High yield

Question 1

Megaloblastic anemia

Answer 1

Folate vs Vit B12 deficiency

Hypersegmented PMNS +

Methylmalonic acid & Homocysteina ⬆️ > Vit B12 def (Schilling test if no radiolabeled in urine > pernicious anemia)

Normal MMA + Homocysteine ⬆️ > Folate

Non megaloblastic: alcohol liver disease

Question 2

Sickle cell disease complications

Answer 2

HbS

––Aplastic crisis >> Parvovirus b19
––Autosplenectomy 
––Osteomelitis >> Salmonella 
––Dactylitis, priapism, acute chest syndrome
––Renal papillary necrosis

Question 3

Sickle cell presentation

Answer 3

Hemolysis leading to&raquo_space;

––Anemia
––jaundice
––cholelithiasis
––⬆️Cardiac output 
––Infections for encapsulated (pneumococcal sepsis)

Question 4

Hypertension + Hypokalemia

Answer 4

THINK IN–Hyperaldosteronism

Preferred initial screening test: Plasma aldosterone/plasma renin ratio
🚫Spironolactone

> 20 + Aldosterone >15 ng dl&raquo_space;> Aldosterone suppression tests &raquo_space;> IF +&raquo_space; Imaginig

Question 5

Glasgow coma scale

Answer 5

Eye opening- 4
Verbal response- 5
Motor response- 6

Question 6

CMV acute infection

Answer 6

Mononucleosis like symptoms +
Negative heterophile antib and positive cmv Igm

Also&raquo_space; Mild pharyingitis
lymphadenopathy
splenomegaly

Question 7

Ludwig angina

Answer 7

Cellulitis of the submandibular space due to dental infections

Question 8

Central retinal artery occlusion

Answer 8

Acute painless monoocular vision loss
clue: cherry red spot, pupil slow reaction to light

Evaluate for a embolic

Question 9

Retinal vein occlusion

Answer 9

Hemorrhages and venous engorgement

Question 10

Retinal detachment

Answer 10

Flashes & floaters > monocular vision loss

Question 11

Vitreous hemorrhage

Answer 11

History of diabetes

Clue: Sudden loss of vision & floaters
Fundis hard to visualiza

Question 12

Nocardia

Answer 12

Gram + partially acid fasr filamentous branching rods

TB like symptoms> if pulmonary > TMP SMX
If brain abs> Carbapenems

Question 13

Parkinson disease

Answer 13

Tremor
Rigidity
Bradikynesia (narrow based gait, hypokinetic) 👔

Question 14

Metabolic syndrom

Answer 14

At least 3:

• Abdominal obesity (men >40 inches women >35)
• Fasting glucose >110
• Blood pressure >130/80
• Triglycerides >150
• HDL <40 and <50

Insulin resistance key in pathogenesis !!

Question 15

Osteomalacia

Answer 15

⬇️Vit D>
⬇️ Ca++ absorption >
⬆️ PTH >
⬆️Ca++ and ⬆️AP ⬇️ pO4

Question 16

Pure motor weakness

Answer 16

Lacunar stroke

due to microatheromas or lipohyalinosis

Question 17

Lambert Eaton syndrome

Answer 17

Anti b against presynaptic memb voltage gated calcium channels

Proximal muscle weakness
autonomic dysfunction
NO DEEP TENDON REFLExES

tx: guanidine

Question 18

CMV esophagitis

Answer 18

Large linear ulceration on endoscopy

give ganciclovir

Question 19

Necrotizing surgical infection

Answer 19

Emergency!!!

Infection symptoms + SIRS + Paresthesia or anesthesia at the edges + cloudy gray discharge + subcutaneous gas

Antibiotics and debridement!!!

Question 20

Wernicke’s encephalopathy

Answer 20

Due to Thiamine (vit b1 def) > Alcoholics, bullimia

🆗 Encepahlopathy (korsakoff’s dementia> horizontal nystagmus, confabulation, amnesia
)
🆗 Ophtalmoplegia > nystagmmus
🆗 Ataxia

Question 21

Most common chilhood malignancy

Answer 21

ALL

Question 22

Sarcoidosis

Answer 22

Young adults african am
Cough, bilateral hilar adenopathy, hypercalcemia
Biopsy: noncaseating granuloma
Tx: corticoids º

Question 23

Vaccines in chronic liver disease

Answer 23

Influenza
Tdap (Td Booster)
Influenza
Pneumococcal > p23 then pcv 13 and ppsv 23 at age 65
Hep A
Hep B

Question 24

Cyanide toxicity tx

Answer 24

Hydroxicobalamin or sodium thisulfate

Question 25

Causes of methahemoglobinemia?

Answer 25

Dapsone Nitrates Topical or local anesthetics

Question 26

Myotonic muscular dystrophy

Answer 26

``` Most common in young adults Autosomal dominant Facial weakness, dysphagia Arrythmias, cataracts, blading Testicular atrophy ```

Question 27

Duchenne muscular dystrophy

Answer 27

``` X linked recessive 2-3 YO Gower maneuver, progressive weakness cardiomyopathy (Becker: less severe presentation) ```

Question 28

Common variable immunodeficiency

Answer 28

``` Recurrent respiratory and GI infections autoimmune disorders Chronic lung disorders Low Iggs Tx: Iggs replacement ```

Question 29

Alcoholic hepatitis

Answer 29

AST/ ALT >2 ⬆️GGTS bilis INR ⬇️ Albumin Fatty liver

Question 30

Intraductal papilloma

Answer 30

Unilateral bloody nipple discharge | No masses No lymphadenopathy

Question 31

Risks for RDS

Answer 31

Male sex perinatal asphyxia maternal diabetes Cesarean section without labor

Question 32

Familial hypocalciuric hypercalcemia

Answer 32

Hypercalcemia ⬆️ PTH ⬇️ urinary calcium excretion

Question 33

Positive hydrogen breath test

Answer 33

Lactose intolerance

Question 34

Alpha antitrypsin deficiency

Answer 34

COPD at a young age COPD with minimal or no smoking Unexplained liver disease Destruction of lower lobes