COMQUEST

Question 1

Symptoms of acute rheumatic fever. Cause of rheumatic fever?

Answer 1

Cause: untreated group A strep pharyngitis
Symptoms: skin findings (erythema marginatum, subcutaneous nodules), central nervous system involvement (Sydenham chorea), arthritis, and pancarditis

Question 2

Most common causes of drug-induced lupus erythematosus? Symptoms?

Answer 2

Most commonly caused by hydralazine, procainamide, quinidine, and isoniazid (can also be caused by sulfa drugs, methyldopa, minocycline, phenytoin, and TNF-alpha inhibitors).
Symptoms: fatigue, joint pain, skin rash, and flu-like symptoms

Question 3

What condition has positive anti histone antibodies?

Answer 3

Drug-induced lupus erythematosus

Question 4

What condition has anti centromere antibodies?

Answer 4

systemic sclerosis

Question 5

Symptoms of limited sclerosis

Answer 5

CREST syndrome (calcinosis cutis, Raynaud phenomenon, esophageal hypo motility (peristalsis and a hypotonic lower esophageal sphincter), sclerodactyly, and telangiectasias)

Question 6

What condition has anti-double stranded DNA antibodies?

Answer 6

systemic lupus erythematosus (presence of these antibodies also conveys an increased risk of lupus nephritis in the future)

Question 7

What condition has positive anti-SSA antibodies?

Answer 7

Sjogren’s syndrome

Question 8

Symptoms of Sjogren’s syndrome

Answer 8

dry eyes, dry mouth, and parotid gland enlargement

Question 9

Slipped capital femoral epiphysis (SCFE) - Age, symptoms? Risk factors?

Answer 9

Obese male children age 10-15

Symptoms: dull aching pain in the hip, goin, thigh, or knee with no history of trauma, altered gait/limp

Risk factors: obesity, renal failure, endocrine abnormality (hypothyroidism, growth hormone deficiency), genetic disorders (Down and Rubinstein-Taybi syndromes)

Question 10

An infant is brought to the offie and can turn his head toward the sound of the door opening, smile directly at the physician and make cooing sounds. When placed prone, he lifts up his head and shoulders and is able to support his upper body with his forearms. He opens and shuts his hands and occasionally swipes at visible objects. He is unable to remain seated without support. What age is the patient?

Answer 10

3 months

Question 11

A baby that can sit without support, roll both ways, reach with one hand, transfer objects from hand-to-hand, uses a raking grasp, babbles, responds to their name, explores using their hands and mouth, and can distinguish emotion by tone of voice is what age?

Answer 11

6 months

Question 12

A baby that crawls well, pulls to stand, uses and immature three-finger pincer grasp, holds a bottle, and is able to throw an object is what age? This baby is able to say mama and dada indiscriminately, wave bye-bye, and enjoys peek-a-boo.

Answer 12

9 months

Question 13

This baby may be shy with strangers, finger-feeds themselves, responds to “no,” can use one to three words, and points in order to get a desired object. Motor skills include standing momentarily without support, moving from sitting to crawling or prone, taking independent steps, and using a two-finger pincer grasp to pick up small objects. What age is this baby?

Answer 13

12 months

Question 14

This baby creeps up stairs, walks backward independently, builds a tower of two blocks, climbs onto furniture, and walks holding an object. This baby can use 3-5 words, can point to one body part, and follow a one-step command. What age is this baby?

Answer 14

15 months

Question 15

You see ringed sideroblasts on peripheral blood smear. What causes that?

Answer 15

Sideroblastic anemia - can be caused by isoniazid, chronic alcohol abuse, chloramphenicol, lead poisoning, neoplastic disease, and genetic causes

Question 16

What lab findings do you expect with sideroblastic anemia?

Answer 16

increased serum iron, increased ferritin, and normal (or slightly decreased/increased) TIBC

Question 17

What is the treatment for sideroblastic anemia?

Answer 17

removal of the offending agent and treatment based on cause. If isoniazid is the cause, continue isoniazid with pyridoxine (Vitamin B6)

Question 18

Anisakis simplex - how to get it? Symptoms?

Answer 18

Zoonotic roundworm obtained by ingestion of raw or undercooked fish (most common being salmon, herring, cod, mackerel, squid, and red snapper)

Symptoms: due to direct tissue damage. The worm burrows through the wall of the small intestine where it dies and forms an abscess, leading to bowel obstruction

Question 19

Ascaris lumbricoides - how do you get it? Symptoms?

Answer 19

parasitic nematode obtained by consumption of infected, undercooked pork or chicken liver or by fecal-oral route

Symptoms: mostly asymptomatic but pulmonary and gastrointestinal symptoms can occur

Question 20

Dracunculus medinensis - how do you get it? Symptoms? Treatment?

Answer 20

guinea worm ingested in contaminated water

Symptoms: worm migrates under the skin, causing intense pruritus and pain. If the patient soaks his leg in water to soothe the pain, the worm does out of the skin and releases eggs into the water

Treatment: worm physically extracted from skin

Question 21

Schistosome mansoni - disease, cause, symptoms?

Answer 21

Causes a human disease called bilharziasis

Infection occurs in Africa after swimming in infested freshwater where the larvae penetrate the skin

Symptoms: skin lesion at the site of penetration, allergic reaction, diarrhea, and abdominal pain

Question 22

Trichinella spiralis - how is it obtained? Symptoms?

Answer 22

obtained from consumption of undercooked meat of mammals, mostly pigs, hoarse, bear, moose, and rodents.

Symptoms: short GI illness followed by severe pain, muscles, tenderness, and swelling when larvae embed themselves in skeletal muscle. Periorbital edema, difficulty breathing, and difficulty moving are seen. Cardiac muscle can be involved and cause myocarditis, which is the most common cause of death

Question 23

TTP path, cause, findings

Answer 23

thrombosis in small blood vessels and thrombocytopenia

Cause: congenital or acquired deficiency of ADAMTS 13 protease

Peripheral smear: schistocytes
Low levels of ADAMTS 13 protease activity

Question 24

Hemolytic uremic syndrome path

Answer 24

microagniopathic hemolytic anemia and progressive renal failure

On exams: think of HUS with a child presenting with microangiopathic hemolytic anemia and acute renal failure occurring after infection with Shigella dysenteries or E. coli

Question 25

ITP path/presentation

Answer 25

autoimmune disorder in which anti platelet antibodies facilitate splenic sequestration and phagocytosis by mononuclear macrophages

Presentation: isolated thrombocytopenia without anemia

Question 26

How do you test for infant botulism?

Answer 26

gold-standard confirmation test for botulism is isolation of the clostridium botulinum toxin from stool, vomit, or food sources