Dermatology, ENT, Endocrine/DM/Metabolism

Question 1

treatment of bullous pemphigoid

Answer 1

clobetasol - High potency topical corticosteroid

Question 2

treatment of allergic rhinitis

Answer 2

inhaled cs

Question 3

Most important risk for DM foot ulcers

Answer 3

neuropathy

Question 4

Testing for DM neuropathy v. PAD

Answer 4

DM = monofilament
PAD = ABI

Question 5

ABI tests large or small vessel disease only?

Answer 5

large

Question 6

HSM in infants = ? (general group of diseases)

Answer 6

glycogen storage disease

Question 7

primary ___ insufficiency: low T4 and cortisol and ACTH and FSH/LH/T.

Answer 7

primary pituitary insufficiency

Question 8

Primary ___ insufficiency = low aldosterone.

Answer 8

Primary adrenal insufficiency

Question 9

what sided cardiac disease in carcinoid?

Answer 9

right sided cardiac valve disease

Question 10

describe potassium in DKA

Answer 10

net loss of K, but hyperK in serum dt acidemia and decr insulin activity causing incr K in the extracellular fluid department.

Question 11

What DM drug class causes weigh tloss

Answer 11

GLP-1 (exenatide)

Question 12

one of the most common B9 skin lesions - waxy

Answer 12

seborrheic keratitis

Question 13

aminoglycosides abx, chemo, ASA, loops (furosemide) have what ENT adverse effect?

Answer 13

ototoxicity

Question 14

What is the dx: Can present with – DM, GI sx (diarrhea, anorexia/wt loss, abd pain), NECROLYTIC MIGRATORY ERYTHEMA (erythematous plaques on face and extremitis with enlarging and central clearing and blistering), neuropsych sx.

Answer 14

glucagonoma

Question 15

first step after plapation of thyroid nodule on physical exam?

Answer 15

TSH and ultrasound

Question 16

screen anyone older than ___ age for DM2

Answer 16

45yo

Question 17

DM neuropathy: two types (small and large nerves) - difference in prentation

Answer 17

SMALL fiber injury characterized by POSITIVE sx (pain, paresthesias).
-LARGE fiber injury characterized by NEGATIVE sx (numbness, loss of propr and vibration, diminished ankle reflexes).

Question 18

fatigue, mm weakness, myalgia in BLE. cramping in legs with walking, sluggish ankle jerks. elevated CK. not elevated ESR. dx and diagnostic test.

Answer 18

Hypothyroid myopathy

Question 19

fatigue, mm weakness, myalgia in BLE. cramping in legs with walking, normal ankle reflexes. elevated CK and elevated ESR. dx and diagnostic test.

Answer 19

polymyositis - dx wtih mm bx

Question 20

Koa’s cottage cheese cysts = ?

Answer 20

epidermal inclusion cyst. look for small central punctum.

Question 21

ML type of organism that causes infection/spesis in severe burn?

Answer 21

Answer: Gram negati (pseudomonas) or fungi (candida)

Question 22

uperficial infantile hemangioma = ??????

MOST COMMON B9 vascula tumr in CHILDREN. Capillaries separated by connective tissue. Bright red, blanch with pressure. Can be found in deep tissues and viscera. Present after birth GROW RAPIDLY until 2 years of li REGRESS spontaneously. Minority don’t - give beta blocker.

Answer 22

STRAWBERRY hemangioma.

Question 23

??? = MOST COMMON B9 in ADULTS. small, violaceous - dilated capillaries in papillary dermis.

Answer 23

CHERRY hemangioma

Question 24

When HSV affects hand

Answer 24

HSV affects the HAND = HERPETIC WHITLOW. Grouped vesicles on an erythematous base.

Question 25

nti-pseudomonal abx =

Answer 25

cipro. or pipercillin or ceftazidime.

pip-tazo

Question 26

PEDS: MCC of acute bacterial bacterial rhinosinusitis are _____ and ____

DIAGNOSITC FEATURES (persisten sx 10 or more days; servere sx >102F purulent discharge, 3 or more face pain; worsening sx 5 or more days after intial improvement with viral URI). Viral URI –COT–> Bacterial rhinosinusitis.

Answer 26

strep penumo and hemophilus.

Question 27

young child, 4-8months, with instpiratoyr stridor worse when supine

Answer 27

laryngomalacia

incr laxityof supraglottic structures. dx wtih laryngoscopy. Tx: none - spont resolution

Question 28

eplerenon and spironolactone - what claass?

Answer 28

aldosterone antagonists

Question 29

+anti-TPO + rapidly enlarging firm goiter _ compressive sx (dysphagia, hoarseness)+ B-sx– thin preexisting chronic lymphocytic thyroiditis (HASHIMOTO) that has tunred into ______

Answer 29

THYROID LYMPHOMA.

Question 30

Can Maternal TSH-receptor ab can CROSS THE PLACENTA?

Answer 30

yes

Question 31

Mom has graves. what does baby present with and what do you treat wiht?

Answer 31

presents as thyrotoxicosis in the newborn. tx the methimazole + BB. will resolve in threemo with disappearance of maternal anti

Question 32

thelarche, adrenarche

Answer 32

thelarche = dt estrogen prod by ovaries
-adrenarche = adrenal androgen production dt insulin

Question 33

PResents with BONE P AIN, MUSCLE WEAKNESS/cramps, walking difficulty. LABS: hypoCa, hypoPhos, hypER-PTH. IMAGING: PSEUDOFRACTIRES or thinning of cortex or concave vertebral bodies.

dx?

Answer 33

osteomalacia

Question 34

MCC of osteomalacia?

Answer 34

is Vit D deficiency. think if pt has had intestinal bypass, malabsorption, celiac, CKD, chronic liver disease who spends a lot of time inside.

Question 35

DM med best for weight loss?

Answer 35

GLP-1

exenatide

Question 36

best DM meds to decr A1c? wt association?

Answer 36

Metformin and sulfonylureas (wt neutral and wt gain respectively)

Question 37

42 yo Fwith fatigue, malaise, weakness, wt loss. GI sx. Syncope. Hyperpigemntaiton of plama creases and vitiligo. Dx?

Answer 37

primary adrenal insufficiency

Question 38

primary adrenal insufficiency. - major electrolyte changes seen? deficiency).

Answer 38

A: Hypona (dt Mineralocorticoid loss) and HyperK (Dt aldosterone

Question 39

first test for cushing syndrome or hypercortisolism

Answer 39

vernight LOW-dose dexamethasone suppression test, late night salivary cortisol, 24-hr free cortisol. –> ACTH (THen) to diff bw ACTH-dependent(cushing dz, actopic acth) frm ACTH independent (adrenal adenoma).

Question 40

Suspect hypocortisolism (primary adrenal insufficiency/Addison’s) –> do what two test?

Answer 40

do EIGHT am cortisol an

then plasma ACTH

Question 41

calcium correction for low albumin

Answer 41

Ca correction for albumin is that Ca concentration falls by 0.8mg/dL for eeyr 1mg/dL decrease in albumin.

Question 42

~Low Mg can mess with what two electrolytes?

Answer 42

Ca (hypoCa), Phos (hypoPhos), K. ESP in alcoholics.

Question 43

four types of MEN1 pancreatic/GI enuroendocrine tumors

Answer 43

gastrinoma (ZES - recurren peptic ulcerS), insulinoma (hypogly), glucagonima (wt loss, nec migr erythema, hyperglycemia), VIPoma (secr diarrhea, hypoK, hypoCl)

Question 44

ORAL ESTROGEN (ie. OCPs) does what to TBG?

Answer 44

DECREASE clearance of TBG, so elevate TBG levels. So, in pt with nml thyroid fxn - increase in thyroxine production to saturate the increased # of TBG binding sites. If pt is hypothyroid, will nto be able to compensate unless increased dose of levothyroxine.

Question 45

If a pt is going through menopause (or pregnant), HRT (estrogen) would resutl in what requirement for levothyroxine.

Answer 45

INCREASE

Question 46

CA-125 is marker for: (think postmenopausal women)

Answer 46

epithelial ovarian cancer.

Question 47

describe estrogen and progesterone relationship to endometrium

Answer 47

estrogen builds endometrium. Progesterone produced in corpus luteum AFTER ovulation, and PROGESTERONE WITHDRAWAL as luteum degenerates makes sloughing = menses.

Question 48

pt has amenorrhea.

nml progesterone withdrawal bleeding signifies that what?

Answer 48

estrogen production is normal and that paroblem lies in progesterone.]