4/30/16

Question 1

Bereaved patients who experience depressive symptoms at least 2 weeks after a major loss should get what

Answer 1

Psychotherapy and a trial of antidepressants

Question 2

Therapy for stable wide complex tachycardia

Answer 2

IV antiarrhythmics (Amoiderone and procainamide)

Question 3

Therapy for stable vs unstable narrow complex tachycardia

Answer 3

Stable: Vagal maneuvers or IV Adenosine or CCB
Unstable: Immediate synchronized DC cardioversion

Question 4

Steroid induce myopathy features

Answer 4

Painless proximal muscle weakness, more prominent in LE

ESR and CK Normal

Question 5

Pansystolic murmur heard loudest at apex 3 days after MI

Answer 5

Mitral regurg due to papillae muscle dysfuction

Question 6

Ventricular septal muscle rupture murmur

Answer 6

Pansystolic murmur best heard at left sternal border

Often has a thrill

Question 7

Ventricular free wall rupture classical results in

Answer 7

Pericardial tamponade

Question 8

HIT type 2

Answer 8

Autoimmune disorder due to antibodies against heparin-platelet factor 4 complexes

Question 9

When to suspect HIT

Answer 9

When platelet counts fall > 50% from baseline 5-4 days after starting heparin

Question 10

Gold standard to dx HIT

Answer 10

Serotonin release assay

Question 11

Why a high level of false negatives in serologic testing for primary syphillis

Answer 11

Many patients have yet to form antibodies

Question 12

Odd place cholecystitis hurts

Answer 12

Right shoulder

Question 13

What is osteomalacia due to? What does it lead to

Answer 13

Due to defective mineralization of the organic bone matrix MC due to severe bit D def, leading to decreased intestinal Ca and PO4 absortion with resultant secondary Hyper-PTH

Question 14

Typical osteomalacia labs

Answer 14

Hypophosphatemia, hypocalcemia, and eleavted Alk-phos

Question 15

Best way to remove FB in kid trachea vs esophagus

Answer 15

Flexible endoscopy for esophagus

Rigid for trachea

Question 16

MCC of congenital hypothyroidism

Answer 16

Thyroid dysgenesis

Question 17

What do you need to dx uncomplicated pancreatitis

Answer 17

Clinical features and 3x increased amylase and lipase

don’t need CT if other 2 are pos- just 2 of 3

Question 18

Pneumo vaccine schedule for patients with chronic medical conditions

Answer 18

PPSV23 once, then reactivation with PCV 13 and PPSV23 at age 65

Question 19

Pneumo vaccine schedule for healthy adults

Answer 19

PCV12 for all adults over 65 with followed by 23-valent PPSV23 after at least 6-12 months

Question 20

Infection in what space carries the highest risk of spread into the mediastinum

Answer 20

Retropharyngeal

Question 21

What kind of bias is loss to follow up

Answer 21

A type of selection bias known as attrition bias

Question 22

What is surveillance bias

Answer 22

When the exposed group undergoes increased monitoring relative to the general population –> tends to increase disease diagnosis relative to general population

Question 23

Most common causes of viral meningitis

Answer 23

Non-polio enteroviruses, such as echovirus and coxsackieviruses

Question 24

3 facial features of FAS

Answer 24

1. Small palpebral fissures
2. Smooth philtrum
3. Thin vermilion border

Question 25

FEV1/FVC for obstructive pattern

Question 26

Why octreotide for variceal bleed

Answer 26

Inhibits release of vasodilator hormones –> leads indirectly to splanchnic vasoconstriction and decreased portal flow

Question 27

3 steps for fixing hyperkalemia

Answer 27

1. Membrane stabilization with calcium
2. Shifting K intracellularly
3. Decreasing total serum K cocentration

Question 28

Folate effect on homocysteine

Answer 28

Lowers by acting as a cofactor for the enzyme cystathionine B-synthase (turns homocysteine into cystathionine)

Question 29

3 reasons for diabetic foot ulcers

Answer 29

Neuropathy, microvascular insufficiency, and relative immunosuppresion

Question 30

Colvesical fixture MCC

Answer 30

Diverticular dz

Question 31

Hepatorenal syndrome features

Answer 31

Acute renal failure (Cr > 1.5) with a very low urine Na level, and absence of blood, casts, or proteinic urine
usually doesn’t improve with IV fluid resuscitation

Question 32

Vertebral compression fracture features? MCC of non-traumatic fracture?

Answer 32

Acute back pain and point tenderness

MCC of non traumatic VCF is osteoporosis