Figure it out, man

Question 1

What are some potential side effects of cyclophosphamide?

Answer 1

Hemorrhagic cystitis
Bladder cancer
Sterility
Myelosuppression

Question 2

What is a more common nephrotic syndrome, membranous or membranoproliferative?

Answer 2

Membranous is more common

MPGN can be either nephritic or nephrotic

Question 3

What is the next step if a FAST exam is inconclusive after blunt abdominal trauma?

Answer 3

Diagnostic Peritoneal Lavage

Question 4

A patient has occasional flushing, diarrhea, abdominal cramps, a right-sided valve issue, and occasional bronchospasms. What does this person likely have? What else could be going on?

Answer 4

Carcinoid syndrome

Niacin (B3)…dermatitis, diarrhea, and dementia

Question 5

How can central retinal artery occlusion be treated?

Answer 5

Intra-arterial thrombolytics w/in 4-6 hours

Ocular massage and high flow oxygen

Question 6

What causes the D-xylose test to have low D-xylose in the urine?

Answer 6

Celiac’s disease and other proximal small intestine malabsorption diseases

Question 7

What is the most premalignant colon polyp?

Answer 7

Villous

Question 8

How does tamoxifen work? What is a potential side effect?

Answer 8

It is a Selective Estrogen Receptor Modulator (SERM)…it has both agonist and antagonist effects

It can cause endometrial cancer

Question 9

What differentiates an acute leukemoid reaction from CML?

Answer 9

Leukemoid reaction has an elevated Leukocyte Alkaline Phosphatase (LAP)
CML has a decreased LAP

Question 10

Old lady has vulvar excoriations, and skin is thin, dry, and white. What should be done? What is likely? What can be done?

Answer 10

Vulvar punch biopsy…possibly lichen sclerosus et atrophicus

Treat with topical corticosteroids

Question 11

An older person has periods of decreased alertness and visual hallucinations and has had balance issues. What should be considered?

Answer 11

Lewy-body dementia

Question 12

What can cause hypotension after an epidural is placed? How can it be prevented? How can it be managed?

Answer 12

Blockage of sympathetic nerves responsible for vascular tone

Aggressive IV fluid expansion prior to placement

Put mom on her left side (improves venous return); fluids; pressors

Question 13

A child is found to have elevated lead levels on capillary blood draw?

Answer 13

Draw venous lead level

Undetectable –> nothing to do
5-44 –> redraw in 1 month
44-69 –> DMSA
70+ –> dimercaprol + EDTA

Question 14

What happens physiologically with ARDS?

Answer 14

Decreased lung compliance
Impaired gas exchange
Pulmonary hypertension

Question 15

When is trihexyphenidate used?

Answer 15

Newly diagnosed Parkinson’s patients with tremors as only real concern

Question 16

What is affected with GBS?

Answer 16

Peripheral nerve demyelination

Question 17

Which lung cancer secretes PTHrP?

Answer 17

Squamous cell carcinoma

Question 18

How can lactose deficiency be diagnosed?

Answer 18

Hydrogen breath test after lactose ingestion

Question 19

When can ‘Odds Ratio’ and ‘Relative Risk’ be considered the same?

Answer 19

Rare diseases

Question 20

Where do most PEs come from?

Answer 20

Proximal deep veins: iliac, femoral, popliteal

Question 21

A person with expected HIV presents with an illness. What should be done?

Answer 21

Treat the illness…wait to start HAART until after well (risk of immune reconstruction syndrome)

Question 22

What is the most common cause of erysipelas?

Answer 22

Strep pyogenes (GAS)

Question 23

What is the first approach to treating alzheimer disease?

Answer 23

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

Question 24

Young, otherwise healthy young man has chronic low back pain that is worse at night and better with activity + elevated ESR = ?

Answer 24

Ankylosing spondylitis…can have restricted chest wall motion

Question 25

Thin, green, vaginal discharge that smells…

Answer 25

Trichomoniasis (flagellated organism)…treat couple with metronidazole

Question 26

What can be given to measles patients to reduce morbidity/mortality?

Answer 26

Vitamin A…Immune enhancement + GI and respiratory epithelium regeneration

Question 27

What is the believed cause of vitiligo?

Answer 27

Autoimmune

Question 28

A Marfanoid patient has a pheochromocytoma and elevated calcitonin in the presence of a hard thyroid nodule. What does this patient likely have? What else has to be considered?

Answer 28

MEN2B (RET-oncogene)

Mucosal (tongue, eyelids, lips) and intestinal neuromas

Question 29

What is the most common cause of bacterial pneumonia in kids (less than 20yo)? Adults?

Answer 29

Kids get staph a infections

Adults get pseudomonas infections

Question 30

How does risperidone cause decreased libido?

Answer 30

Decreased dopamine activity in the tuberoinfundibular pathway

Question 31

A patient has a predominant mood disorder…but has multiple episodes of schizophrenia like symptoms in the absence of mood disorder. What is the diagnosis?

Answer 31

Schizoaffective disorder

Question 32

How is candida vaginitis treated?

Answer 32

Oral fluconazole

Question 33

How are absence seizures treated?

Answer 33

Ethosuximide; OR

Valproic acid

Question 34

What are some possible effects of nephrotic syndromes?

Answer 34

Hyperlipidemia

Increased coagulability

Question 35

Patient has conjunctivitis with corneal neovascularization (pannus). What is the diagnosis?

Answer 35

Chlamydia trachomatis serotype A-C…Trachoma

Question 36

What is the most common form of kidney disease with HIV?

Answer 36

FSGS

Question 37

What can be used to help with ALS?

Answer 37

Riluzole…glutamate inhibitor