 30

AE of prolonged seizures or Status Epilepticus

Answer 30

Cortical Laminar necrosis

Question 31

Otosclerosis Presentation

Answer 31

Conductive hearing loss Low frequency loss Middle aged individuals

Question 32

Presbycusis

Answer 32

Sensorineural hearing loss AGING Symmetric High frequency hearing impairment

Question 33

Presentation of giant cell tumor of bone

Answer 33

Young adults Pain, swelling, decreased ROM Wt bearing joints - Distal femur and proximal tibia = knee joint

Question 34

X ray findings Giant Cell Tumor of Bone

Answer 34

Expansile and eccentric lytic area = soap bubble appearnce

Question 35

Pathology of giant cell tumor of bone

Answer 35

Sheets of interspersed large osteoclast giant cells | Round-to-oval polygonal or elongated mononuclear cells

Question 36

First line TX for giant cell tumor of bone

Answer 36

Surgery

Question 37

Presentation of Baker's cyst

Answer 37

Swelling on medial side of popliteal fossa

Question 38

Cause of osteitis fibrosa cystica | Imaging findings

Answer 38

von Recklinghausen dz of bone Hyperparathyroidism from parathyroid carcinoma Subperiosteal bone resorption on radial middle phalanges, distal clavicular tapering

Question 39

Presentation of osteoid osteoma

Answer 39

Sclerotic, cortical lesion w central nidus of lucency | Pain worse at night, not related to activity

Question 40

Which murmurs should be worked up and how

Answer 40

Diastolic Continuous Echo - TTE

Question 41

Abdominal pain + hematemesis + Metabolic acidosis + tablets seen on xray

Answer 41

Iron poisoning | Iron pills radiopaque

Question 42

Pathognomonic for Crohn's

Answer 42

Non-caseating granulomas

Question 43

Presentation of cholesterol embolization

Answer 43

Majority of cases = post angiography Skin: feet, blue toe syndrome, Livedo reticularis, reddish/cyanotic skin discoloration Acute Renal Failure Labs: Increased eosinophils, low complement levels