COMBANK questions

Question 1

Disease name (and its milder form) of hyperaldosteronism with decreased serum Na+ and decreased serum K+, increased urine Na+ and Cl-, increased renin, hypokalemic alkalosis, but normal blood pressure?

Answer 1

Bartter’s syndrome and Gitelman’s syndrome

inherited defect in thick ascending loop of Henle = failure of kidney to resorb Na/Cl and respond to angiotensin

Question 2

brown discoloration and softening of nails + oncholysis is seen in what endocrine disorder?

Answer 2

Graves disease / hyperthyroidism

called “Plummer’s nails”

Question 3

Necrotic migratory erythema (itchy rash that comes and goes) should make you think of what disease etiology? What is its management?

Answer 3

DISEASE: Glucagonoma (maybe with MEN I; less common causes = ‘pseudoglucagonoma’=zinc deficiency, liver dz, IBD)
MANAGEMENT: Insulin administration + surgical resection of pancreatic islet cell tumors

Question 4

What are LH and FSH levels in Klinefelter syndrome?

Answer 4

high LH, very high FSH

Question 5

What is drug used for prostate cancer, endometriosis, breast cancer, uterine fibroids, and precocious puberty?

Answer 5

leuprolide (GnRH agonist)

Question 6

What screening test should be performed in pregnant women between 24th and 28th week of pregnancy?

Answer 6

oral glucose tolerance test (checks for gestational diabetes)

Question 7

Treatment for Wegener’s OR Goodpasture’s syndrome?

Answer 7

steroids + cyclophosphamide

with Goodpasture, may also add anti-GBM Ab removal plasmapheresis

Question 8

acetazolamide: what acid/base effects?

Answer 8

Alkalinizes the urine = treats kidney stones, plus it means more HCO3 excreted = metabolic acidosis (non-AG) to compensate for the respiratory ALKALOSIS of hyperventilation from mountain sickness!

Question 9

what Renal tubular acidosis is associated with diabetes/renal insufficiency, low aldosterone, increased K+, low renin?

Answer 9

type IV (most common)

Question 10

what Renal tubular acidosis is associated with Fanconi’s syndrome, low K+?

Answer 10

type II

Question 11

what Renal tubular acidosis is associated with nephrocalcinosis, low K+, responds well to therapy?

Answer 11

type I

Question 12

What situation is a physician obligated to override HIPAA patient privacy in relation to talking to family members of the patient?

Answer 12

Genetic conditions (i.e. FAP) that they might be affected by (can take “reasonable steps” to warn them)

Question 13

Drugs that cause AV block (7)?

Answer 13

6 of 7 are cardiac meds!

1) adenosine
2) beta blockers
3) CCBs
4) digitalis
5) class I antiarrythmics (Na+)
6) class III antiarrhythmics (K+)
7) lithium

Question 14

In what conditions do you see oxalate stones in the urine?

Answer 14

Chronic diarrheal states because the increased bile salts cause more absorption of oxalate in the bowels, i.e. with IBD
(NOT calcium stones: when they refer to calcium stones ie. from primary hyperparathyroidism/pseudogout, this is calcium phosphate stones!!)

Question 15

What 3 bacteria cause struvite stones?

Answer 15

Proteus, Pseudomonas, and Klebsiella (because they are urease-producing–>alkaline urine)

Question 16

What condition besides gout do you see uric acid stones?

Answer 16

Hypercatabolic states because of increased purine degradation: patients undergoing chemotherapy, myeloproliferative disorders
(also remember these are radiolucent stones)

Question 17

Treatment for allergic rhinitis vs viral rhinitis?

Answer 17

Allergic: acetaminophen & intranasal budesonide
Viral: pseudoephedrine, ibuprofen, nasal saline

Question 18

Two treatment uses of thiazide diuretics outside of HTN/heart dz?

Answer 18

kidney stones and osteoporosis

decrease Ca+2 in urine

Question 19

Two treatment uses of CCBs outside of HTN/heart dz?

Answer 19

Raynaud phenomenon, esophageal spasm

Question 20

Triple therapy for H pylori infection? When to use quadruple therapy for H pylori and what is it?

Answer 20

Triple therapy: PPI + clarithromycin + amoxicillin
Quadruple therapy (if patient previously received macrolide Abx, bc of high resistance, but ALSO IS FIRST LINE BC RESISTANCE HIGH IN MOST OF US): PPI + bismuth + tetracycline + metronidazole

Question 21

Where does each type of hernia protrudes anatomically?:

1) femoral
2) direct inguinal
3) indirect inguinal

Answer 21

1) below inguinal ligament, medial to femoral vein
2) medial to inferior epigastric vessels
3) lateral to inferior epigastric artery

Question 22

3 indicators for long term therapy for COPD patients

Answer 22

1) SaO2 <88%
2) PaO2 <55
3) PaO2 55-59 if R sided HF or erythrocytosis

Question 23

Pseudogout treatment: acute and chronic

Answer 23

acute: NSAIDs
chronic: colchicine

Question 24

Gout treatment: acute and chronic

Answer 24

acute: NSAIDs
chronic: allopurinol

Question 25

3 levels of treatment for plantar fasciitis

Answer 25

1st step (4-6 wks): rest, ice, NSAID, stretching, activity modification/avoidance of flat shoes 2nd step: PT, steroid injection, custom shoe inserts 3rd step/final resort: surgical fasciiotomy

Question 26

Painful, warm, or erythematous fluctuant mass at elbow - management?

Answer 26

SEPTIC BURSITIS (elbow = superficial bursitis, so never do steroid injections for olecranon, prepatella, or retrocalcaneal bursitis) 1) joint aspiration for decompression + gram stain, culture, crystals 2) antibiotic (usually Staph so peniciliin or clindamycin)

Question 27

Fluctuant mass at elbow that is not tender - management?

Answer 27

ASEPTIC BURSITIS | 1) conservative: joint protection, RICE, NSAIDS/tylenol

Question 28

What symptoms to remember associated with Clonorchis sinensis microorganism?

Answer 28

liver fluke (worm) that occludes bile ducts, so obstructive jaundice, cholangitis, cholangiocarcinoma

Question 29

What disease is the source of a pleural effusion with lymphocytes >80%, high adenosine deaminase (>50)?

Answer 29

tuberculosis

Question 30

Light criteria for exudative pleural effusion?

Answer 30

2 of 3: 1) ratio TP pleural fluid : TP serum > 0.5 2) ratio LDH pl fl : LAH serum >0.6 3) LDH pl fl >2/3 upper limit of normal serum LDH

Question 31

What diseases cause very low glucose in pleural effusion?

Answer 31

RA, empyema, malignancy

Question 32

With what etiologies would you see a white, milky pleural effusion with a high TG count?

Answer 32

(*chylothorax*) | with lymphoma and trauma caused by thoracic surgery

Question 33

How do you diagnosis hereditary spherocytosis? How to treat?

Answer 33

Dx: Peripheral smear, then osmotic fragility test Tx: splenectomy + prophylactic pneuococcal & H flu vaccines

Question 34

What is test for patients with B12 deficiency to see if they have pernicious anemia?

Answer 34

Schilling test

Question 35

Carcinoid syndrome diagnosis (2 steps)?

Answer 35

1) 24 hour urine excretion of 5-hydroxyindoleacetic acid | 2) CT scan or somatostatin receptor scintigraphy

Question 36

Carcinoid syndrome treatment?

Answer 36

``` IF RESECTABLE: - resection IF UNRESECTABLE: 1) octreotide (somatostatin) - for flushing/diarrhea 2) theophylline/albuterol for wheezing 3) any tx for diarrhea ```

Question 37

What disease entities can show low voltage QRS on EKG?

Answer 37

- Acute pericarditis (but would also have diffuse ST elevation) - Restrictive cardiomyopathy - Constrictive pericarditis

Question 38

What are the findings that differentiate constrictive pericarditis and restrictive cardiomyopathy?

Answer 38

Constrictive: [+]JVD [+]Kussmaul sign (paradoxical rise in JVD w/ inspiration) [+]pericardial knock (diastolic knocking after 2nd heart sound) [-] ventricular biopsy

Question 39

What # phase of a clinical trial does a drug being tested on small # of healthy volunteers to determine side effects?

Answer 39

Phase I of V | health as in DON'T have the disease treated

Question 40

What # phase of a clinical trial is a large scale/randomized/double blind trial that tests drug against placebo or standard of care?

Answer 40

Phase III of V [while IV of V=after drug has been released, gen surveillance step] [and V of V = years following release of drug]

Question 41

What # phase of a clinical trial is the testing of a drug on a small # patients with the disease?

Answer 41

Phase II of V

Question 42

Treatment of choice for stable but symptomatic patient with a narrow QRS complex tachy with regular rhythm on EKG?

Answer 42

(this is SVTs) adenosine 6 mg IV push + vagal maneuvers if no response, double adenosine, then go to antiarythmics (procainamide/amiodarone/sotalol)

Question 43

Treatment for symptomatic tachycardia in patient with hypotension, cyanotic limbs, decreased O2/urine?

Answer 43

* unstable patient (but NOT pulseless)* | - sedation and synchronized cardioversion

Question 44

What EKG leads show ST elevations for occlusion to left circumflex artery?

Answer 44

I, aVL, V5-V6 if lateral MI (most common)

Question 45

Germ cell tumor of the ovary that causes feminization and precocious puberty?

Answer 45

Granulosa-theca tumor | estrogen-prog releasing; meanwhile Sertoli-Leydig causes virilization bc MALE hormones

Question 46

Renal artery stenosis in young woman: definitive management?

Answer 46

renal artery vascularization via percutaneous angioplasty

Question 47

What electrolyte disturbance leads to Torsades de pointes?

Answer 47

HYPOkalemia

Question 48

Young patient with h/o multiple episodes of syncope triggered by exercise/cold, +/- hearing loss, family history of cardiac death, who has Torsades de pointes on EKG - what is the cause?

Answer 48

Long QT Syndrome

Question 49

Dressler syndrome: what are findings on cardiac auscultation, and what is treatment?

Answer 49

Auscultation: pericardial friction rub (b/c Dressler = a post-MI, autoimmune inflammatory pericarditis!) Tx: high dose aspirin +/- steroids

Question 50

Below what temp + what symptoms defines severe hypothermia and what is the treatment?

Answer 50

below 82 degrees F, with coma, end organ damage, LOSS of shivering Tx: CORE REWARMING with IV warmed crystalloid, warmed humidified O2, active external rewarming -->if fails, go to abd cavity irrigation

Question 51

What EKG leads show ST elevations for occlusion to right main coronary artery?

Answer 51

II, III, aVF (inferior wall MI) + | check R-sided leads (V3 &V4) to assess for RV ischemia

Question 52

In the diastolic murmurs (mitral stenosis and aortic regurg), which is early murmur and which is late with click?

Answer 52

Aortic regurg: early | Mitral stenosis: late with click

Question 53

At what EF in CHF do you install an implantable cardioverter defibrillator?

Answer 53

<30%

Question 54

Older patient with abdominal pain / diarrhea, chronic joint pain, weight loss, and confusion with rhythmic jaw and tongue movements + spontaneous convergence of the eyes, macrocytic anemia and high PT/INR - diagnosis? What do you use to diagnose?

Answer 54

``` Whipple disease (group of neuro findings are called 'oculomasticatory dysrhythmia'; fat-soluble vitamins will be deficient i.e. B12->macrocytic anemia, vit K->high INR) ``` Dx: biopsy of duodenum with PAS staining

Question 55

How to diagnose lactose intolerance?

Answer 55

hydrogen breath test

Question 56

Incompatibility with gestational age on U/S + LMP and with fundal height -- how to work up?

Answer 56

Biophysical profile (U/S to measure fetal growth + amniotic fluid, b/c most common causes of the descrepancy are macrosomia and polyhydramnios)

Question 57

Determining proper gestational age by uterus fundal height - trick to remember?

Answer 57

20 weeks = 20 cm (at umbilicus)