4th year downloads

Question 1

biggest risk factor for endocarditis

Answer 1

prior endocarditis

Question 2

What should you consider when patient has persistent fever with endocarditis

Answer 2

valve abscess

Question 3

Benign looking rash on face with HIV could be

Answer 3

seborrheic dermatitis

Question 4

IBD usual age of patient

Answer 4

bimodal age distribution (15-30, 50-80)

Question 5

DRESS syndrome stands for what? What are some causative drugs? How does it present (timing, symptoms)

Answer 5

drug reaction with eosinophilia and systemic symptoms

allopurinol, anti-epileptics, antibiotics

presentation: 2 - 8 weeks after starting drug, patient presents with fever, facial edema, morbilliform rash, enlarged nodes

Question 6

GPA presentation (different presentations at different ages) and findings

Answer 6

Presentation: constitutional symptoms (fevers, WL), sinusitis; can be systemic (ages 45-60) or localized (young females)

Findings: pulmonary nodules, anti-PR-3 positive

Question 7

Dosing for methadone, bup, and naltrexone

Answer 7

Methadone: 80 - 100mg (can be more)
Bup PO: 4 - 32mg
Naltrexone (Depot injection): 380mg

Question 8

Legally intoxicated blood alcohol level

Answer 8

> 0.08%

Question 9

Workup of nonspecific findings like joint pain, skin lesions, and/or constitutional symptoms should include:

Answer 9

infectious (STI, fungal, hepatitis labs) and autoimmune (ANA, ANCA, complement) rule out

Question 10

Normal LP opening pressure

Answer 10

5 - 20

Question 11

Euthyroid hyperthyroxinemia (high T4/total T4 and normal TSH) can be caused by what 2 etiologies?

Answer 11

TSH-producing adenoma or drugs that inhibit conversion of T4 to T3 (amio, high-dose propranolol, amphetamine abuse)

Question 12

Radioactive iodine is contraindicated in what disease process?

Answer 12

active moderate Grave’s ophthalmopathy

Question 13

Two important questions for patient with murmur discovered

Answer 13

family hx of congenital heart disease; history of rheumatic fever

Question 14

Neuromyelitis optica spectrum disorder (NMOSD) is a severe, demyelinating disorder of the CNS. What antibody is highly specific for it and what does this antibody do pathophysiologically?

What two inflammatory signs might patients present with?

Answer 14

NMO-IgG, which binds to AQP4, is highly specific for it. Antibody-antigen binding signals an inflammatory cascade that results in astrocyte dysfunction and demyelination of adjacent cells.

Optic neuritis and/or transverse myelitis

Question 15

Findings that raise concern for inflammatory breast cancer include rapid onset and progression of symptoms and what two other signs?

Answer 15

generalized involvement of the breast and absence of fever or lab findings consistent with inflammation

Question 16

Signs of fungal infection of breast

Answer 16

pain out of proportion to physical exam, shiny/flaky skin of affected nip

Question 17

Co-morbidities to think about in a patient

Answer 17

the 4 C’s including CHF, COPD, cirrhosis CKD

Question 18

Turtle sign (what is it?) is pathognomonic for what?

Answer 18

Turtle sign: baby’s head delivers and then retracts back into vagina

shoulder dystocia, which should emergently be managed with Mcroberts maneuver and suprapubic pressure

Question 19

What co-infection is common with cavernous sinus thrombosis?

Answer 19

Bacterial meningitis (up to 50%)

Question 20

What imaging study is recommended for suspected urolithiasis?

Answer 20

KUB ultrasound; if negative, KUB CT