7

Question 1

lichen planus diagnostic test
(intense pruritic polygonal shaped violaceous papules in flexure surfaces (mostly wrist), buccal mucosa, or external genitalia)

Answer 1

punch biopsy

Question 2

Treatment of polycystic ovarian disease

Answer 2

weight loss

if that fails, then clomiphene citrate

Question 3

In absence of MPOA or advance directives, who should the staff contact?

Answer 3

highest priority surrogate decision maker

ethics committee only consulted when opinions are opposing

Question 4

Horner’s syndrome (miosis, ptosis and often anhidrosis) and unilateral headache, ddx and best diagnostic test

Answer 4

carotid artery dissection

CT angiography is first step, catheter angiography is gold standard, MRA alternative

Question 5

Whats the best initial screening test for thyrotoxicosis for pregnant ladies?

Answer 5

TSH

total T4 and T3/free T4 T3 not as reliable as they are higher than normal, has to be adjusted

Question 6

When is amiodarone preferred as antiarrythmic drug in paroxysmal afib patients?

Answer 6

structural heart disease (LVH, CHF)

normal heart: flecainide

Question 7

Diagnosis and treatment for epistaxis, petechiae, worse with use of aspirin, normal platelet count.

Answer 7

VWF

• ristocetin cofactor assay, VWF level (carries factor VIII in blood)
• first line tx: desmopressin/DDAVP
• next best step: factor VIII replacement (has both vwf and factor VIII)

Question 8

Drugs that increase TBG and decrease free T4 may need higher doses of thyroxine replacement. Which drugs?

Answer 8

estrogen
tamoxifen
raloxifene
methadone, heroine

Question 9

Drugs that decrease TBG and increase free T4 may need lesser doses of thyroxine replacement. Which drugs?

Answer 9

steroids
androgens
danazol

Question 10

hydrothorax, a common cause of transudative pleural effusion in patients with cirrhosis and ascites and is located on the right. Treatment?

Answer 10

• sodium restriction, diuretics

- TIPS as second line

Question 11

E.coli and GBS are common bugs in neonates (<28 days), strep pneumo and neisseria (>28 days). Broad spectrum abx needed immediately. Which ones?

Answer 11

• ampicillin and gentamicin or cefotaxime

- ceftriaxone or cefotaxime, +/- vanc based on meningeal involvement

Question 12

Infant botulism from environmental dust containing spores. Treatment?

Answer 12

Human derived botulinum toxin

Question 13

Following viral pericarditis/cardiac surgery, pt presents with right heart failure, peripheral edema, ascites, elevated JVP, hepatojugular reflex, Kussmaul’s sign, pericardial knock, pericardial calcifications on chest radiograph. Ddx?

Answer 13

Constrictive pericarditis

Question 14

Saw palmetto’s use and SE

Answer 14

benign prostate hyperplasia

risk of bleeding

Question 15

Most common complication of lumbar myelomeningocele

Answer 15

bladder dysfunction

Question 16

Which smoking cessation meds should be avoided in pts with depression or SI? seizures?

Answer 16

avoid varenicline for unstable psych sx

avoid buproprion for seizures

Question 17

abrupt onset of butterfly rash, sharp demarcation, painful, red, edematous. ddx? common bug?

Answer 17

erysipelas

group a strep

Question 18

postpartum endometritis treatment?

Answer 18

clindamycin and gentamicin

* metronidazole is contraindicated in breastfeeding mothers

Question 19

maculopapular rash that spreads from face caudally, acute arthritis, thrombocytopenia, and encephalitis, fever, lymphadenopathy of posterior cervical and suboccipital nodes. Ddx?

Answer 19

Rubella

Question 20

Cough, conjunctivitis, coryza, blue white koplik spots, starts on face and spreads caudally. Ddx?

Answer 20

Measles/ Rubeola

Question 21

Causes of post operative hypoxemia

Answer 21

immediate: airway obstruction/edema, residual meds effect
early: bronchospasm (wheezing)
1-5 days: pneumonia
2-5 days: atelectasis
3 days to over a week: PE

Question 22

Which electrolyte imbalance post op causes hyperactive deep tendon reflexes

Answer 22

hypocalcemia

Question 23

Management and treatment of seborrheic keratosis

Answer 23

if symptomatic and cosmetically disfiguring, then can do curettage/shave excision
otherwise, no treatment needed

Question 24

Whats the best contraceptive method for pts with sickle cell disease?

Answer 24

progestin only methods (intrauterine device), as it decreases amount of menses
estrogen containing methods promote thromboembolism
copper IUD has severe bleeding and dysmenorrhea first year

Question 25

type of poisoning in improperly stored seafood that causes palpitations, abdominal cramps, diarrhea, oral burning, headache.

Answer 25

scombroid poisoning

Question 26

ocular melanoma, most sensitive diagnostic test and treatment

Answer 26

US
asx w/ small lesions - observe and reassess
large lesions- radiation therapy

Question 27

Most important factor in prognosis in COPD patients

Answer 27

FEV1

FEV1 <40% is severe COPD

Question 28

Brief shooting back pain, positive straight raising test in 60, worsens with bending and straining. Ddx?

Answer 28

nerve root irritation

Question 29

Possible explanations of positive ELISA-anti-HCV antibodies? What test is needed for confirmation of HCV?

Answer 29

• persistent Hep C infx
• cleared infection
• false positive result
• HCV RNA is a high specificity test

Question 30

Treatment for latent TB

Answer 30

• first line: isoniazid for 9 months for both children and adults
• second line: rifampin 6 months in children, 4 in adults

Question 31

If patient presents with fever, jaundice, and RUQ (Charcot’s triad), then what ddx do you think of? Management and treatment?

Answer 31

• acute cholangitis
• hydration, VS monitoring, and antibiotics
• need blood culture and abx- ampicillin and gentamicin or imipenem or levofloxacin
• if clinically improves, then elective ERCP

Question 32

Treatment of bile-induced diarrhea in short gut syndrome or post cholecystectomy

Answer 32

• bile salt binding resins such as cholestyramine

Question 33

Screening test for primary aldosteronism (Conn’s syndrome)- hypertension, hypokalemia

Answer 33

plasma aldosterone to plasma renin activity greater than 30