04 JAN 2017 2028 IM

Question 1

what is the triad of trichenellosis?

Answer 1

• periorbital edema
• myositis
• eosinophilia

Question 2

aortic regurgitation has what kind of murmur? what movement elicits it best?

Answer 2

• early decrescendo diastolic murmur

- patient sitting up, leaning forward, holding breath in full expiration

Question 3

what are the two most common types of cancer that cause a pancoast tumor?

Answer 3

• squamous cell carcinoma

- adenocarcinoma

Question 4

what is the characteristic colonoscopic finding seen with laxative abuse?

Answer 4

melanosis coli - dark brown discoloration of the colon with pale patches of lymph follicles that can give the appearance of alligator skin

Question 5

what are Hollenhorst plaques? what do they indicate?

Answer 5

• bright yellow refractile plaques in the retinal artery

- indicate a proximal source such as the internal carotid artery

Question 6

what is the relationship of citrate to calcium levels in the body?

Answer 6

• citrate binds calcium, leading to hypocalcemia (e.g. in large blood transfusions)
• typically occurs in patients with liver damage, since the liver usually metabolizes citrate and renders it ineffective at causing hypocalcemia anyway

Question 7

What is the most common cause of sudden cardiac death during an acute MI?

Answer 7

VF

Question 8

Patients with VF or pulseless V tach should be managed with ________________

Answer 8

Immediate defibrillation

Question 9

Cardiac index = ?

Answer 9

CO / body surface area

*relates cardiac performance to the size of the individual

Question 10

How does bronchiectasis differ from chronic bronchitis?

Answer 10

Bronchiectasis has more prominent sputum production, and exacerbations are typically bacterial and require antibiotics (chronic bronchitis has viral exacerbations)

Question 11

What is the best diagnostic tool for bronchiectasis? What does it show?

Answer 11

High resolution CT – characteristic bronchial dilation, lack of airway tapering, bronchial wall thickening

Question 12

What is used to treat hypertensive encephalopathy?

Answer 12

Labetalol

Question 13

Acetaminophen taken at higher doses (over 2g/day) for over 1 week may significantly (increase / decrease) the anticoagulant effects of warfarin

Answer 13

Increase

Question 14

When is PCV13 recommended?

Answer 14

• All adults 65 or older (then followed by PPSV23 6-12 months later)
• Sequential PCV13 and PPSV23 for adults under 65 with certain high risk underlying conditions (CSF leaks, sickle cell, cochlear implants, congenital or acquired asplenia, immunocompromised, chronic renal failure)

Question 15

When is PPSV23 alone recommended?

Answer 15

Adults under 65 who are current smokers or have certain medical conditions (heart or lung disease, diabetes, chronic liver disease)

Question 16

What is salvage therapy?

Answer 16

For of treatment for a disease when a standard treatment fails

Question 17

What is the most definitive diagnostic test for polymyositis?

Answer 17

Muscle biopsy

Question 18

How do ventricular aneurysms present on ECG?

Answer 18

• Persistent ST elevation after a recent MI

- Deep Q waves in the same leads

Question 19

What type of cell is seen in CLL?

Answer 19

Smudge cell

Question 20

What is the hallmark lab result in CLL?

Answer 20

Dramatic lymphocytosis

Question 21

What drug is used for diabetic gastroparesis? What is the MOA?

Answer 21

• Metoclopramide
• Has both prokinetic and antiemetic properties and is useful for symptomatic relief of nausea, bloating, and postprandial fullness in patients with diabetic gastroparesis

Question 22

What is the main adverse effect of metoclopramide?

Answer 22

Extrapyramidal effects

Question 23

The anemia in anemia of chronic KIDNEY disease is due to a deficiency of _______________. Treatment consists of __________

Answer 23

• Erythropoietin
• IV iron preparations (e.g. iron dextran)

compare: anemia seen in chronic disease = infection, chronic immune activation, and malignancy. These conditions all produce massive elevation of Interleukin-6, which stimulates hepcidin production and release from the liver, which in turn reduces the iron carrier protein ferroportin so that access of iron to the circulation is reduced.

Question 24

What is the hallmark of ischemic hepatopathy (shock liver)?

Answer 24

Rapid and massive increase in the transaminases with modest accompanying elevations in total bilirubin and alkaline phosphatase

Question 25

What is the most common side effect of levodopa / carbidopa?

Answer 25

Hallucinations