5

Question 1

HTN, tachy, cardiac arrhythmias, high fever, tremor, AMS, lid lag, think ?

Answer 1

thyroid storm

Question 2

isolated, symmetric LE symptoms including loss of sensation and UMN dysfunction (weakness, hyperreflexia, extensor plantar response) consider?

Answer 2

spinal cord compression, UMN presents distal to lesion

medical emergency, requires spinal MRI for diagnosis

Question 3

acute Lyme presents with

Answer 3

erythema migraines, headache, arthralgias, myalgias

late disseminated disease: mos-yrs: subacute encephalopathy (men/encep) and axonal polyneuropathy

Question 4

von Willebrand will present with what derangements

Answer 4

prolonged bleeding time and aPTT

normal platelet counts typically

Question 5

Bernard-Soulier is due to absent ?

Answer 5

platelet glycoprotein 1b-IX-V (receptro for vW factor)

AR disease, mild thrombocytopenia, “big suckers”, platelet dysfunction

Question 6

recurrent episodes of UNILATERAL hearing loss and tinnitus with feeling of fullness in ear

Answer 6

Meniere

increased volume and pressure of endolymph due to defective resorption

Question 7

Meniere tx

Answer 7

restrict sodium, caffiene, nicotine, etOH
can use benzos, antihistamines, antiemetics for acute symptoms
diuretics for long-term management

Question 8

when to give meningococcal vaccine

Answer 8

age 11-12, booster recommended at 16

esp. important for asplenia, complement deficiency, military recruits, college students, travelers to sub-Saharan Africa

Question 9

avoid live attenuated vaccines for

Answer 9

allergy to eggs, AIDS with CD4 less than 200, immunodeficiencies (thymus related), recent stem cell transplant
immunosuppressive agents (anti-TNFs, systemic cortsteroids as in Crohns)

Question 10

arterial ulcers vs diabetic ulcers

Answer 10

arterial insufficiency ulcers will be at the tips of toes + other signs of arterial insufficiency (diminished pulses)

Question 11

causes of constrictive pericarditis

Answer 11

idiopathic/viral
cardiac surgery
radiation
TB in endemic areas

Question 12

hemorrhagic bullae, necrotizing fasciitis with signs of septic shock, think what organism?

Answer 12

Vibrio vulnificus
acquired through ingesting oysters or wound contamination in sea water or seafood handling
liver diz and hemochromatosis pts are at higher risk

Question 13

pt presents with muscle weakness, arrhythmias after being treated for asthma exacerbation, think?

Answer 13

B-agonist (albuterol)-induced hypokalemia

Question 14

hypoglycemia FOLLOWING meals in an insulin-dependent diabetic, consider

Answer 14

gastroparesis

tx: prokinetics (metoclopramide, erythromycin, cisapride)

Question 15

loss of peripheral vision and cupping of the optic disc, think ?

Answer 15

primary open angle glaucoma

more common in African Americans

Question 16

loss of central vision

Answer 16

macular degeneration

Question 17

poor night vision, floaters

Answer 17

diabetic retinopathy

Question 18

transient vision loss with changes in head position consider ?

Answer 18

papilledema

Question 19

b/l LE muscle weakness and diminished pain/temp (proprioception, vibratory sensation, light touch unaffected)

Answer 19

anterior cord syndrome (trauma to ASA)

Question 20

decreaed sensation and motor function in arms with relative sparing of legs +/- bladder dysfunction

Answer 20

central cord syndrome

seen in whiplash injuries and underlying cervical spondylotic myelopathy

Question 21

myasthenia gravis may be precipitated by ?

Answer 21

infection, surgery, pregnancy, medications (FQs)

Question 22

tx for restless leg

Answer 22

iron for iron deficiency, dopamine agonists (pramipexole) alpha-2-delta calcium channel ligands (gabapentin)

Question 23

HIV screening involves ?

Answer 23

HIV p24 antigen and antibody testing

gonorrhea not recommended in men as they will have significant symptoms

Question 24

if lesion appears very different from others, or it itches, bleeds or develops new nodularity, suspect ?
what to do next ?

Answer 24

melanoma

excisional biopsy with 1-3mm margins

Question 25

tx of actinic keratosis

Answer 25

cryotherapy or topical fluorouracil

Question 26

unilateral vision loss, proptosis, esotropia, optic disc pallor with cafe-au-lair macules think ?

Answer 26

optic pathway glioma seen in NF1

Question 27

scabies tx

Answer 27

topical permethrin or oral ivermectin

Question 28

painless, rapid, transient "curtain descending" over visual field, think ? how to dx?

Answer 28

amaurosis fugax duplex US of neck as most commonly caused by retinal ischemia due to atherosclerotic emboli from ipsilateral carotid artery

Question 29

what to do in 1st 24 hrs after caustic ingestion

Answer 29

endoscopy to evaulate severity of damage and to guide therapy

Question 30

posterior knee/calf pain with arc of ecchymosis distal to medial malleolus (crescent sign) think?

Answer 30

``` ruptured popliteal (Baker) cyst US can r/o DVT and confirm popliteal cyst ```

Question 31

in acute glaucoma, avoid agents that cause ? such as ?

Answer 31

mydriatic (dilating) agents like atropine

Question 32

refeeding syndrome manifests as ? | how to tx

Answer 32

edema, heart failure, seizures may be associated with thiamine deficiency tx with IV phosphate

Question 33

supplemental O2 in COPD pts can worsen ? due to ?

Answer 33

hypercapnia due to increased dead space perfusion causing V/Q mismatch, decreased affinity of oxyhemoglobin for CO2 and reduced alveolar ventilation goal oxyhgb sat: 90-93%

Question 34

progressive proximal muscle weakness and atrophy WITHOUT pain/tenderness, think ?

Answer 34

steroid-induced myopathy may be associated with weight gain, bone loss, hypertension, hirsutism (Cushing) most commonly from exogenous steroids cortisol has direct catabolic effects on skeletal muscles-->atrophy

Question 35

eye exam reveals micro aneurysms, dot/blot hemorrhages, hard exudates, macular edema, think ?

Answer 35

(diabetic) retinopathy this presentation is background/simple retinopathy pre-proliferative: cotton wool spots proliferative: new vessels

Question 36

tx for DM retinopathy

Answer 36

argon laser photocoagulation

Question 37

macular degeneration presentation and eye exam

Answer 37

affects central vision, distorted vision, central scotoma atrophic: sores in the macula exudative: new blood vessels that may leak/bleed/scar the retina smoking increases the risk

Question 38

Who should get a statin?

Answer 38

clinically significant athersclerotic disease (ACS, MI, angina, revascularization, CVA, TIA, PAD) LDL 190+ all diabetics age 40-75 estimated 10-yr ASCVD risk 7.5%+

Question 39

low testosterone and low/normal LH/FSH, think ?

Answer 39

secondary (central) hypogonadism; as LH/FSH should be increased when testosterone is low so it is a hypothalamic/pituitary problem (not gonadal) i.e. from mass lesions, hyperprolactinemia (suppresses GnRH), steroid/opiate use, severe systemic illness

Question 40

what does use dependence refer to in the context of cardiac medications

Answer 40

``` enhanced effects of a drug during faster HR Class IC (i.e. Flecainide): decrease impulse conduction with faster HR-->^QRS duration Class IV (CCBs: verapimil, diltiazem): prolong refractory period of the AV node-->^PR interval B-blockers also increase the refractory period of the AV node, do not display use dependence ```

Question 41

well-circumscribed verrucous nodules and plaques that progress to microabscess, think what fungus?

Answer 41

blastomycosis

Question 42

why is a MM pt is at increased risk of infection?

Answer 42

BM infiltration by neoplastic cells alters normal lymphocyte population-->ineffective Ab production, hypogammaglobulinemia-->respiratory infections and UTIs

Question 43

secondary hyperparathyroidism: | vitamin D deficiency vs CKD

Answer 43

vitamin D deficiency: low/normal phosphate, normal Ca2+ (dx by measuring 25, OH-vitamin D) CKD: ^phosphate, low Ca2+, low 1,25-OH vit D; magnitude of PTH^ corresponds to renal failure

Question 44

who should get tamiflu (oseltamivir)?

Answer 44

65+, pregnant, chronic medical problems | OR consider if present less than 48 hrs of onset, may shorten duration of illness

Question 45

common organs affected in GVHD

Answer 45

skin (rash), intestine (blood+ diarrhea), liver (LFT abnormal, jaundice) donor T cells against host HLA antigens (CMI)

Question 46

most beneficial therapy to reduce progression of DM nephropathy

Answer 46

strict BP control: less than 130/80

Question 47

levels in Paget disease of bone

Answer 47

^alk phos, ^bone turnover markers: urine hydroxyproline, procollagen type 1 N propeptide (PINP) Ca2+ and phosphorus typically NORMAL unless underlying condition

Question 48

most common valvular abnormality in infective endocarditis

Answer 48

mitral regurgitation (rarely stenosis) "MAT" aortic stenosis 2nd (rarely regurg) tricuspid regurg 3rd (IVDU)

Question 49

GBS precipitants besides campy

Answer 49

herpes viruses, mycoplasma, H. flu | more common in pts with lymphoma, sarcoid, SLE, recent HIV, immunization