UW5

Question 1

What acid base disorder would a pt with cyanide toxicity have? Why?

Answer 1

Lactic acidosis (metabolic acidosis) because the cyanide inhibits the electron transport chain so everything goes into lactic acid fermentation

Question 1

What is the most important prognosticator of TCA overdose?

Answer 1

Length of the QRS

Question 1

What is the general mgmt of myasthenia crisis?

Answer 1

ABC’s then (plasmapheresis OR IVIG) + Steroids; HOLD anticholinesterases in this setting to prevent resp. secretions and worsening resp. status

Question 1

Which renal syndrome is assoc with Hodgkin lymphoma? Which is assoc with solid organ tumors (carcinomas)?

Answer 1

Minimal change dz; membranous nephropathy

Question 2

What is the treatment for cyanide toxicity?

Answer 2

Sodium thiosulfate and HYDROXYcobalamin (why give cyanocobalamin! It has cyanide!)

Question 2

What is Charcot’s triad? Reynold’s pentad?

Answer 2

RUQ pain, Fever, jaundice; same + MS changes and shock

Question 3

What if a person with AIDS has ring enhancing lesion with EBV in the CSF?

Answer 3

Primary CNS lymphoma (DLBCL) tx is CHOP or RCHOP (or in theory, EPOCH)

Question 3

Allopurinol can be used prophylactically for urate nephropathy but what kidney issue can it cause?

Answer 3

Interstitial nephritis

Question 4

When do pts with masked primary hyperaldosteronism often first develop hypokalemia?

Answer 4

When placed on diuretics

Question 4

An abnormal D-xylose test (i.e. low serum and urine concentrations after ingestion) indicates what?

Answer 4

Malabsorption (small bowel) since it is absorbed in proximal small bowel via passive diffusion

Question 5

What 2 antibodies are present in most pts with Hashimoto’s?

Answer 5

Anti-thyroid peroxidase and Anti-thryoglobulin

Question 6

What is a major distinguishing factor between osteoporosis and osteomalacia in terms of symptoms?

Answer 6

Osteomalacia usually has bone pain whereas osteoporosis does not; osteomalacia also has pseudofractures (looser zones)

Question 7

What is the number 1 form of drug induced CKD?

Answer 7

Analgesic nephropathy (tubulointersitial nephritis)

Question 7

Aside from porphyria cutanea tarda, what other skin disorder is HCV assoc with?

Answer 7

Lichen planus

Question 8

Why may dermatomyositis be “associated with malignancy”?

Answer 8

Because it can be a paraneoplastic syndrome

Question 9

What is more common to see on renal bx of DM nephropathy, diffuse glomerular sclerosis or nodular glomerulosclerosis?

Answer 9

Diffuse is more common but nodular (Kimmelstiel Wilson nodules) are pathognomonic

Question 10

For every 1 point drop in albumin how much does the serum calcium drop?

Answer 10

0.8 but recall that you need to correct the calcium

Question 11

What is a reentrant ventricular arrhythmia?

Answer 11

Essentially ventricular fibrillation!

Question 12

Why should you look for sx of fatigue, dry skin, and constipation in a pt just started on amiodarone?

Answer 12

It can cause hypothyroidism (note it can also cause hyperthryoidism)

Question 12

Which valvular disease commonly has hemoptysis?

Answer 12

MS

Question 13

How is Trichinella spiralis often transmitted?

Answer 13

From pork or bear meat; encysts in muscle causes myalgias with peripheral eosinophilia often preceded by intestinal sx; can have splinter hemorrhages

Question 14

What is required in all pts with newly dx’d lupus nephritis and why?

Answer 14

Renal biopsy because the treatment is different by stage (Class I = minimal mesangial; Class IV = advanced sclerosis i.e. wire-looping)

Question 15

If a person is on PDE-5 inhibitor and alpha blockers how would you advise the pt to take them?

Answer 15

Have at least a 4 HOUR INTERVAL to decrease the risk of hypotension; PDE5 inh are CI with nitrates though!

Question 17

What pulmonary-renal syndrome may be associated with pyoderma gangrenosum?

Answer 17

Wegeners

Question 18

What TB drug can cause interstitial nephritis? Describe the casts?

Answer 18

Rifampin; WBC casts with eosinophils

Question 19

What is often the clinical scenario in which ascending cholangitis develops? Potential complication?

Answer 19

Choledocolithiasis since there is no where to go but up; Pyogenic liver abscess

Question 20

How do you treat exercise induced asthma?

Answer 20

B2 agonists 30 min prior to exercise NOT ipratropium

Question 21

Describe necrolytic migratory erythema and what else you'd expect them to present with

Answer 21

Erythematous papules and plaques often assoc with mild hyperglycemia ("DM II") due to increased hepatic production from the glucagon stimulation; weight loss and diarrhea too

Question 22

Lynch Syndrome II increases the risk of which cancers?

Answer 22

Colon and Endometrial

Question 22

How is the treatment of stomach CA guided?

Answer 22

By stage; limited stage gets surgical resection and more widespread gets chemo and palliative surgery; so after dx get a CT

Question 24

What is the difference between interstitial nephritis and chronic tubulointerstitial nephritis?

Answer 24

Interstitial nephritis is essentially an allergic rxn; chronic tubulointerstitial is a form of CKD due to analgesics both have WBC casts (not to confuse with pyelonephritis)

Question 26

What are the PTH levels in hypercalcemia of malignancy?

Answer 26

Suppressed (unless of course, the cause was parathyroid carcinoma)

Question 27

What is DOC for cat bites? Human bites? Dog bites?

Answer 27

AMOXICILLIN-CLAVULANATE

Question 29

What are the contraindications for radioactive iodine ablative tx?

Answer 29

Pregnancy is the main one (severe ophthalmopathy but don?t read too much into this)

Question 31

What kind of study is best for studying the incidence of a disease?

Answer 31

Cohort study

Question 32

What is removed in radical orchiectomy?

Answer 32

Testis and spermatic cord not just testis; via high-inguinal incision

Question 33

What is the study of choice for Zenker's

Answer 33

Barium esophagogram

Question 35

What are 3 interventions that can help with uremic bleeding?

Answer 35

DDAVP, Cryoprecipitate, and CONJUGATED ESTROGENS

Question 37

HCV is classically assoc with blood products from before what year?

Answer 37

1992

Question 38

What is the MC cause of mitral regurgitation in developed countries?

Answer 38

MVP

Question 39

How do you treat central retinal artery occlusion in first 4-6 hours? After?

Answer 39

tPa; Ocular massage (dislodge the thrombus) and High flow O2

Question 40

In a pt with pleural plaques from asbestosis what would be the cause of breathing problems?

Answer 40

Interstitial lung disease, the plaques are just there not the cause of the dyspnea

Question 41

What should be suspected in a pt with post-cholecystectomy syndrome in which no stones are found on ERCP? Tx?

Answer 41

Sphincter of Oddi dysfunction; tx is sphincterotomy during the ERCP

Question 42

What is the most likely group to develop emphysematous cholecystitis?

Answer 42

Elderly diabetics; often the bugs are clostridial

Question 43

Name 2 common causes of drug induced esophagitis

Answer 43

Potassium chloride (PO) and Bisphosphonates, I believe Iron tablets can do it too

Question 43

What is porphyria cutanea tarda assoc with? What does it present like?

Answer 43

HCV; Vesicles and photosensitivity

Question 44

A young woman with anterior knee pain when climbing stairs probs has what? Tx?

Answer 44

Patellofemoral syndrome; Exercises to strengthen thigh muscles

Question 45

What is the tx of PML?

Answer 45

None the pts die in about 6 months

Question 47

Why would a pt with ankylosing spondylitis for several years possibly develop restrictive lung dz?

Answer 47

Diminished chest wall and spinal mobility

Question 48

What is the corrected calcium equation?

Answer 48

(Measured total calcium + 0.8(4 - serum albumin)

Question 49

What is a big thing to consider when the ddx includes RA and paravoviral arthritis?

Answer 49

TIME; RA needs to be present for 6 weeks whereas parvovirus is more acute

Question 51

When someone is diagnosed with hereditary hemochromatosis? What is an important clinical question to ask?

Answer 51

IS THERE END ORGAN DAMAGE?? i.e. cardiomyopathy, diabetes, etc.

Question 52

What do progressive multifocal leukencephalopay lesions look like on MRI or CT?

Answer 52

THEY ARE NON CONTRAST ENHANCING

Question 53

Why does alcohol precipitate gout?

Answer 53

Metabolized to lactate and competes with urate in kidney (pct)

Question 54

Why does AS cause exertional syncope?

Answer 54

Because you cannot increase your cardiac output to meet the demands of exercise

Question 55

What electrolyte abnormality should you watch out for in a pt being treated for severe asthma attack?

Answer 55

Hypokalemia (B2 agonists pull K into the cell)

Question 56

What is the mechanism by which bence jones proteins cause CKD

Answer 56

Tubular obstruction of distal tubules

Question 57

What ist he pathophys of presbyopia?

Answer 57

decreased elasticity of the lens

Question 58

Describe the vision loss in age related macular degeneration

Answer 58

Central vision loss mostly

Question 59

What may be seen on CXR for LA enlargement?

Answer 59

Elevation of L mainstem bronchus

Question 60

What is the eponym for multiple myeloma?

Answer 60

Kahlers dz

Question 62

What causes NPH?

Answer 62

Decreased CSF absorption by arachnoid granulations; do CT first then LP

Question 63

What is the temporizing treatment of constrictive pericarditis? Permanent?

Answer 63

Diuretics; Pericardiectomy

Question 64

What is the worst prognosticator in HAV infection

Answer 64

Increasing PT -- this can be an indicator of fulminant hepatic failure (development of encephalopathy within 8 d of acute liver injury)