13

Question 1

sudden onset CHF in otherwise healthy pt think ?

Answer 1

dilated cardiomyopathy most likely due to acute viral myocarditis

Question 2

development of DIASTOLIC murmur and AV block in IVDUser think ?

Answer 2

perivalvular abscess, may extend into adjacent cardiac conduction tissue
murmur of tricuspid endocarditis is SYSTOLIC (regurg)
^risk with IVDU and aortic valve endocarditis

Question 3

recurrent nose bleeds, oral lesions, digital clubbing, think ?

Answer 3

Osler-Weber-Rendu (hereditary telangiectasia)

may develop pulmonary AVMs with R–>L shunts (clubbing)

Question 4

bone pain, headaches, unilateral hearing loss, femoral bowing, think ?

Answer 4

Paget disease of bone (osteoclast dysfunction, ^osteoblast activity)
in contrast osteoblast apoptosis may occur with steroid use, causing osteoporosis

Question 5

44 yo immigrant
gradually worsening SOB, orthopnea, crackles
CXR: enlarged heart, vascular congestion, elevated left main stem bronchus
EKG: a fib

Answer 5

mitral stenosis due to rheumatic heart disease

longstanding mitral stenosis may lead to LAE and a fib

Question 6

most common cause of chronic mitral regurg in developed countries

Answer 6

MVP: caused by myxomatous degeneration of the mitral valve leaflets and chordae
mitral annular calcification may also cause MR but more likely in older adults

Question 7

pt with inferior wall MI develops sudden hypotension what to do next?

Answer 7

IV NS bolus to increase RV preload and improve CO

next, inotropic agents (dobutamine) may be needed for RV MI patients with persistent hypotension

Question 8

source of infection in Ludwig’s angina

Answer 8

teeth roots (infected mandibular molar)
rapidly progressive cellulitis o the submandibular and sublingual spaces

Question 9

erythematous, tender nodule at the eyelid margin, think ?

how to treat?

Answer 9

external hordeolum (stye)
tx with warm compresses

Question 10

1st step if hypercalcemia

Answer 10

measure PTH

hypercalcemia of malignancy will have high or inappropriately normal PTH, and Ca2+ levels typically 14+

Question 11

pneumonia with nodular infiltrate with cavitation, think what organism?

Answer 11

S. aureus

may occur as a result of tricuspid endocarditis fragments embolizing to lungs in IVDUsers

Question 12

if hyponatremic with serum Osm greater than 290, think ?

Answer 12

marked hyperglycemia, advanced renal failure

Question 13

if hyponatremic and dilute urine (Osm less than 100), think?

Answer 13

primary polydipsia, malnutrition (beer drinker’s potomania)

Question 14

initial stabilization of acute STEMI

Answer 14

MONA BASH-C
Morphine (if persistent severe pain, not routinely used)
O2 (if less than 90%)
Nitrates (IV nitro if persistent pain, HTN, HF)
ASA 325 mg
B-blocker (unless low BP, brady, chronic HF, heart block)
ACE inhibitor (Lisinopril 5mg, avoid if hypotensive)
Statin (high dose: atorvastatin 80mg)
Heparin vs Plavix

Question 15

after initial stabilization of acute STEMI, then presents with unstable sinus bradycardia, what to do ?

Answer 15

IV atropine

Question 16

after initial stabilization of acute STEMI, then presents with pulmonary edema, what to do next?

Answer 16

IV furosemide (not if pt is hypotensive of hypovolemic)

Question 17

loss of pain/temp over ipsilateral face and contralateral body, vertigo, nystagmus, Horner’s, hoarseness

Answer 17

Wallenberg syndrome: lateral medullary infarct due to occlusion fo PICA or vertebral artery
vestibulocerebellar symptoms, sensory symptoms, bulbar weakness (hoarseness), autonomic dysfunction

Question 18

medial medullary syndrome

Answer 18

contralateral hemiparesis (medullar pyramid)
contralateral loss of tactile, vibratory, position sense (medial lemniscus)
ipsilateral tongue paralysis with deviation to side of lesion (hypoglossal nucleus/fibers)

Question 19

lateral mid-pontine lesions typically affect what CN?

Answer 19

CN V : trigeminal: weakness of muscles of mastication, diminished jaw jerk reflex, impaired tactile and position sensation over face

Question 20

nephrotic syndrome due to amyloidosis is seen in what condition?

Answer 20

MM (deposition of Ig light chains)

Question 21

renal disease presenting with AKI, hematuria, HTN, typically associated with autoimmune conditions

Answer 21

cresenteric glomerulonephritis

Question 22

FSGN is associated with ?

Answer 22

HIV, obesity, heroine, African American/Hispanic ethnicity, some meds

Question 23

membranoproliferative glomerulonephritis is associated with ?

Answer 23

Hepatitis B + C, lipodystrophy, chronic bacterial infections (endocarditis), some autoimmune conditions

Question 24

most common renal disease associated with cancer?

other associations?

Answer 24

membranous nephropathy

adenocarcinoma (breast, lung), NSAID use, hepatitis B, SLE

Question 25

most common renal disease associated with LYMPHOMA

Answer 25

minimal change disease (usually in kids otherwise)

also associated with NSAID use

Question 26

First line drug for narcolepsy

Answer 26

Modafinil, A non-amphetamine med that promotes wakefulness, it is well tolerated and has less abuse potential compared to other stimulants
Others: antidepressants and sodium oxybate

Question 27

Complications of mumps besides parotits and orchitis

Answer 27

Aseptic meningitis, pancreatitis, sterility

Question 28

How to treat chronic rhinitis symptoms without a specific etiology

Answer 28

Intranasal and to histamine and/or intranasal steroids

non-allergic rhinitis: no obvious trigger, later onset, red nasal mucosal instead of pale/blue

Question 29

how does giving O2 in COPDers worsen hypercapnia?

Answer 29

^dead-space perfusion causing V/Q mismatch, decreased affinity of oxyHgb for CO2, and reduced alveolar ventilation
goal sat: 90-93%

Question 30

if trial of SSRI doesn’t work, may switch to ?

Answer 30

other FIRST LINE AGENT, i.e. SNRI, buproprion (if no seizure risk)
NOT TCAs, MAOIs

Question 31

antiphospholipid labs

Answer 31

prolonged PTT and thrombocytopenia

Question 32

methanol vs ethylene glycol damage

Answer 32

methanol: eyes
ethylene glycol: kidneys
BOTH can cause anion gap metabolic acidosis and ^osmolar gap

Question 33

if can’t get a sputum sample and suspect PCP, do what?

Answer 33

bronchoalveolar lavage

Question 34

what accounts for 80% of ascites in the US?

what accounts for that cause?

Answer 34

cirrhosis, typically due to alcoholic liver disease and hepatitis C

Question 35

fever, arthralgias, dark urine, painful fingertips, DOE, normocytic anemia, ^ESR, think?

Answer 35

infective endocarditis

Question 36

RA and RV pressures nearing PCWP (measure of LA pressure) consider ?
what to do next?

Answer 36

pericardial tamponade (elevation and equalization of intracardiac diastolic pressures)
get urgent echo, may see RA and RV collapse

Question 37

subacute does NOT refer to ? in subacute thyroiditis

Answer 37

does NOT imply no s/s or lab values within normal range…
AKA de Quervain thyroiditis: fever, neck pain, hyperT s/s, tender goiter follwing URI, eventually recover
tx: BB, NSAIDs

Question 38

in contrast to subacute, suppurative thyroiditis presents how?

Answer 38

rare, high-grade fever with painful/palpable thyroid gland, but patients are typically EUTHYROID (focal gland involvement)

Question 39

GBS is the most common cause of early onset (less than ds) neonatal sepsis AS WELL AS?

Answer 39

LATE onset neonatal sepsis and meningitis in young infants (horizontally transmitted)
the latter of which is not prevented by intrapartum PCN or C-section

Question 40

requirements for dx of acute liver failure

Answer 40

signs of encephalopathy
INR +1.5
^LFTs (often in 1000s)
(in pts without cirrhosis or underlying liver disease)

Question 41

lab values in alcoholic hepatitis

Answer 41

^LFTs (typically not more than 300)
^GGT (present in liver cells)
^ferritin (acute phase reactant)
^WBCs (PMNs)

Question 42

Meniere disease is due to

Answer 42

defective reabsorption of endolymph

^volume and pressure: endolymphatic hydrops

Question 43

best dx step if suspect aortic dissection in pt with renal insufficiency

Answer 43

TEE

Question 44

CSF findings in HSV encephalitis

Answer 44

Hi percentage of lymphocytes, very high RBC due to destruction of frontotemporal lobe’s, normal glucose, Slightly elevated protein

Question 45

If FEV1/FVC is higher than each value by themselves, think?

Answer 45

Interstitial lung disease

Obstructive should have a normal FVC

Question 46

Neurogenic versus vascular claudication

Answer 46

Neurogenic is relieved with spinal flexion, as in walking uphill, get an MRI

Question 47

Paraneoplastic syndrome of squamous cell carcinoma

Answer 47

PTHrP

Think Elevated “Qalcium”

Question 48

Hypertension, hyper pigmentation, easy bruising in a patient with a mediastinal mass, think?

Answer 48

Cushing syndrome due to ACTH production from small cell lung cancer
ACTH is a polypeptide hormone produced by cleavage of POMC, which also yields MSH causing hyperpigmentation, which would not occur if the tumor produce cortisol instead of ACTH
Easy bruising is a symptom of hypercortisolism

Question 49

Uterine contractions are adequate when they occur?

One is labor considered arrested warranting C-section instead of oxytocin?

Answer 49

Adequate when their forceful and occur every 2 to 3 minutes
Arrest when no cervical change for more than four hours with adequate contractions or more than six with in adequate contractions

Question 50

What meds are best at reducing thromboembolic risk in a fib?

Answer 50

Anticoagulation: warfarin or NOACs: rivaroxaban, Apixaban

Aspirin and Plavix are antiplatelets and significantly less effective compared to anticoagulants and reducing TE risk