11 June

Question 1

What to look for when thinking MDD

Answer 1

Look for psychotic features, treatment is different as you need to add anti psychotics

Question 2

What are the 2 primary complications of symptom onset of aortic dissection and how to differentiate between them

Answer 2

Aortic insufficiency and pericardial effusion, in pericardial effusion there is JVD symptoms and symptoms of right sided failure whereas aortic insufficiency there is predominantly pulmonary edema

Question 3

Next step in single metastatic tumor at the gray white junction in the brain?

Answer 3

Surgical resection

Question 4

Complicated pyelo in a pediatric patient next step

Answer 4

Abx and renal and bladder US

Question 5

Varicella post exposure prophylaxis

Answer 5

Varicella vaccine if immunocompetent, if not varicella Ig

Question 6

What blood lead levels warrant chelation therapy

Answer 6

> 44

Question 7

NEXT step when suspected nephrolithiasis

Answer 7

Abdominal and pelvis US or NON CONTRAST spiral CT

Question 8

Abnormal uterine bleeding in a 14 year old most probable cause

Answer 8

Hypothalamic pituitary axis immaturity, in the question the patient had heavy bleeding

Question 9

Major toxicity of mycophenolate

Answer 9

bone Marrow suppression (myco for marrow, m for m)

Question 10

Major toxicity of azathiopurine

Answer 10

Diarrhea, leukopenia and hepatotoxicity

Question 11

Major toxicity of cyclosporine

Answer 11

Neurotoxicity, nephrotoxicity, hyperkalemia, bone marrow supression, gym hypertrophy, HTN, tremor, hirsutism

Question 12

Major toxicity of tacrolimus

Answer 12

Same as cyclosporine except for hirsutism and gum hypertrophy

Question 13

Ambiguous genitila in CAH

Answer 13

Only ambiguous in girls

Question 14

Another name of supraventricular tachycardia and what is its tx in stable and unstable patients?

Answer 14

Narrow complex tachycardia, stable patients vagal maneuvers or adenosine, unstable pts -> synchronized cardioversion

Question 15

Most common childhood leukemia and what is the presentation

Answer 15

ALL: lymphadenopathy, hepatosplenomegaly, fever, anemia, leukocytosis/leukopenia, bone pain, night sweats, chills, weight loss, thrombocytopenia leading to bruising

Question 16

How to differentiate aplastic anemia from ALL

Answer 16

Aplastic anemia does not cause fever or pain

Question 17

What disease do we see Auer rods in?

Answer 17

AML, presents more acutely than CML

Question 18

Tests to confirm Hep C

Answer 18

Serology and PCR

Question 19

Transposition of great vessels associated with?

Answer 19

DiGeorge

Question 20

Tetralogy of Fallot associated with?

Answer 20

Down syndrome or DiGeorge

Question 21

What is the name of the pulseless disease and what are its symptoms

Answer 21

Takayasu arteritis, differences in BP between both arms

Question 22

Most important risk factor for abdominal aortic aneurysm expansion

Answer 22

Size more than 5.5 cm, rapid expansion and active smoking

Question 23

Nephrotic syndrome puts the patient at risk for what

Answer 23

Thromboembolism and atherosclerosis

Question 24

Untreated giardia infection complication?

Answer 24

Lactose intolerance

Question 25

Tx for metastatsis of the cancer to the bone

Answer 25

Usually results in hypercalcemia for which the tx is bisphosphonates, for prostate cancer it is radiation

Question 26

Whats the difference between Waldenstorm macroglobulinemia, MM and monoclonal gamoopathy of undetermined significance

Answer 26

Waldenstorm has a single Ig spike usually of IgM, MM has spikes of all Igs, monoclonal usually has a spike in only one other than IgM (like IgG or IgE etc) but it does not cause hyperviscosity syndrome and stuff like Waldenstorm causes

Question 27

Symptoms of Waldenstorm macroglbulinemia

Answer 27

Hepatosplenomegaly, lymphadenopathy, hyper viscosity syndrome, neuropathy, bleeding, Roleoux formation

Question 28

Ideal respiratory settings for intubation

Answer 28

1. Low tidal volume ventilation - 6 ml/kg 2. SpO2 more than 88%, 3. FiO2 of less than 0.6

Question 29

Most common complication of sickle cell trait

Answer 29

Hypothenuria and hematuria

Question 30

Whats different about vascular dementia

Answer 30

It presents with sudden change in executive function and mild memory loss, like within an year

Question 31

2 tests to check for CGD

Answer 31

Dihydrorhodamine test and nitroblue tetrazoleum test

Question 32

2 tests to check for CGD

Answer 32

Dihydrorhodamine test and nitroblue tetrazoleum test

Question 33

Most common cause of acute cervical lymphadenitis in children?

Answer 33

Staph aureus

Question 34

What changes are seen in methemoglobulinemia

Answer 34

Cyanosis, oxidized iron binds to O2 more tightly, normal PaO2 since that is the O2 in plasma, the O2 bound to Hb is tightly held causing cyanosis, pulse oximetry shows reduced reading since the oxidised Fe3+ changes hemoglobin structure and the light absorbed by it. PaCO2 actually decreases because patients hyperventialte in cyanosis

Question 35

Difference between complicated pleural effusion and empyema

Answer 35

Both have pH less than 7.2, empyema has positive bacterial culture

Question 36

Precoccious puberty evaluation in a pediatric patient

Answer 36

1. Measure bone age 2. If bone age is normal, then its premature therlarche or adrenarche 3. If bone age is advanced measure LH 4. If LH is low, do GnRH stimulation test to see if there is an increase in LH 5. If LH increases with GnRH or is high by itself, then it is central precocious puberty - patient require an MRI although most of the cases are idiopathic and treated with GnRH analog to make them tall 6. If LH remains low then it is peripherap precocious puberty and a more thorough medical eval is required

Question 37

Most common cause of mastoiditis and the best next step when mastoiditis is suspected

Answer 37

Head MRI, Strep pneumo

Question 38

Explain the cardinal features of serum sickness

Answer 38

Starts 1-2 weeks after medication exposure, fever, hives (maculopapular rash) and joint pain

Question 39

Treatment of varicella zoster infection - whether its chicken pox or shingles

Answer 39

Valcyclovir

Question 40

What causes increased BP in thyrotoxicosis

Answer 40

Increased HR and inotropy, I said increased vascular resistance

Question 41

What is PSC associated with in term of antibody

Answer 41

pANCA

Question 42

Beads on a string appearence

Answer 42

PSC

Question 43

``` Muddy brown cast RBC cast WBC cast Fatty cast Broad and waxy cast Hyaline cast ```

Answer 43

``` Muddy - ATN RBC - Glomerulonephritis WBC - Interstitial nephritis or pyelo Fatty cast - nephrotic syndrome Broad and waxy cast - chronic renal failure Hyaline cast - normal ```

Question 44

Urine Na and FENA when there is ATN

Answer 44

Urine Na > 20 and FENA is >2%

Question 45

What is the buzzword for fibrocystic changes of breast on physical exam

Answer 45

Diffusely nodular breast, nodular breast etc

Question 46

Myotonic dystrophy features

Answer 46

Unable to release hand after shaking, autosomal dominant, inverted V shaped cheeks, temporal wasting, cardiac conduction abnormalities and arrythmias, testicular atrophy, insulin

Question 47

Increased DLCO

Answer 47

Asthma

Question 48

How can you differentiate between SCID and CVID

Answer 48

Depending on what lab values they give you it can be hard to distingusih, just know SCID presents in infancy, like wayyy early than CVID

Question 49

Management of CVID

Answer 49

IVIG

Question 50

Tx of reactive arthritis

Answer 50

NSAIDs

Question 51

Does asbestosis cause restrictive lung disease by itself?`

Answer 51

No, it is the collective pulmonary fibrosis due to multiple etiologies that can cause ILD, pleural calcifications on their own do not cause lung disease

Question 52

Symptoms of scarlet fever and tx

Answer 52

Pharyngeal erythema with exudate, strawberry tongue, sandpaper rash, tender lymphadenopathy, penicillin

Question 53

What is choanal atresia associated with

Answer 53

CHARGE syndrome

Question 54

Next best step when lupus is suspected

Answer 54

ANA titers

Question 55

Most common thrombophilias

Answer 55

Factor V Leiden deficiency and 2nd most common is prothrombin mutation