UW 7

Question 1

Drugs that increase digoxin levels

Answer 1

Amiodarone
Verapamil
Quinidine
Propafenone

Question 2

Management when starting digoxin w Amiodarone

Answer 2

Decrease digoxin dose by 25%-50%

Monitor digoxin levels for next few weeks

Question 3

Pathophys of Malignant Hyperthermia

Answer 3

Uncontrolled efflux of calcium from sarcoplasmic reticulum

After admin of anesthetics (halothane, succinylcholine) in certain people (AD genetics)

Question 4

Management for Penile Fracture

Answer 4

Surgical Emergency

1. Emergent urethrogram to r/o urethral injury
2. Surgical Exploration

Question 5

USPSTF screening for chlamydial infxn

Answer 5

All sexually active women < 24 yoa and other asymptomatic women at increased risk

Question 6

What to do if white reflex seen on exam?

Answer 6

REFER to opththo b/c considered retinoblastoma until proven otherwise
Intraocular tumor of

Question 7

Presentation of bed bugs

Answer 7

Painless bites
Purpuric macules
Pruritic

Question 8

Presentation of Scabies

TX

Answer 8

Generalized itching
Pruritic papules over penis, scrotum, areolas, breast
Gray wavy channels in finger webs, heels of palms, wrist creases
Tx: Permethrin neck down and overnight

Question 9

Mitral Stenosis Presentation

Answer 9

LA dilation b/c of Increased LAP,pulm vascular pressure increases = congestion = dyspnea, hemoptysis, nocturnal cough
Risk of A fib, Cardiac emboli
Rheumatic fever

Question 10

Pertussis TX

PEPX

Answer 10

ALL close contacts (even if immunized)
If < 1 month of age = Azithromycin for 5 Days
If > 1 month of age = Azithro ( 5 Days), Clarithro (7 days) Erythro (14 days)

If not immunized = immunize according to recommended schedule

Question 11

MCC neonatal hypothyroidism in the U.S.

Answer 11

Thyroid Dysgenesis

- aka aplasia, dysplasia, ectopic gland

Question 12

Pathophys of lacunar stroke

Answer 12

Lacunar infarcts = occlusion of single, deep, penetrating artery in brain
Microatheroma + Lipohyalinosis

Question 13

MC site for lacunar infarct

Answer 13

Posterior limb of internal capsule

Pure motor stroke = CS tract and some CB motor fibers

Question 14

Infective Endocarditits TX

PCN sensitive?

Answer 14

IV Pen G q4-6 hrs or 24h infusion OR
IV Ceftriaxone QD 4 wks
Oral Abx NOT recommended for initial therapy with IE.

Question 15

Difference b/t Cauda Equina syndrome and Conus Medullaris Syndrome
Management?

Answer 15

CE = LMN signs; spinal nerve roots below L1-L2
CM = BOTH LMN + UMN signs
TX: Emergency MRI, IV glucocorticoids, neurosurgical evaluation

Question 16

Presentation of Cauda Equina

Answer 16

Gradual onset severe back pain w Unilateral Radiculopathy
Saddle anesthesia
Hyporeflexia
Asymmetric LE weakness
Late onset bowel/bladder dysfnc

Question 17

Presentation of Conus Medullaris

Answer 17

Sudden onset severe back pain
Perianal hypoanesthesia
Symmetric motor weakness
Hyperreflexia
Early onset bowel/bladder dysfnc

Question 18

BUN/Cr in Pregnancy?

Answer 18

Decreased

RPF and GFR are increased causing decrease in BUN/Cr

Question 19

Presentation of ACL injury

Answer 19

Rapid deceleration/direction change, pivot on LE
Soccer, Bball, tennis
Pain - rapid onset
Popping sensation
Swelling - effusion/hemarthrosis
Joint instability

Question 20

Presentation of MCL injury

Answer 20

Pivoting/twisting w knee struck from lateral side
Tenderness of medial knee
Not ass’d with hemarthrosis

Question 21

Presentation of Meniscal tear injury

Answer 21

Rapid direction changes

Subacute or chronic locking or popping sensationfff

Question 22

Presentation of Patellofemoral pain

Answer 22

Chronic overuse in young female athletes

Pain reproduced by extending knee and compressing patella

Question 23

CMV Colitis Presentation
Colonoscopy findings
Bx findings
TX

Answer 23

HIV infected pt w bloody diarrhea and normal stool exam
Multiple mucosal erosions and colonic ulceration
BX large cells w eosinophilic intranuclear and basophilic intracytoplasmic inclusions
TX Ganciclovir, Foscarnet if intolerable

Question 24

Pathophys of gallstones in TPN

Answer 24

Normal stimulus for CCK release (proteins and FAs in duodenum) and GB contraction is absent ->
Biliary stasis causes bile sludge and gallstones to form

Question 25

Neonatal jaundice + conjugated hyperbilirubinemia

Answer 25

Neonatal Cholestasis | Impaired hepatic excretion of bilirubin

Question 26

Electrical alternans w sinus tachycardia | TX

Answer 26

Large Pericardial Effusion | Emergency Pericardiocentesis

Question 27

Paget's dz of breast Presentation

Answer 27

Eczematous rash near nipple Does not improve w topical tx Ass'd with underlying breast adenocarcinoma

Question 28

Cells seen on skin BX of Paget's dz of breast

Answer 28

Large cells appear to be surrounded by clear halos

Question 29

TX of acute cocaine toxicity

Answer 29

1. Supplemental Oxygen 2. IV Benzos to reduce sympathetic outflow 3. ASA 4. Nitrates and CCBs vasodilate

Question 30

Vaccination for chronic liver disease

Answer 30

``` Tdap/Td q 10 yrs Influenza q year Pneumococcal 1 dose w repeat 5 yrs later Hep A - 2 doses Hep B - 3 doses ```

Question 31

Arthritis in Hyperparathyroidism

Answer 31

Pseudogout Acute onset, monoarthritis MC knee Rhomboid, positively birefringent

Question 32

Complications ass'd with current or previous DX of anorexia nervosa

Answer 32

``` Miscarriage IUGR Hyperemesis gravidarum Premature C section Postpartum depression Osteoporosis ```

Question 33

Common findings in anorexic pts

Answer 33

``` Osteoporosis Elevated cholesterol and caroten Cardiac arrhythmias - prolonged QT Euthyroid sick syndrome HPA dysfnc Hyponatremia ```

Question 34

What is effect modification

Answer 34

An external variable positively or negatively impacts the effect a risk factor has on disease Ex. risk of venous thrombosis is increased w estrogen therapy, and this effect is augmented by smoking

Question 35

What does randominzation control in studies

Answer 35

Confounding

Question 36

Ways to control confounding in a study

Answer 36

Design stage - matching - restriction - randomization

Question 37

What is ascertainment bias

Answer 37

Study participants or investigators have knowledge of which intervention each participant is receiving

Question 38

APGAR less than 7 Management

Answer 38

Further evaluation | Resuscitation

Question 39

APGAR HR < 100 + Irregular breathing Management

Answer 39

Pulse Ox monitoring | Positive pressure ventilation

Question 40

Therapeutic window for thrombolysis stroke pt

Answer 40

3 - 4.5 hours

Question 41

AE's of Cyclosporine

Answer 41

``` Nephrotoxic HTN Neurotoxic GLucose intolerance Infxn Malignancy Gingival hypertrophy hirsutism GI = anorexia, N/V, diarrhea ```