27 APR 2017 0859 MIX

Question 1

what is the treatment for ITP in children with only skin manifestation? what about with symptomatic bleeding?

Answer 1

• only skin: observe (self resolves in 6 months)
• bleeding: IVIG or glucocorticoids

*same goes with adults

Question 2

what should be measured in a 16 yo girl with primary amenorrhea?

Answer 2

• FSH if no secondary characteristics development
• pituitary MRI IF FSH is decreased
• karyotype IF FSH is increased

Question 3

an eczematous plaque on the nipple / areola in a female is indicative of:

Answer 3

paget disease of breast (underlying adenocarcinoma)

Question 4

the majority of patients with paget disease of the breast have an underlying:

Answer 4

breast adenocarcinoma

Question 5

_____________________ is elevated in acute intermittent porphyria (AIP)

Answer 5

urinary porphobilinogen

Question 6

what is used as an indication for sodium bicarbonate therapy in TCA overdose?

Answer 6

QRS duration (over 100 ms)

Question 7

what are the first and second line medications for gestational diabetes?

Answer 7

• first line: diet modifications

- second line: insulin, metformin, glyburide

Question 8

what is the zavanelli maneuver? when is it performed?

Answer 8

• replacing fetal head into maternal pelvis

- used if all other dystocia maneuvers fail in order to perform an emergency cesarean delivery

Question 9

what therapy causes worsening ophthalmopathy in (severe) Graves disease? what adjunctive therapy is advised? what is the ultimate preference?

Answer 9

• radioactive iodine therapy
• give glucocorticoids (prednisone) with RAI
• thyroidectomy is ultimately preferred over RAI for moderate or severe ophthalmopathy

Question 10

what is the triad of meniere disease?

Answer 10

• low frequency tinnitus
• episodic vertigo
• sensorineural hearing loss (variable in severity but worsens over time)

Question 11

what are the 1) preventative, 2) acute, and 3) long term therapies for meniere disease?

Answer 11

• preventative: restrict sodium, caffeine, nicotine, alcohol
• acute: benzos, antihistamines, antiemetics
• long term: diuretics

Question 12

21-hydroxylase deficiency prevents _______________ from being converted to _____________ and ___________

Answer 12

• 17-hydroxyprogesterone

- aldosterone and cortisol

Question 13

what is the gold standard test for diagnosing suspected partial deficiencies of 21-hydroxylase?

Answer 13

cosyntropin stimulation test

Question 14

besides recent antibiotic use, what are the other risk factors for acquiring c. diff?

Answer 14

• age over 65

- gastric acid suppression (PPI use)

Question 15

neonatal thyrotoxicosis results from transplacental passage of ___________________ during the third trimester

Answer 15

anti-TSH receptor antibodies

Question 16

what is the treatment for symptomatic neonatal thyrotoxicosis?

Answer 16

• methimazole

- beta blocker

Question 17

A-a gradient elevation occurs in processes that cause:

Answer 17

impaired gas exchange

Question 18

what is the first line therapy for diffuse esophageal spasm?

Answer 18

CCBs