12

Question 1

Indications for cystoscopy

Answer 1

• gross hematuria with no signs of infection/glomerular disease
• recurrent UTI
• obstructive sx w/ suspiscion for stones, stricture
• irritative sx w/o UTI
• abnormal bladder imaging or urine cytology

Question 2

Prognosis of childhood absence seizures

Answer 2

good, usually disappears by teenage years if not related with generalized tonic clonic sezures

Question 3

Diagnostic test and treatment of intussusception (currant jelly stool, episodic crampy abdominal pain, “sausage shaped” abdominal mass). Common risk during tx?

Answer 3

• “target” lesion on ultrasound
• treatment: enema (air or water soluble contrast), surgical removal of lead point
• common risk: perforation

Question 4

Positive pregnancy test, abdominal tenderness and guarding, no intrauterine pregnancy. Diagnosis and management?

Answer 4

• ruptured ectopic pregnancy

- surgical evaluation

Question 5

Most common short term complication with LEEP (loop electrosurgical excision procedure)

Answer 5

bleeding

Question 6

Most useful strategy to decrease mortality in ARDS patients

Answer 6

• low tidal volume mechanical ventilation

Question 7

Clinical features of epididymitis

Answer 7

• mild to moderate scrotal pain with swelling and tenderness
• normal UA
• decrease in pain on testicular elevation
• cremasteric reflex intact

Question 8

Acute chest syndrome in sickle cell disease diagnostic criteria and treatment

Answer 8

• new chest x-ray finding PLUS 1 or more of the following:
• ——fever, hypoxemia, chest pain, increased work of breathing, coughs, tachypnea, wheezing
• tx: ceftriaxone and azithromycin, IV fluids, pain control

Question 9

TCA overdose (mental status changes, seizures, arrhythmias, prolonged intervals, anticholinergic effects) treatment?

Answer 9

sodium bicarb for arrhythmias
IV fluids
activated charcoal w/i 2 hours of ingestion
oxygen, intubation

Question 10

Prognosis and TX of sleep terror and sleep walking

Answer 10

Self limiting

Low dose benzo if episodes are recurrent and distressing

Question 11

Asthma most commonly caused by?

Answer 11

House dust mites

Question 12

Diagnosing criteria for Tourette’s syndrome, and treatment

Answer 12

• both motor AND vocal tic >1 year *yelling obscenities is in minority of pts
• tx: antipsychotics, behavioral therapy, alpha adrenergic receptor agonists (clonidine)

Question 13

organophosphate toxicity (cholinergic toxicity— excessive salivating, drooling) treatment

Answer 13

atropine and pralidoxime

Question 14

Giardia treatment? traveler’s diarrhea tx?

Answer 14

giardia: metronidazole

traveler’s: cipro. TMP-SMX

Question 15

Diagnosis of malaria (fever, headaches, thrombocytopenia, subsaharan africa)

Answer 15

peripheral blood smear

* no vaccines, just antimalarial ppx

Question 16

Classic features of allergic bronchopulmonary aspergillosis (ABPA)

Answer 16

• hx of asthma/CF
• x-ray- fleeting infiltrates, CT- central bronchiectasis
• Diagnostic testing: increased IgE and IgG, eosinophilia, skin test for aspergillus fumigatus

Question 17

Tight blood glucose control in patients with diabetes will decrease risk in what kind of complications?

Answer 17

microvascular– nephropathy, retinopathy

** macrovascular not yet established (MI, stroke, PVD)

Question 18

How do you treat acute hemolytic reactions after blood transfusion? (w/i one hour of transfusion, b/l flank pain, renal failure, DIC, fever– caused by ABO incompatibility, positive coombs test)

Answer 18

• stop transfusion and give IV fluids

*** IV steroids are only given for IgA rx which occurs immediately

Question 19

Which lab levels are needed to monitor disease activity in SLE?

Answer 19

anti dsDNA and serum complements, NOT anti smith or ANA

Question 20

Treatment of Alzheimers

Answer 20

donepezil, rivastigmine, galantamine (cholinesterase inhibitors)

Question 21

Which lab levels are needed to monitor disease activity in SLE?

Answer 21

anti dsDNA and serum complements, NOT anti smith or ANA

Question 22

Treatment of Alzheimers

Answer 22

donepezil, rivastigmine, galantamine (cholinesterase inhibitors)

Question 23

acute stress disorder timing, PTSD timing

Answer 23

3 days to one month

PTSD: 1 month or more

Question 24

Multiple demyelinating nonenhancing region with no mass effect in AIDS patient

Answer 24

progressive multifocal leukoencephalopathy

Question 25

botulism (acute bulbar, descending limb weakness, absent reflexes, autonomic dysfx–blurry vision, preserved sensation) treatment

Answer 25

acetylcholinesterase inhibitors (same treatment for myasthenia gravis too. MG does not lose reflexes)

Question 26

Features of radiation induced cardiotoxicity

Answer 26

• MI/ infarction
• restrictive cardiomyopathy with DIASTOLIC dysfx
• constrictive pericarditis
• valvular abnormalities
• conduction defects

Question 27

hypocalcemia clinical signs

Answer 27

• chovstek’s signs, trousseau’s signs

Question 28

preferred means of treating hemochromatosis

Answer 28

phlebotomy

Question 29

Treatment of hyperkalemia with severe ECG changes

Answer 29

IV calcium gluconate

Question 30

Most appropriate next step in patients suspected for pseudotumor cerebrii.

Answer 30

• ophthalmoscopic exam

- then perform neuroimaging study (should be negative), THEN lumbar puncture

Question 31

Bugs seen in CF pts who presents with pneumonia, and appropriate treatment

Answer 31

• staph aureus and pseudomonas

- 2 drugs active against pseudomonas (i.e. cefepime, amikacin, zosyn, etc) and vancomycin if MRSA present

Question 32

Most important initial step in PEA— presence of organized rhythm (i.e. afib w/ RVR) without sufficient cardiac output to produce palpable pulse or measurable blood pressure

Answer 32

chest compression and vasopressors
** do not give atropine, give epi for vasopressor therapy!
defibrillation: vfib/pulsess ventricular tachycardia
synchronized cardioversion: unstable tachycardia