UW11

Question 1

What is the best tx for Phyllodes tumor of breast?

Answer 1

Wide local excision; these are large polylobated tumors that look histologically like a fibroadenoma but can be benign or malignant

Question 1

What is the gold standard to diagnose nephrotic syndrome

Answer 1

24 hour urine collection showing > 5 g of protein; note this is just to dx the nephrotic syndrome not the underlying etiology

Question 2

How do you tx magnesium sulfate toxicity?

Answer 2

Calcium gluconate (i.e. decreased DTR or resp. depression, pulm edema)

Question 3

What are 3 common risk factors for chorioamnionitis?

Answer 3

Nulliparity, Prolonged labor, multiple digital exams

Question 3

What are 2 renal diseases lithium can be assoc with?

Answer 3

Nephrogenic DI; Membranous nephropathy (Tx is steroids and if severe, cyclophosphamide)

Question 3

What is the issue with smoking when you have CML?

Answer 3

Increases risk of developing blast crisis

Question 3

How do you tx Type I RTA

Answer 3

Potassium citrate and sodium bicarbonate (recall, assoc. with SLE and other autoimmune phenomena)

Question 4

What is the MC complication of an interscalene nerve block?

Answer 4

Blocking the phrenic nerve which can lead to respiratory distress though more likely due to phrenic nerve block than ptx still check CXR

Question 5

How do you tx mild comedonal acne?

Answer 5

Benzoyl peroxide and if that fails then topical retinoids

Question 6

How do you tx severe PCP PNA? What are the indications (3)

Answer 6

IV TMP-SMX and steroids; PaO2 35

Question 6

If you have a positive Thompson test and wish to confirm the dx what do you do? What is the tx?

Answer 6

MRI (achilles tendon rupture); long leg cast in plantarflexion for 6 weeks

Question 6

Where is proper endotracheal tube placement in an adult?

Answer 6

4 cm above the carina

Question 6

What is a major AE of the oral hypoglycemics that can cause weight loss

Answer 6

i.e. GLP-1 agonists cause pancreatitis

Question 6

When is an annual low dose CT recommended for lung CA screening

Answer 6

pts 55-80 with a 30 pack year smoking Hx who are currently smoking or who have quit in the last 15 years

Question 7

How do you tx acute bleeding in Hemophilia A?

Answer 7

Cryoprecipitate

Question 7

What dz has the pencil in cup deformity of PIP and DIP

Answer 7

Psoriatic arthritis also look for pitting of nails

Question 7

What is Heyde’s syndrome?

Answer 7

Angiodysplasia of the colon with Aortic Stenosis and CKD

Question 7

What if the HIV viral load in a woman in labor is >1000

Answer 7

That is an indication for c section

Question 7

What is the best mgmt of ACL tear?

Answer 7

PT to strengthen quads then surgery

Question 8

Which ovarian tumors is inhibin the marker for? LDH?

Answer 8

Granulosa cell; Dysgerminoma

Question 9

What is the first line nonpharmacologic tx of OA? Pharmacologic?

Answer 9

Exercise and weight loss; Acetaminophen

Question 11

How do you tx pityriasis rosea? What else should you rule out

Answer 11

No tx it is self-limiting; check RPR or VDRL to rule out secondary syphilis

Question 12

What if you have a microcytic anemia refractory to iron therapy in a mediterranean pt?

Answer 12

Likely thalassemia

Question 14

What if a pt with meningococcal meningitis refuses tx

Answer 14

You can hospitalize them against their will bc it is highly communicable dz

Question 14

What do Burton's lines in the gums suggest?

Answer 14

Lead poisoning

Question 14

Who gets erythrasma?

Answer 14

i.e. corynebacterium minitussiumum and it is normal skin flora that complicates DM and IC pts

Question 15

What is the MC cause of hypertrophic osteoarthropathy

Answer 15

Adenocarcinomas of the lung

Question 15

What is the main concern in a pt who is developing Erythema multiforme?

Answer 15

That it will progress to SJS or TEN

Question 15

Describe Stage 0 through Stage 4 breast CA

Answer 15

0 = no ca, I = tumor less than 2 cm II a = tumor less than 2 cm with 1-3 nodes, II b = tumor 2-5 cm no nodes, III =more than 2 cm with nodes IV = distant mets

Question 17

What is chordee? Assoc?

Answer 17

Ventral curvature of the penis, assoc. with hypospadias

Question 18

How do you look for sperm after rape?

Answer 18

Saline prep for sperm is done and often check with a Wood's lamp? YOU DO THIS EVEN IF THE WOMAN HAS SHOWERED

Question 19

How do you tx Kaposi sarcoma?

Answer 19

HAART

Question 21

What is the classic EKG finding assoc with hypothermia?

Answer 21

J wave (Osborn wave)

Question 22

What does erythrasma look like on Wood's lamp? What is the bug? G stain? Tx?

Answer 22

Coral red; Corynebacterium minitussimum; Gram positive club shaped rod, erythromycin

Question 22

What CN is usually responsible for poor suckle response in a neonate?

Answer 22

CN XII

Question 24

How do you tx chancroid?

Answer 24

Ceftriaxone

Question 24

What are the empiric abx tx for NEONATAL meningitis?

Answer 24

Ampicillin and gentamicin

Question 24

What is the most sensitive and specific test for ANY myasthenia gravis?

Answer 24

Single Fiber EMG

Question 24

What is the MOA of topiramate (used for migraine ppx)

Answer 24

Inhibits voltage gated Na channels

Question 25

What is a major differentiator in the hx of a pt with preseptal cellulitis vs. orbital cellulitis?

Answer 25

Orbital cellulitis often has diplopia (MC predisposing factor is bacterial sinusitis)

Question 26

What are the indications for steroids in addition to tmp smx for PCP pna?

Answer 26

PaO2 35

Question 28

What is the separation of the nail from the nail bed?

Answer 28

Onycholysis

Question 28

What is the preferred tx for hypocalcemia

Answer 28

IV calcium gluconate by SLOW INFUSION

Question 29

How do you deal with a misplaced central line? i.e. ended up in the subclavian

Answer 29

Place a new one and then after confirming placement of the new one, retrieve the old one

Question 30

What anti-inflammatory meds should be avoided in Crohns dz? Why? What serum abs are often positive in Crohn's?

Answer 30

NSAIDs can induce flares; Anti-Saccharomyces cerevisiae abs

Question 31

What end tidal CO2 on waveform capnography indicates that a pt coding is receiving adequate resuscitations? What indicates return of spontaneous circulation?

Answer 31

10-25 mmHg indicates adequate resuscitation; 35-40 indicates ROSC

Question 32

Why would a pt whose mother took DES while pregnant have repeated abortions?

Answer 32

There is an increased risk of cervical incompetence as well as vaginal adenocarcinoma

Question 33

What if a CT scan of solitary pulmonary nodule has high risk features?

Answer 33

Do surgery, skip the bronchoscopy

Question 35

What are the earliest vasooclusive crises to present in sickle cell? How do you prevent?

Answer 35

Dactylitis (Swelling of hands and feet); Hydroxyurea

Question 37

In what position does a post-dural puncture headache get better? What is the most effective tx?

Answer 37

When lying down (these are from accidental puncture of the dural membrane); Epidural blood patch

Question 38

What dz is assoc with seropositivity for anti-saccharomyces cereviseae abs

Answer 38

Crohn's dz

Question 39

What is the most likely cause of bloody vaginal discharge in a newborn

Answer 39

Circulating maternal estrogens, same deal if a newborn boy has little breast buds

Question 41

Is glucosuria a normal finding in pregnancy?

Answer 41

Yes assuming glucose levels are normal, if they are elevated though you want to suspect GDM

Question 43

Define Fever of Unknown Origin

Answer 43

T \> 101 on several occasions greater than 3 weeks in duration with failure to reach a dx despite 1 week of inhospital tx

Question 45

How do you tx heavy acute uterine bleeding?

Answer 45

High dose estrogen

Question 46

Name 3 extrahepatic sequelae of hcv

Answer 46

Mixed essential cryoglobulinemia; Porphyria cutanea tarda; and membranoproliferative glomerulonephritis

Question 46

What is a normal Q angle? What does a Q angle greater than this suggest?

Answer 46

14-17, if greater than 17 think genu valgum

Question 47

After a pt with a primary relative is screened initially for colon CA how often should they be re-screened?

Answer 47

i.e.. Dad had CA at 50 then initial screening of son is at 40 and then EVERY FIVE years rather than q10

Question 49

How do you tx critical aortic coarctation?

Answer 49

i.e. presents early in life with cardiogenic shock and radiofemoral delay, give PGE1 to keep the ductus arteriosus open

Question 50

What 3 drugs can be given for CAP in outpt setting?

Answer 50

macrolide, doxycycline, or quinolone

Question 50

What is Sever's dz? Tx?

Answer 50

Osteochondritis at the insertion of the achilles on the calcaneal tuberosity in skeletally immature pts; conservative tx preferred

Question 51

Where does sympathetic innervation to the lower extremities come from?

Answer 51

T11-L2

Question 52

Why is there increased risk of Alzheimers in downs?

Answer 52

APP is on chromosome 21, they get a 3rd helping

Question 54

How do you treat Lyme meningitis?

Answer 54

IV ceftriaxone

Question 56

How can you tx hypotension in the setting of PE? What should you NOT give?

Answer 56

Inotropes; do NOT give fluids as it can worsen RV strain

Question 57

What effect can hypothyroidism have on the voice?

Answer 57

Hoarseness

Question 58

What is the adult TBSA for burns i.e. 1) Head 2) Arm 3) Leg 4) Trunk

Answer 58

1) Head is 9% as opposed to 18% in kids 2) Each arm is 9% just like kid 3) Each leg is 18% unlike 14% in kids 4) and the trunk is 36% with 18% anterior and 18% posterior same deal in kids

Question 60

How do you tx DT's refractory to lorazepam? What is the next best step in a pt with status epilepticus refractory to lorazepam?

Answer 60

Barbiturates like phenobarbital; Fosphenytoin? Note the difference in pathology of DT vs status epilepticus

Question 62

How can you tell the difference between prolactinoma and antipsychotic induced hyperprolactinemia based on prolactin levels

Answer 62

Prolactin levels in prolactinoma are usually \> 200 whereas antipsychotic levels are usually far lower

Question 64

What is Neer's test used for

Answer 64

Rotator cuff pathology

Question 66

What is the TBSA for a little kid in a burn for 1) Head 2) Arm 3) Leg and 4) trunk

Answer 66

1 )Head is 18% (as opposed to 9 for adult) 2) arm is 9% just like adult 3) leg is 14% as opposed to 18 in adult and 4) trunk is 36% like in adult with 18% ant and 18% post

Question 68

5 cancers with psammoma bodies

Answer 68

Papillary thyroid CA, Meningioma, Mesothelioma, Endometrial CA, and serous cystadenocarcinoma

Question 69

What is the deal with the timing of prenatal visits?

Answer 69

Monthly until 28 weeks, biweekly until 35 weeks then weekly until birth

Question 70

Chronic NSAID abuse can lead to which RTA?

Answer 70

Type IV i.e. aldosterone def.

Question 71

What is the MOA of the drug that tx's the dyskinesia of Huntington's chorea?

Answer 71

VMAT-2 inhibitor the drug is tetrabenazine

Question 72

What is the best mgmt of acute aortic regurgitation?

Answer 72

Afterload reducers such as hydralazine and ACE-I

Question 73

How do you manage hemodynamic instability in a pt with penetrating abdominal wound

Answer 73

Immediate laparotomy

Question 74

What is the thompson test?

Answer 74

When you squeeze the calf and if no plantarflexion it indicates a positive test and a ruptured achilles tendon

Question 75

What is the best way to confirm a dx of carpal tunnel

Answer 75

EMG with nerve conduction study

Question 77

What HLA is DM I assoc with?

Answer 77

HLA DR3 and DR4

Question 79

What is a common cause of PID after insertion of IUD?

Answer 79

Actinomyces israelii, tx is PCN G ive also seen ampicillin

Question 81

What effect does scurvy have on coags and platelets

Answer 81

All normal

Question 82

What is TACO how do you tx?

Answer 82

Transfusion Associated Circulatory Overload; Furosemide

Question 83

What should you think in pt with advanced bone age, coarse axillary and pubic hair with severe cystic acne? Screening test? Confirm? Tx?

Answer 83

Non-Classical CAH due to partial 21 hydroxylase def; 17-OH-P, Cosyntropin stimulation test; Replace glucocorticoids and give fludricortisone

Question 84

In which dz will you see Pappenheimer bodies?

Answer 84

Sideroblastic anemia

Question 85

How do you tx a first eclamptic seizure? Recurrent?

Answer 85

Magnesium Sulfate; add diazepam

Question 86

What is a likely cause of low pleural LDH effusion in a pt with ascites?

Answer 86

Hepatic Hydrothorax; a transudative effusion that occurs due to the hypoalbuminemic state of cirrhosis

Question 87

What is the most common cause of folliculitis? What is the MC cause of hot tob folliculitis?

Answer 87

S. aureus; P. aeruginosa

Question 88

How do you tx black widow spider bites?

Answer 88

Antivenom

Question 89

What is the acute tx of nonsevere PCP pna?

Answer 89

IV TMP-SMX

Question 90

How much does each unit of PRBC increase Hgb by? What about Hct?

Answer 90

1 g; 3% recall that hct is essentially 3 times the hgb

Question 91

Formication is most strongly assoc with overdose on what drug?

Answer 91

Cocaine (cocaine bugs)

Question 92

What is the MC nerve injured during thyroidectomy? What muscle is paralyzed? How do you confirm the dx?

Answer 92

Recurrent laryngeal nerve; posterior cricoarytenoid; Fiberoptic laryngoscopy

Question 93

What clinical test can elucidate the cause of vasovagal syncope in unclear cases?

Answer 93

Upright Tilt Table Testing

Question 94

Why would a pt with aortic dissection have LE paraplegia?

Answer 94

Spinal ischemia due to occlusion of artery of Adamkiewicz

Question 96

What is the least radiosensitive tissue in the body?

Answer 96

Bone

Question 97

What is the difference between onycholysis and onychorrhexis?

Answer 97

Onycholysis is splitting of nail from nail bed; onychorhexis is splitting the nail itself