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Question 1

MCC of MR?

Answer 1

MVP (developed nations).

Question 2

An HIV pt with CD4 count under 50 and diarrhea potentially has?

Answer 2

Mycobacterium avium or CMV. Hematochezia and abdominal pain is common in CMV. High fever (>102°) and watery diarrhea occurs in Myco. Weight loss occurs in both.

Question 3

What other organisms cause diarrhea in HIV?

Answer 3

Cryptosporidiosis causes watery diarrhea with CD4<200. Microsporidium if CD4<100. Entamoeba, giardia, Kaposi sarcoma (hematochezia) as well.

Question 4

Why is BUN elevated in prerenal AKI?

Answer 4

Hypovolemia causes reduced renal blood flow which activates RAAS. Increased salt/water uptake occurs and passive urea absorption occurs also causing somewhat increased BUN/Cr ratio (>20:1). Injury does not technically occur unless prolonged leading to acute tubular necrosis. Thus, UA is unremarkable (no protein, cells, casts).

Question 5

Ventricular aneurysms expected when after MI and with what EKG findings?

Answer 5

Weeks to months after MI. Present with persistent ST -segment elevation after MI and deep Q waves in same leads.

Question 6

Long term effects of ventricular aneurysms?

Answer 6

LV enlargement that leads to HF, angina, arrythmia, mural thrombus, or mitral annular dilation with MR. Confirm with Echo.

Question 7

Correction of folate but not B12 in a man with signs of anemia and neurologic complications lead to what sequelae?

Answer 7

Rapidly worsening of neurologic complications with mild correction of megaloblastic anemia. The worsening occurs for unknown reasons.

Question 8

Rx for primary or secondary syphillis?

Answer 8

IM PCN G benzathine. Confirm effective Rx with 4-fold decrease in serologic titers at 6-12 months.

Question 9

Rash begins where and moves where in syphillis?

Answer 9

Centripetally (on trunk) moving outward to the hands/feet.

Question 10

Rash begins where and moves where in Rocky Mountain Spotted Fever?

Answer 10

Spreads toward the trunk from the hands and feet.

Question 11

Man presents with fever, low platelets (<20,000), severe anemia, and high reticulocytes. He has small nonpalpable purple spots on his legs. Creatinine is elevated and he is confused. Dx?

Answer 11

Thrombotic thrombocytopenic purpura. This condition occurs due to decreased ADAMTS13 activity. Note the super low platelets. Though this may appear similarly to a cryoglobinemia with purpura and anemia and such. Cryoglobinemia does not have low platelets and usually has low C4.

Question 12

What is the MC malignancy of the lip?

Answer 12

SCC. 95% of cases occur in the lower lip vermilion.

Question 13

For a study to be statistically significant, the 95% confidence interval must NOT contain what?

Answer 13

The Null value. eg the 95% CI cannot span 0.85 - 2.1 as it would contain 1, which is the null value.

Question 14

What lab value has a high predictive value for diagnosing gallstone pancreatitis in the presence of pancreatitis symptoms?

Answer 14

ALT>150 U/L. Some studies show that this value has a 95% predictive value for gallstone pancreatitis.

Question 15

When is ERCP recommended in patients with gallstone pancreatitis?

Answer 15

In the case of cholangitis, visible common bile duct dilation/obstruction, or increasing liver enzyme levels.

Question 16

What is the Rx of choice for aspergillosis?

Answer 16

Voriconazole.

Question 17

Anyone with blue feet or toes and signs of possible arterial occlusion elsewhere (AKI, stroke, plaques on fundoscopy, intestinal ischemia, etc) after cardiac cath or any wire guided cardiac procedure most likely have?

Answer 17

Cholesterol crystal embolism (atheroembolism). Livedo reticularis (blanching netlike discoloration), gangrene, and ulcers of the fingers/toes are common skin signs. Eosinophilia, eosinophiluria, and hypocomplementemia are common lab findings.

Question 18

Casts in contrast induced nephropathy?

Answer 18

Muddy-brown granular casts or epithelial cell casts.

Question 19

What is the most accurate dating method of gestational age?

Answer 19

US dating with fetal crwon-rump measurement in the first trimester is the most accurate way to determine estimated GA. Dating should NOT be changed if second or third trimester measurements do not align with this.

Question 20

First line Rx for HTN in pregnancy?

Answer 20

Beta blockers
Calcium channel blockers
Hydralazine
Methyldopa

Question 21

Second line Rx in HTN in pregnancy?

Answer 21

Clonidine
Thiazides
***ACEI/ARBs/renin inhibitors, Nitroprusside, spirinolactone, and loop diuretics are all contra’d.

Question 22

What renal etiology is responsible for a normal anion gap acidosis and failure to thrive in a newborn?

Answer 22

Renal tubular acidosis type 1 or 2.

Type 1 likely genetic disorder in neonates. Type 2 likely Fanconi syndrome (glucosuria, phosphaturia, aminoaciduria).

Question 23

Summarize Type 1, 2, and 4 RTA cause.

Answer 23

1: retain hydrogen in DCT
2: poor HCO3- resorption in PCT
* **First two are hypokalemic metabolic acidosis
4: Aldosterone resistance causes K+ retention and hyperkalemia leads to hyperkalemic, hyperchloremic, metabolic acidosis

Question 24

What does hydroxyurea do in sickle cell disease?

Answer 24

Reduce Hgb S concentration by increasing HgbF concentration causes less occlusive crises.

Question 25

How does acalculous choleecystitis present?

Answer 25

Fever, leukocytosis in a critically ill person with GB thickening and distention with pericholecystic fluid on Xray. Rx is percutaneous cholecystectomy.

Question 26

When would MRI be necessary for radiculopathy?

Answer 26

If progressive sensory or motor deficits, signs of cauda equina syndrome (saddle anesthesia), or epidural abscess signs arise (fever, IV drug use).

Question 27

What is next step in management of a young man who recently exercised and is now presenting with pain that radiates from the lower back to the foot?

Answer 27

NSAIDs. Conservative treatment always first. Most Pts experience spontaneous resolution.

Question 28

Pyridoxine leads to what kind of anemia?

Answer 28

Sideroblastic anemia. This is a microcytic/hypochromic anemia similar to iron deficiency, but iron studies show elevated iron levels and low TIBC.

Question 29

What is the most important pathogenic factor in Zenker’s diverticulum?

Answer 29

Motor dysfxn (esophageal dysmotility). Occurs above the upper esophageal sphincter in the cricopharyngeal muscle. Dx is barium esophagram and Rx is surgical.

Question 30

Lateral medulla infarct leads to?

Answer 30

Wallenberg syndrome (PICA or vertebral artery occlusion). Characterized by loss of pain/temperature over ipsilateral face and contralateral body. Ipsilateral bulbar muscle weakness occurs as well, though motor fxn of face/body is spared. Vestibulocerebellar impairment and Horner’s syndrome also occur. These Sx are more common to the medulla due to CN 9 and 10 involvement.

Question 31

Lateral mid-pontine lesion leads to?

Answer 31

Motor and sensory nuclei of the ipsilateral trigeminal nerve (CNV) are damaged, causing weakness in mastication muscles, dminished jaw jerk reflex, and impaired tactile/position sense over the face.

Question 32

Medial medullary syndrome Sx?

Answer 32

AKA Alternating hypoglossal hemiplegia. Vertebral or anterior spinal artery branch occlusion leads to contralateral paralysis of the arm/leg and tongue deviation toward the lesion (ipsilateral).

Question 33

Medial mid-pontine infarction Sx?

Answer 33

Contralateral ataxia and hemiparesis of the face, trunk, and limbs (ataxic hemiparesis).

Question 34

Any patient with cirrhosis needs what imaging done?

Answer 34

Endoscopy for varices. Rx is nadolol or propanolol if found.

Question 35

First Rx in MS attack?

Answer 35

Steroids.

Question 36

Refractory to steroids in MS attack need?

Answer 36

Plasma exchange.

Question 37

First step in management of neuroleptic malignant syndrome?

Answer 37

Stop antipsychotics and give supportive care (hydrate, cool). If they do not improve give dantrolene or bromocriptine.

Question 38

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Answer 38

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