14 APR 2017 1825 MIX

Question 1

how is the gait characterized in normal pressure hydrocephalus?

Answer 1

broad based and shuffling

Question 2

what is the most common cause of B12 deficiency in whites of northern european background?

Answer 2

pernicious anemia

Question 3

how long does it take to develop B12 deficiency on a purely vegan diet? what about for folate deficiency?

Answer 3

• B12: 4-5 years

- folate: 4-5 months

Question 4

what are the side effects of isoniazid?

Answer 4

• peripheral neuropathy
• hepatotoxicity
• sideroblastic anemia

Question 5

how does an increase in true positives and false positives affect PPV?

Answer 5

decrease, because PPV = (TP / [TP + FP])

Question 6

in slipped capital femoral epiphysis where is the pain often referred?

Answer 6

knee

Question 7

what is the presentation of slipped capital femoral epiphysis? what is the diagnostic imaging of choice?

Answer 7

• loss of abduction and internal rotation of the hip
• hip / thigh is externally rotated when being flexed
• frog leg xray

Question 8

what are the physiologic renal and urinary changes in pregnancy? what are the lab findings?

Answer 8

PHYSIOLOGIC:

• increased renal blood flow
• increased GFR
• increased renal basement membrane permeability

LABORATORY:

• decreased serum BUN
• decreased serum creatinine
• increased renal protein excretion

Question 9

what is the treatment for latent TB? active TB?

Answer 9

• latent: isoniazid and pyridoxine

- active: rifampin, isoniazid, pyrazinamide, ethambutol

Question 10

what are the potential complications of asymptomatic bacteriuria in pregnancy? what is the definition of asymptomatic bacteriuria? what is the treatment?

Answer 10

• acute pyelonephritis
• low birth weight
• preterm labor
• 100,000 CFU
• treatment: cephalexin, augmentin, nitrofurantoin, fosfomycin

Question 11

atypical glandular cells seen on pap test indicates what three management procedures?

Answer 11

• endometrial biopsy
• colposcopy
• endocervical curettage

Question 12

• focal substernal burning pain
• odynophagia
• large linear ulcerations, distal esophagus
• intranuclear and intracytoplasmic inclusions on biopsy

what is the diagnosis and treatment?

Answer 12

• diagnosis: CMV esophagitis

- treatment: ganciclovir

Question 13

• multiple, small, well circumscribed esophageal lesions with round / ovoid “volcano like” appearance
• cells show ballooning degeneration and eosinophilic intranuclear inclusions

what is the diagnosis and treatment?

Answer 13

• diagnosis: HSV esophagitis

- treatment: acyclovir

Question 14

what drug is used for the prevention and treatment of pneumocystis pneumonia in patients with advanced HIV who cannot take TMP-SMX?

Answer 14

pentamidine

Question 15

how is DI classified based on urine osmolality? what about based on etiology? what are the cutoffs?

Answer 15

• complete: urine osmolality under 300 mOsm/kg
• partial: urine osmolality 300-600 mOsm/kg
• serum osmolality is elevated in both types
• central: decreased ADH
• nephrogenic: renal ADH resistance

Question 16

what is the treatment for lithium induced nephrogenic DI?

Answer 16

• salt restriction

- discontinuation of lithium

Question 17

how does cardiac tamponade lower right and left ventricular filling?

Answer 17

increased intrapericardial pressure above the diastolic ventricular pressure, restricting venous return to the heart

Question 18

eggshell calcification of a hepatic cyst on CT is indicative of __________________ and the treatment is _______________________

Answer 18

• hydatid cyst (ecchinococcus granulosus)

- surgical resection under the cover of albendazole

Question 19

what is the formula for determining the degree of respiratory compensation in primary metabolic alkalosis?

Answer 19

PaCO2 = (0.9 x bicarb) + 16 +/- 2

Question 20

what are the microscopy features of Lewy bodies?

Answer 20

• eosinophilic intracytoplasmic inclusions representing alpha-synuclein protein
• may be seen in substantia nigra, locus ceruleus, dorsal raphe, substantia innominata

Question 21

how does elevated pH lead to decreased levels of ionized calcium?

Answer 21

• hydrogen ions dissociate from albumin molecules, thereby freeing up the albumin to bind with calcium
• increased affinity of albumin for calcium leads to decreased levels of ionized calcium

Question 22

why can people with respiratory alkalosis present with signs of hypocalcemia?

Answer 22

• elevated pH leads to dissociation of protons from albumin
• albumin is freed up to bind with calcium
• increased affinity of albumin for calcium leads to decreased levels of ionized calcium (which is the active form of calcium)

Question 23

subchondral lucency on xray is indicative of:

Answer 23

avascular necrosis of bone

Question 24

for gender dysphoria, hormone suppression therapy can be offered by Tanner stage __ of development to delay puberty and give patients time to decide how to proceed

Answer 24

2