8

Question 1

If patient is asymptomatic with actinomyces on pap smear and she has copper IUD, how do you manage?

Answer 1

observe, no abx needed as actinomyces is part of normal flora

Question 2

Rapidly progressive weakness of b/l lower extremities followed by URI, with sensory loss and urinary retention. Ddx?

Answer 2

transverse myelitis

Question 3

Types of diabetes screening test, and when to repeat these tests?

Answer 3

• A1C: >6.5
• random glucose >200
• oral glucose tolerance test- >200 (most sensitive test)
• fasting blood glucose >126
• if pt is asymptomatic with abnormal test, repeat same test on same day. If 2 tests are concordant, then no need to repeat

Question 4

Lab values for thalassemia

Answer 4

low MCV
normal RDW (elevated in iron deficiency anemia)
high ferritin for increased RBC turnover (low in iron deficiency anemia)
normal RBCs

Question 5

Features of sarcoidosis

Answer 5

• common in Af. Am
• b/l hilar adenopathy
• anterior and posterior uveitis
• hepatomegaly, splenomegaly
• arthritis, migratory polyarthralgia
• central diabetes, hypercalcemia (tx: responds to steroids)
• erythema nodosum

Question 6

Clinical features, management and treatment of spinal epidural abscess

Answer 6

• fever, focal spinal tenderness, neurological dysfunction
• MRI, blood cx, inflammatory markers, CT guided aspiration and culture, abx
• Tx: emergency surgical decompression and drainage abscess

Question 7

Treatment of group A streptopharyngitis

Answer 7

penicillin or amoxicillin

Question 8

Treatment of skin abscess

Answer 8

• I& D

- abx needed if systemic signs are present or if size is >5cm, immunocompromised, multiple abscesses

Question 9

most frequent complication of TURP

Answer 9

retrograde ejaculation

Question 10

Features of neurosyphilis (usually has prodrome several days before)

Answer 10

early neurosyphilis: meningitis, ocular (posterior uveitis, decreased visual acuity), otosyphilis
late neurosyphilis: general paresis (dementia), tabes dorsalis

Question 11

Treatment of latent TB infection

Answer 11

• isoniazid and rifapentine weekly for 3 months
• isoniazid monotherapy for 6-9 months
• rifampin for 4 months
• isoniazid and rifampin for 4 months

Question 12

asymptomatic pulmonary sarcoidosis with erythema nodosum, treatment?

Answer 12

none needed, high rates of spontaneous recovery

Question 13

pseudohypoparathyroidism lab values

Answer 13

low calcium, high phosphorus
high PTH (PTH increases calcium levels and lowers phosphate levels normally)

Question 14

c.diff treatment

Answer 14

• mild to moderate: oral metronidazole
• severe (WBC >15000, creatinine >1.5x baseline, serum albumin <2.5): oral vanc, IV metronidazole
• toxic megacolon, severe ileus: subtotal colectomy, diverting loop ileostomy with colonic lavage

Question 15

Treatment of lyme arthritis and primary diagnostic test

Answer 15

• doxycycline or amoxicillin if <8 yo

- enzyme linked immunosorbent assay, followed by confirmatory western blot

Question 16

low T3, normal T4 and TSH. Ddx and treatment

Answer 16

• euthyroid sick syndrome/ low T 3 syndrome

- it is often present with other severe acute illnesses, treatment not recommended until baseline health returns

Question 17

How often do HIV patients on/about to start HAART need HIV and CD4 counts checked?

Answer 17

3-4 months

Question 18

RA-like sx with small joint involvement and weakly positive RF with less than six weeks of sx, with prior URI. Ddx and treatment

Answer 18

• viral arthritis- parvovirus infection

- self limited, symptomatic management

Question 19

First test to differentiate between insulinoma and oral hypoglycemic agent use?

Answer 19

• hypoglycemic drug assay

Question 20

Best treatment for borderline personality disorder

Answer 20

dialectical behavior therapy

Question 21

Interpersonal therapy is effective for which psych disorder?

Answer 21

depression

Question 22

diagnostic test for pheochromocytoma (headaches, diaphoresis, and tachycardia), and follow up tests when positive

Answer 22

• 24 hour urine collection for metanephrine and catacholamine
• CT or MRI of abdomen; if negative or has large tumor or extraadrenal disease, then MIBG scan

Question 23

Diagnostic test for chronic lymphocytic leukemia

Answer 23

• flow cytometry
• severe lymphocytosis and smudge cells
• LN & BM biopsy not generally needed

Question 24

rotator cuff tendonitis presents with what kind of shoulder pain? anterior vs posterior vs lateral

Answer 24

lateral

• anterior: biceps tendonitis, acromioclavicular or glenohumeral joint OA
• posterior: referred pain

Question 25

Treatment of OCD

Answer 25

• exposure and response prevention/CBT and/or SSRI
• clomipramine or antipsychotic if refractory
• DBS for severe cases

Question 26

First step in management in hyperosmolar hyperglycemic state (more likely in T2DM, no ketones)

Answer 26

1. aggressive fluid resuscitation

2. IV insulin

Question 27

When is statin therapy recommended?

Answer 27

• age 40-75 with diabetes
• LDL >190
• calculated atherosclerotic coronary heart disease risk >7.5%
• clinically significant atherosclerotic disease

Question 28

Diagnosis of SAH

Answer 28

• noncontrast CT >90% sensitive within 2-6 hours of onset
• lumbar puncture required to r/o definitely in pts with negative CT
• xanthochromia confirms ddx >6 hours from onset
• cerebral angiography to identify bleeding source

Question 29

urethral diverticula ( three d’s: postvoid dribbling, followed by dysuria and dyspareunia) ddx test

Answer 29

• transvaginal ultrasound

- MR

Question 30

Molluscum contagiosum (transmitted by skin to skin contact)–> what screening test should be considered?

Answer 30

HIV testing

Question 31

hypopigmented spots with b/l deafness

Answer 31

Neurofibromatosis-2

Question 32

Hyponatremia (<115) should be treated with what?

Answer 32

hypertonic saline (3%) avoid raising more than 12 meQ in first 24 hours

Question 33

First line agent for osteoporosis

Answer 33

alendronate (bisphosphonates)