Form 1 Block 1 - Created July 18

Question 1

depression versus grief

Answer 1

both: sad, anhedonia, sleep and appetite change, impaired concentration
grief: sadness less persistent, no low self-esteem, no excess in guilt, no SI

Question 2

what to do with kid who swallowed a coin

Answer 2

do endoscopy if UNKNOWN time of ingestion, > 24 hrs, or having SYMPTOMS

Question 3

when to operate on AAA

Answer 3

having sxs, size >2x normal aorta, size >5.5cm, growth >0.5 cm over 6 months

Question 4

when to do parathyroidectomy

Answer 4

age <50, symptomatic hyperCa, osteoporosis, kidney stones, CKD, U Ca excretion >400 mg/day

Question 5

what to do with high PTH patient if parathyroidectomy not indicated

Answer 5

follow-up with serum Ca, Cr, and DXA testing

Question 6

high-intensity statins

Answer 6

atorva 40-80 mg

rosuva 20-40 mg

Question 7

when to give high-intensity statins

Answer 7

1. all patients < 75 with established ASCVD
2. LDL >190
3. age>40 w/ DM and 10 yr risk >20%
4. high 10yr risk otherwise

Question 8

description of erythema multiforme and leading cause of it

Answer 8

erythematous plaques with central clearing that begin on limbs; HSV

Question 9

what to do in pt with breast mass and > 30 yo

Answer 9

do diagnostic mamm first

a) when it’s benign or indeterminate, do U/S next to characterize the mass
b) if malignant, do core needle biopsy

Question 10

what to do in pt with breast mass and < 30 yo

Answer 10

do U/S first

a) simple cyst - needle
b) can’t tell - mamm
c) complex cyst/mass - biopsy

Question 11

presentation of PE

Answer 11

SOB, pleuritic CP, sinus tachycardia, hypoxemia

Question 12

CT appearance of pulmonary infarct (possible complication of acute PE)

Answer 12

hemispherical consolidation abutting the pleura (look for wedge-like appearance)

Question 13

bleomycin pulmonary fibrosis on CT

Answer 13

diffuse pattern of reticular septal thickening and honeycombing

Question 14

cells from which HCC arises; tumor marker

Answer 14

liver parenchyma; AFP

Question 15

who can “request” organ donation from a family

Answer 15

Organ Procurement Organization staff member or a physician who has undergone specialized training

Question 16

prostate cancer: very low-risk

Answer 16

1. Gleason score of 6 or less with < 3 cores affected
2. normal DRE
3. PSA < 10

Question 17

prostate cancer surveillance in very low-risk individuals

Answer 17

1. PSA q3-6 mo.
2. DRE qYr
3. repeat prostate biopsy in 1 yr

Question 18

presentation of inhalant use

Answer 18

transient euphoria, lethargy, poor coordination, LOC, may look drunk; lasts 15-45 minutes

Question 19

presentation of cocaine use

Answer 19

tachycardia, HTN, euphoria, hyperarousal

Question 20

presentation of pertussis

Answer 20

1st: 1-2 wks URI sxs
2nd: 2-6 wks of cough w/ insp. whoop, posttussive V, apnea

Question 21

dx and tx of pertussis

Answer 21

dx: Cx or PCR; lymphocytic leukocytosis
tx: macrolides to pt and close contacts

Question 22

presentation of sarcoidsosis

Answer 22

Afr.Am., gradual onset of SOB, cough, malaise, wt loss; imaging shows ILD (opacities, nodules, cysts, fibrosis) and hilar LAP

Question 23

confirmation of dx

Answer 23

noncaseating granulomas on transbronchial biopsy

Question 24

silicosis CXR

Answer 24

multiple, bilateral, small/round nodules in upper lobes

Question 25

when to do surgery for kids with inguinal hernia

Answer 25

Asx: 1-2 wks
Incarceration: immediate

Question 26

when to do surgery for hydrocele; varicocele; undescended testis

Answer 26

hydro: resolves by age 1
varico: early puberty
testis: 6 months

Question 27

orthostatic hypotension

Answer 27

> 20 mmHg drop in SBP or >10 mmHg drop in DBP

Question 28

contraindications to menopausal hormone therapy

Answer 28

coronary heart dz, active liver dz, h/o breast cancer, venous thromboembolism, or stroke

Question 29

possible meds that can interact with statins and cause statin-induced myopathy

Answer 29

cyclosporine, HIV protease inhibitors, gemfibrozil, macrolides

Question 30

timing of pneumococcal vaccines in adults

Answer 30

PPSV23 - <65 with severe dz and again at age 65

PCV13 - at age 65 if pt didn’t get it before

Question 31

Kawasaki criteria

Answer 31

Fever > 5 days plus 4 of CREAM:
Conjunctivitis
Rash
Edema (hands/feet)
Adenopathy (cervical)
Mucositis

Question 32

what to suspect with only prolonged aPTT, in setting of easy bruising

Answer 32

hemophilia A and B (XR, prior h/o of bleed), von Willebrand dz (prior h/o bleed), and certain acquired disorders (like coagulation factor inhibitor)

Question 33

what to do if pt has new atrial flutter or fib for >48 hours

Answer 33

start anticoagulation and continue for 3/+ wks (warfarin, apixaban, rivaroxaban, dabigatran)

Question 34

meds for rate and rhythm control of a.fib or flutter

Answer 34

rate: digoxin
rhythm: amiodarone

Question 35

chemical cardioversion of a.fib or flutter

Answer 35

IV ibutilide