Clinic

Question 1

How to know when to give an osteopenic pt a bisphosphonate?

Answer 1

Calculate risk of fracture w/ FRAX calculator

-gives 10 year fracture risk taking into account: age, height, weight, hx of fracture or corticosteroid use, smoker

Question 2

Fosamax

Answer 2

Fosamax = brand name for alendronate

-bisphosphate

Question 3

Name of the strongest statin

(a) What is the next strongest?

Answer 3

Statins
Strongest = rousuvastatin (crestor)

(a) one of the stronger = atorvastatin (lipitor)

Question 4

Describe the typical ankylosing spondylitis patient

Answer 4

Pt under 40 yoa w/ pain for 3+ mo that improves w/ exercise

-pain started gradually and is worse in the morning (morning stiffness)

Question 5

What is sciatica?

(a) Clinical presentation
(b) Most common etiology

Answer 5

Sciatica = condition of leg pain going down the leg from the lower back

(a) Sharp/burning pain that radiates posteriorly or laterally down the leg (usually down to the foot or ankle)
- often associated w/ numbness or paresthesia
(b) 90% cases caused by spinal disk herniation compressing lumbar or sciatic nerve root

Question 6

Lumbar disk herniation

(a) most common symptom
(b) diagnostic physical exam maneuver

Answer 6

Lumbar disk herniation

(a) Almost all pts present w/ sciatica = leg pain that radiates down from the lower back
(b) Straight leg test- pt lies supine and you raise straight leg 30-90 degrees and reproduce pain

Question 7

Characteristic finding of spinal stenosis

Answer 7

Spinal stenosis typically presents w/ neurogenic claudication = pain in legs after walking

Question 8

Most common location of lumbar disk herniation

Answer 8

Lower lumbar nerve roots: L5 and S1

Question 9

What determines the overall tx regimen of Hepatitis C

Answer 9

Tx varies by the different genotypes (strains) of the virus

-most common is genotype 1

Question 10

Describe the general tx of Hep C

Answer 10

Generally 12 weeks to treat chronic (not active/acute) Hep C of antivirals
-no longer use interferon or ribavarin

Bunch of dif drugs => chose depending on provider coverage and side effect profile

Question 11

Syphilis

(a) Organism
(b) Incubation period
(c) Describe primary syphilis
- Findings
- Duration

Answer 11

Syphilis

(a) Treponema pallidum
(b) Primary syphilis develops on average 4 weeks after exposure
(c) Primary syphilis comprises of a chancre at the site of infection
- lasts about 3 weeks
- Chancre = ulcerative, often painless, lesion
- often painless and small => usually doesn’t come to medical attention

Question 12

Syphilis

(a) Primary
(b) Secondary
(c) Tertiary

Answer 12

Syphilis

(a) Primary = chancre- ulcerative sore usually on mouth or genitals
(b) Secondary = typically rash involving hands and soles
- fever, headache, malaise
- anorexia, diffuse lymphoadenopathy
(c) Tertiary = gummas (non-cancerous soft growths), neurological, cardiac features

Question 13

Define latency period in syphilis

Answer 13

Latency (in general) = infected as supported by serologic evidence, but asymptomatic at the time

Question 14

Most common presentation of ocular syphilis

Answer 14

Posterior uveitis (as part of secondary syphilis) 
-pt presents w/ decrease in visual acuity

Question 15

Describe what it means to say that anti-Smith is very specific, but not very sensitive

Answer 15

Very specific but not very sensitive:

So if pt has anti-Smith it is practically pathognomonic for SLE (aka very specific), but only 15% of SLE pts have +anti-Smith (not very sensitive)

SpPin and SnNout

Question 16

2 side effects to look out for in pt on methotrexate

(a) What labs are monitored on MTX

Answer 16

Methotrexate- monitor for oral ulcers and hair loss

(a) Monitor LFTs every 3 mo

Question 17

Typical age distribution of lupus

Answer 17

Lupus has a bimodal distribution:
peak at ages:
-18-24 and
-38-42

Question 18

PrEP

(a) What is it?
(b) Who is it indicated for?

Answer 18

PrEP = pre-exposure prophylaxis for HIV

(a) Truvada = combo of two HIV drugs that pt takes daily for prophylaxis
(b) Indicated for populations at high risk for HIV
- MSM in NYC, IVDU, unprotected sex

Question 19

Rate in a fib vs aflutter

Answer 19

Flutter- regularly irregular, grouped beats

• slower, rate of 300 bpm
• organized electrical circuit usually in the RA

Fib- irregularly irregular
-can be faster, like 500 (holey shit)

Question 20

Compare the bugs implicated in cystitis vs prostatitis

Answer 20

Cystitis- UTI bugs so mostly e. Coli, also proteus klebsiella and pseudomonas

Prostatitis in young sexually active adult- test for STI bugs mainly GC/chlamydia

Question 21

Difference in tx for acute vs chronic prostatitis

Answer 21

Can use the same abx: bactrum, cipro, levofloxacin

Acute- 2-4 weeks duration

Chronic- 6-12 weeks

Question 22

Minute ventilation

Answer 22

Minute ventilation = RR x TV

Question 23

FiO2 on room air

Answer 23

21

Question 24

Alkalemia vs. alkalosis

Answer 24

Emia is the objective finding, aka pH over 7.40

Then the Osis is a process going on.

Question 25

Most sensitive EKG finding of a PE

Answer 25

Sinus tachycardia

Question 26

What does rosc stand for

Answer 26

Return of systemic circulation- after cardiac arrest Ex: pt went into cardiac arrest in the ambulance, rosc after one minute

Question 27

Why do you need an ABG to confirm hypoxia seen on pulse of

Answer 27

Bc of the hgb dissociation curve the pt can have pretty low paO2 before it is made apparent on spO2. So doing ABG gives you a much better idea of the oxygen concentration

Question 28

3 most common causes of chronic cough

Answer 28

GERD Asthma Post-nasal drip (now called upper airway cough syndrome)