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Boards Step 3 > COMBANK questions > Flashcards

COMBANK questions Flashcards

1
Q

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?

A

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

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2
Q

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

A

Graves disease / hyperthyroidism

called “Plummer’s nails”

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3
Q

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

A

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

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4
Q

What are LH and FSH levels in Klinefelter syndrome?

A

high LH, very high FSH

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5
Q

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

A

leuprolide (GnRH agonist)

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6
Q

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

A

oral glucose tolerance test (checks for gestational diabetes)

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7
Q

Treatment for Wegener’s OR Goodpasture’s syndrome?

A

steroids + cyclophosphamide

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

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8
Q

acetazolamide: what acid/base effects?

A

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!

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9
Q

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

A

type IV (most common)

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10
Q

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

A

type II

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11
Q

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

A

type I

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12
Q

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

A

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

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13
Q

Drugs that cause AV block (7)?

A

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

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14
Q

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

A

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!!)

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15
Q

What 3 bacteria cause struvite stones?

A

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

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16
Q

What condition besides gout do you see uric acid stones?

A

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

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17
Q

Treatment for allergic rhinitis vs viral rhinitis?

A

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

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18
Q

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

A

kidney stones and osteoporosis

decrease Ca+2 in urine

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19
Q

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

A

Raynaud phenomenon, esophageal spasm

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20
Q

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

A 
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
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21
Q

Where does each type of hernia protrudes anatomically?:

1) femoral
2) direct inguinal
3) indirect inguinal

A

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

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22
Q

3 indicators for long term therapy for COPD patients

A

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

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23
Q

Pseudogout treatment: acute and chronic

A

acute: NSAIDs
chronic: colchicine

24
Q

Gout treatment: acute and chronic

A

acute: NSAIDs
chronic: allopurinol

25
Q

3 levels of treatment for plantar fasciitis

A

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

26
Q

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

A

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)

27
Q

Fluctuant mass at elbow that is not tender - management?

A

ASEPTIC BURSITIS

1) conservative: joint protection, RICE, NSAIDS/tylenol

28
Q

What symptoms to remember associated with Clonorchis sinensis microorganism?

A

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

29
Q

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

A

tuberculosis

30
Q

Light criteria for exudative pleural effusion?

A

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

31
Q

What diseases cause very low glucose in pleural effusion?

A

RA, empyema, malignancy

32
Q

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

A

(chylothorax)

with lymphoma and trauma caused by thoracic surgery

33
Q

How do you diagnosis hereditary spherocytosis? How to treat?

A

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

34
Q

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

A

Schilling test

35
Q

Carcinoid syndrome diagnosis (2 steps)?

A

1) 24 hour urine excretion of 5-hydroxyindoleacetic acid

2) CT scan or somatostatin receptor scintigraphy

36
Q

Carcinoid syndrome treatment?

A 
IF RESECTABLE:
- resection
IF UNRESECTABLE:
1) octreotide (somatostatin) - for flushing/diarrhea
2) theophylline/albuterol for wheezing
3) any tx for diarrhea
37
Q

What disease entities can show low voltage QRS on EKG?

A
  • Acute pericarditis (but would also have diffuse ST elevation)
  • Restrictive cardiomyopathy
  • Constrictive pericarditis
38
Q

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

A

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

39
Q

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

A

Phase I of V

health as in DON’T have the disease treated

40
Q

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

A

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]

41
Q

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

A

Phase II of V

42
Q

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

A

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

43
Q

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

A
  • unstable patient (but NOT pulseless)*

- sedation and synchronized cardioversion

44
Q

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

A

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

45
Q

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

A

Granulosa-theca tumor

estrogen-prog releasing; meanwhile Sertoli-Leydig causes virilization bc MALE hormones

46
Q

Renal artery stenosis in young woman: definitive management?

A

renal artery vascularization via percutaneous angioplasty

47
Q

What electrolyte disturbance leads to Torsades de pointes?

A

HYPOkalemia

48
Q

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?

A

Long QT Syndrome

49
Q

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

A

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

50
Q

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

A

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

51
Q

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

A

II, III, aVF (inferior wall MI) +

check R-sided leads (V3 &V4) to assess for RV ischemia

52
Q

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

A

Aortic regurg: early

Mitral stenosis: late with click

53
Q

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

A

<30%

54
Q

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?

A 
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

55
Q

How to diagnose lactose intolerance?

A

hydrogen breath test

56
Q

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

A

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

57
Q

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

A

20 weeks = 20 cm (at umbilicus)

Boards Step 3 (4 decks)

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