I didn't know that :/

Question 1

Patient with type 2 DM who presents with a UTI, blurred vision and signs of dehydration should raise suspicion of a

Answer 1

hyperosmolar hyperglycemic state (HHS)

Question 2

Patients with type 2 DM have a reduced insulin secretion capacity, leading to acute ___ in times of stress (infections, surgery, trauma)

Answer 2

hyperglycemia

due to increased insulin demand

Question 3

Thyroid nodule felt on physical exam. What do next?

2-3

Answer 3

Get TSH levels→ RAIU → If HOT get fT4 levels → if COLD ≥ 1cm get FNA → Cytology

(Fine needle biopsy)

Question 4

In a cirrhotic patient who underwent TIPS, increasing confusion, irritability, and an altered sleep-wake cycle, as well as a below-average performance in the number connection test, should raise suspicion of

Answer 4

hepatic encephalopathy (HE)

Can be 2/2 Constipation

Question 5

What is the first-line treatment for acute hepatic encephalopathy

Answer 5

lactulose (1st line)

(Improves HE by decreasing absorption of AMMONIA in the bowel & is a laxative for constipation)

Rifaximin (add on med)

a poorly absorbed ABx that reduces ammonia production by eliminating ammonia-producing colonic bacteria.

Question 6

H/o hematochezia, anal pruritus, painful defecation, and weight loss in a patient with an exophytic, friable, ulcerated mass above the anal verge/ BELOW dentate line is suggestive of

Answer 6

Anal Squamous cell carcinoma

Biopsy (if a female, get gynecologic screen)

Question 7

Risk factors for Anal SCC

2

Answer 7

HIV

HPV

Question 8

Chronic excessive alcohol intake causes what 2 electrolyte abnormalities?

Answer 8

hypocalcemia
hypomagnesemia

(Replace hypomagnesemia first otherwise Ca will not respond)

Question 9

Hypothyroidism can cause what neurological finding especially in obese patients?

Answer 9

Carpal Tunnel

treat the hypothyroidism

Question 10

1st line treatment for patients with essential tremor and asthma or COPD?

Answer 10

Primidone (barbituate)

not propanolol

Question 11

Elevated BUN, elevated creatinine, and hyperkalemia, as well as signs of volume overload (pitting edema, jugular venous distention), in conjunction with a history of untreated SLE, are concerning for

Answer 11

renal failure

2/2 lupus nephritis

Question 12

Asymptomatic microhematuria and risk factors for urothelial carcinoma such as nicotine abuse, age > 35, and reccurent UTIs.
Next step is to obtain what?

Answer 12

CT Urography

to r/o cancer

Question 13

Edema, massive proteinuria, fatty casts, hypoalbuminemia, and hyperlipidemia are suggestive of

Answer 13

nephrotic syndrome

thickened loops/ spike & domes

Question 14

Hypertrophic osteoarthropathy (HOA) presents with arthritis, digital clubbing, and periostal thickening of the distal diaphysis of long bones.

Associated with what malignancy?

Answer 14

adenocarcinoma of the lung

Question 15

can be used to treat acute postoperative urinary retention, postpartum urinary retention, or urinary retention in patients with a neurogenic bladder

Answer 15

Bethanechol

M3 agonist

Question 16

Decreased breath sounds, hyperresonant percussion, and decreased tactile fremitus are consistent with pulmonary hyperinflation, which can be 2/2

Answer 16

severe asthma exacerbation

wheezing not always present

Question 17

___ may result in aortic regurgitation (due to involvement of the aortic valve), which causes an early diastolic murmur that is heard best at the right upper sternal border.

Answer 17

Aortic dissection

Question 18

Conjunctival injection, accumulation of pus in the anterior chamber (hypopyon), and a round corneal infiltrate (ulcer) w/ a h/o contact lenses = infective Keratitis caused by what bacteria?

Answer 18

Pseudomonas

Question 19

The presence of neutrophilia (segmented) without left shift (no increase in bands) is classic for ____ -induced leukocytosis.

Answer 19

glucocorticoid

Question 20

Patient presents with systemic (fatigue, fever, weight loss) and musculoskeletal symptoms (symmetric pain in the shoulders and hips, morning stiffness w/o weakness on PE) as well as elevated ESR/CRP.

These features are consistent with

Answer 20

polymyalgia rheumatica (PMR)

tx: low dose steroids

Question 21

Empiric antibiotic treatment for vertebral OSTEOMYELITIS should provide coverage against staph (including MRSA), strep, & gram (–)

What 2 Abxs would you use:

Answer 21

Vancomycin (staph/MRSA)
\+
Cefepime (anti-pseudomonal, Gram+/–)
or
Ciprofloxacin/Levofloxacin (anti-pseudomonal FQ, Gram+/–)

Question 22

__ is commonly used to treat arthritic gout and ankylosing spondylitis.

Answer 22

Indomethacin (NSAID)

Question 23

In cases of massive PE with hemodynamic instability (e.g., SBP < 90 mm Hg), ___ is indicated.

Answer 23

Thrombolysis with alteplase or tissue plasminogen activators (tPA)

Question 24

Anticoagulation with ___ is appropriate treatment for patients with hemodynamically stable PE.

Answer 24

heparin, rivaroxaban, warfarin, or apixaban

Question 25

Cocaine can induce acute lung toxicity in the form of diffuse

Answer 25

alveolar hemorrhage (DAH)

crackles

Question 26

New-onset asthma can present as an acute exacerbation

Treatment includes (2)

Answer 26

Albuterol (SABA)

Prednisone (glucocorticoid)

Question 27

Supplemental oxygen in patients with advanced COPD can worsen hypercapnia due to a combination of (2)

Answer 27

1. increased dead space perfusion causing v/q mismatch
2. decreased affinity of oxyhemoglobin for CO2
3. reduced alveolar ventilation (decr min ventilation)

Question 28

___ in patients with acute COPD exacerbation helps to unload the work of breathing and decreases mortality and need for intubation.

Answer 28

Noninvasive positive pressure ventilation