WRONG ABIM

Question 1

Management acute Charcot Joint

Answer 1

Casting to reduce edema & offload weight-bearing. If chronic: orthotic footwear, infection management & surgical realignment

Question 2

Meningitis. CSF w/ GP bacilli. Tx?

Answer 2

ampicillin (or pen G +/- synergistic aminoglycoside) only for Listeria

Question 3

Meningitis. CSF w/ GN bacilli * patients at risk of resistant organisms (immunocompromise, neurosurgical device, recent neurosurgery or head trauma). Abx of choice?

Answer 3

Cefepime monotherapy

Question 4

Z scores estimate fractures in which patients?

Answer 4

young PREmenopausal women or children

Question 5

Which medications can cause increased Cr w/o change in GFR?

Answer 5

trimethoprim, cimetidine, ketone bodies (they compete w/ creatinine for tubular secretion)

Question 6

Tx hyperammonemic encephalopathy

Answer 6

D/C valproate. Lactulose & L-carnitine

Question 7

DM pt develops GI sx, AMS, SOB & hypoTN. Labs w/ HAGMA. Dx?

Answer 7

Consider lactic acidosis

Question 8

Tx PAN

Answer 8

prednisone & cyclophosphamide. ACEi for HTN

Question 9

Fever, w.loss, livedo reticularis, myalgia, neuropathy, testicular pain, HTN, AKI, HBV. ANCA neg, ANA neg. Dx?

Answer 9

PAN (prednisone & cyclophosphamide. ACEi for HTN)

Question 10

Which conditions is PAN assd w/?

Answer 10

HBV, ~HCV

Question 11

Angiography showing renal, hepatic & mesenteric microaneurysms. Dx?

Answer 11

PAN

Question 12

Parapneumonic effusion >10mm on CXR. Loculations on US/CT (or thickened pleura). NSIM?

Answer 12

Drainage w/ fluid analysis.

Question 13

Parapneumonic effusion >10mm on CXR. NO loculations, thickened pleura. NSIM?

Answer 13

diagnostic thoracentesis (if showing positive gram/Cx or pH <7.2, drain w/ fluid analysis)

Question 14

Parapneumonic effusion <10mm on CXR. NSIM?

Answer 14

Likely to improve w/ just abx

Question 15

What are high risk parapneumonic effusion features?

Answer 15

loculation, >1/2 hemithorax, pleural thickening. pH <7.2, gluc <60 or positive gram stain/Cx

Question 16

Metabolic alkalosis. Urine Cl >20 & hypOvolemic. Dx?

Answer 16

Bartter & Gilteman

Question 17

Metabolic alkalosis. Urine Cl >20 & hypERvolemic. Dx?

Answer 17

Excess mineralocorticoids (primary hyperaldo, Cushing, etopic ACTH)

Question 18

What do you expect for urine chloride levels in diuretic abuse?

Answer 18

HIGH during active use & LOW when effects wear off

Question 19

Sx of digoxin tox?

Answer 19

GI sx, neuro/visual, electrolyte imbalance (hyperK), arrhythmia

Question 20

PSC w/o IBD. Colonoscopy screening intervals?

Answer 20

Q5yrs (along w/ gallbladder CA screen)

Question 21

Tx PSC vs PBC

Answer 21

PSC: endoscopic dilation & stenting of strictures, liver transplant.
PBC: ursodeoxycholic acid & liver transplant

Question 22

Imaging showing beaded bile duct appearance & onion skin fibrosis. Dx?

Answer 22

PSC

Question 23

Tear drop cells on blood smear w/ massive splenomegaly. Dx test for definitive Dx?

Answer 23

BMB shows dry tap & fibrosis (primary myelofibrosis)

Question 24

You suspect serotonin syndrome. Temp 106F. NSIM?

Answer 24

Immediate sedation, paralysis & intub. (obv stop all 5HT meds). May Tx w/ benzos or cyproheptadine.

Question 25

Cyproheptadine use?

Answer 25

serotonin antagonist (possible use in 5HT syndrome)

Question 26

Cardiac surgery > SOB at rest & SUPINE HYPOX, CXR reveals hemidiaphragm. How do you confirm the dx?

Answer 26

fluoroscopic sniff test (during inhalation the diapharagm should move down hwr in unilateral diaphragmantic paralysis, one side will move up)

Question 27

What is this used for: fluoroscopic sniff test

Answer 27

To confirm uunilateral diaphragmantic paralysis