13 June

Question 1

Hemodynamically stable and wide complex and narrow complex tachycardia

Answer 1

Look for fusion beats, if there are fusion beats, its Vtach, treat with IV amiodarone, if there are no fusion beats its SVT, do carotid message, vagal maneuvers and if it fails do IV adenosine

Question 2

Know the difference between polymyositis and polymyalgia rheumatica

Answer 2

Creatinine kinase and other muscle enzymes are elevated in polymyositis as well as ESR, muscles enzymes are normal in polymyalgia rheumatica

Question 3

What is the cause of transient tachypnea of the newborn

Answer 3

Delayed reabsorption and clearance of lung fluid

Question 4

According to UWorld who should get a VCUG for pediatric patients

Answer 4

Recurrent febrile UTIs or a febrile UTI by an organism other than E. Coli

Question 5

How to avoid uric acid kidney stones

Answer 5

Urine alkalinization by potassium citrate

Question 6

Describe the gait of Parkisonsons disease

Answer 6

Shuffling, hypokinetic gait

Question 7

Does Touretty syndrome movements stop when patients focus like when they play a musical instrument?

Answer 7

Yes!

Question 8

Describe a breath holding spell and what are they associated with

Answer 8

Episode of cyanosis, loss of conciousness, patients is awake after a few seconds, acts normally then.

Associated with normal development

Question 9

What is so special about lung consolidation

Answer 9

Literally the only lung pathology that has increased breath sounds, and it has increased tactile fremitus, nothing else has an increase in either of these properties

Question 10

What are the different pH of pulmonary effusion

Answer 10

Normal pleural pH is 7.60
Transudative have 7.40 to 7.55
Exudative have 7.30 to 7.45

Question 11

What test can confirm venous valve insufficiency

Answer 11

Duplex US

Question 12

Most common cause of sudden cardiac arrest in patients who just had an MI

Answer 12

Re entrant ventricular arrhythmia

Question 13

In primary amenorrhea eval, what do you do next when FSH is low?

Answer 13

Check prolactin and serum TSH

Question 14

What if TSH and prolactin are normal?

Answer 14

It is then functional hypothalamic amenorrhea

Question 15

What is basophilic stippling associated with

Answer 15

Alcoholism (megaloblastic anemia), lead toxicity, thalassemia

Question 16

First step when IUFD is suspected

Answer 16

Abdominal US to determine fetal heart rate

Question 17

What is retroperitoneal lymphadenopathy a potential symptom of?

Answer 17

Testicular cancer

Question 18

Most common bugs that cause acute bacterial rhinosinusitis

Answer 18

Most common is hemophilus non typeable, next 2 is a tie between Group A Strep and Moraxalla

Question 19

Findings of euthyroid sick sinus syndrome

Answer 19

Only significant findings is low T3, hence its other name is low T3 syndrome

Question 20

Unique adverse effect of OCPs

Answer 20

Cervical cancer

Question 21

Explain aromatase deficiency and its classic presentation

Answer 21

Adolescent girl with delayed puberty, has high testosterone levels represented by increased hair distribution, osteoporosis and clitoromegaly, ovaries on US are polycystic due to high concentration of gonadotrophins.

At birth they can have ambiguous genitilia and their mothers during birth can experience virilization

Question 22

What fetal syndrome classically associated with virilization in mother during pregnancy

Answer 22

Placental aromatase deficiency

Question 23

Treatment of PID

Answer 23

Thurd gen cephalosporin + Azithro or doxy

Question 24

What is supravavlular aortic stenosis associated with?

Answer 24

Williams syndrome

Question 25

First step to do when there is spiked T waves in setting of hyperkalemia?

Answer 25

Give calcium gluconate

Question 26

6 month old girl with a to and fro murmur and persistent infection, what is the diagnosis?

Answer 26

She has PDA, persistent infections cause prostaglandins release leading to a murmur

Question 27

52 year old assymptomatic man wanting to start exercising, what is the best next step?

Answer 27

Exercise stress test

Question 28

How do you know when an antipsychotic is in the long acting form?

Answer 28

Has decanoate in its name, like Haldol Decanoate

Question 29

What does NF1 include and what is it inheritance pattern?

Answer 29

Autosomal dominant: 1. Cafe au lait 2. Cutaneous neurofibromas 3. Optic glioma 4. Lisch nodules 5. Pheochromocytoma

Question 30

Unqiue drug used for hypertensive encephalopathy

Answer 30

Nitroprusside

Question 31

Most common cause of post partum fever

Answer 31

Endometritis

Question 32

Most common bacteria causing endometritis

Answer 32

Poly microbial, aerobic and anaerobic

Question 33

How long does post partum blues last for?

Answer 33

2 weeks only

Question 34

Bruning and peeling aroela with bright red nipples for a breast feeding mother, what is the dx and what is the next best step

Answer 34

Candida infection, examine the baby's mouth

Question 35

A young female recently had a D&C done for termination of a pregnancy and comes to the clinic after 4 days with fever, spotting with scant blood in the vagina and abdominal discomfort. US shows 8 mm endometrial strip. What is the diagnosis?

Answer 35

Classic case of uterine perforation. Retained products of conception would not be the answer since that would cause a lot of bleeding and septic abortion

Question 36

Systemic diseases that increase the risk of spontaneous abortion

Answer 36

Diabetes, chronic renal disease and lupus

Question 37

Screening guidelines 2 points for pregnant women

Answer 37

1. Universal screening between 24 and 28 weeks gestation | 2. Women with risk factors should be screened on their first visit

Question 38

What do we need to know about mitral valve prolapse and its treatment?

Answer 38

Most women are asymptomatic, but those that develop chest pain, palpitations and other symptoms either before or during pregnancy can be treated with beta blockers

Question 39

What do the following lab findings show: Hg 9.1, MCV: 72, serum ferritin: normal, HB electrophoresis normal

Answer 39

Alpha thalessemia trait

Question 40

Most common pregnancy complication for a morbidly obese woman?

Answer 40

HTN and pre eclampsia

Question 41

There is a fine line in expectant management of pre eclampsia and delivery in case it occurs very early in pregnancy. What are the indications for immediate delivery?

Answer 41

Inability to control BP, oligouria, LFTs x2 normal limit, eclampsia, persistent CNS symptoms, non reassuring fetal surveillance AND thrombocytopenia < 100,000

Question 42

Most significant chronic disease that increases the likelihood of pre eclampsia?

Answer 42

Chronic renal disease

Question 43

Best test to check for fetal anemia?

Answer 43

Middle cerebral artery peak systolic velocity

Question 44

Explain the phenomenon and pathogenesis of fetal hydrops fetalis What are the 2 disease caused by Rh sensitization

Answer 44

Hydrops fetalis is characterized by fluid in the organs of the fetus due to decreased protein production by the liver, can consist of pericardial effusion, pleural effusion, ascites, can easily be seen in US. 2 disease caused by Rh sensitization are hydrops fetalis and fetal erythroblastosis in which there is destruction of the fetal RBCs by Anti D IgG. In that case amniotic fluid has increased levels of bilirubin

Question 45

Most common cause of fetal demise in a 30 week gestation woman?

Answer 45

Undiagnosed poorly controlled diabetes

Question 46

What do you use to induce labor?

Answer 46

Misoprostol

Question 47

What are the different stages of labor and what are they marked by

Answer 47

1. First stage, onset of contractions to 10 cm dilation 2. Second, Fetal expulsion 3. Third, placental expulsion First is characterized by active and latent phase, the cut off for them is 6 cm, that's when active phase begins

Question 48

Duration of active and latent phase

Answer 48

Latent phase is prolonged if more than 20 hours in nulliparous and 14 hours in multiparous, active phase is usually around 3 or 2 hours for multiparous and nulliparous

Question 49

What is the best next step when there is secondary arrest of dilation

Answer 49

Amniotomy

Question 50

Strongest association of umbilical cord prolapse

Answer 50

Fetal positioning, especially a backup transverse lie

Question 51

Cut off for PPROM management

Answer 51

34 weeks