Mix12

Question 1

Initial Rx for dermatitis herpetiformis?

Answer 1

Remove gluten from diet. Temporize with dapsone.

Question 2

Primary treatment for borderline personality disorder?

Answer 2

Dialectical behavior therapy. SSRI are typically not effective (unless there is comorbid major depressive disorder or anxiety disorder)

Question 3

Older man presents with lower back pain, constipation, renal insufficiency and hypercalcemia. What is the cause and what diagnostic step do you do?

Answer 3

Multiple myeloma (plasma cell dyscrasia)&raquo_space; IgG overproduction.

CRAB. Calcinosis, Renal Failure, Anemia, Bone pain.

Dx = Spep/Upep (M spike), skeletal survey, confirmed w/BM biopsy

Rx = Melphalan (antineoplastic) + steroids

Question 4

Rx for Langerhans cell histiocytosis?

Answer 4

Chemo (prednisone + vinblastine). Desmopressin for associated central DI.

Question 5

What’s the main pathology behind Langerhans cell histiocytosis?

Answer 5

Histiocytes (Macs within tissue) proliferate and infiltrate one or more organ systems: bone (punched out lytic lesions in skull, femur, vertebrae, etc), skin (eczematous rash), lymph nodes, lungs, liver, spleen, CNS (central DI with polyuria and hypernatremia).

Question 6

Infant initially appears normal at birth but gradually develops apathy, weakness, difficulty feeding, hypotonia, large tongue, abdominal bloating, and sluggish movements. What’s the most likely cause?

Answer 6

Congenital hypothyroidism

Question 7

How can you tell the difference between laryngomalacia vs vascular ring in a child with stridor?

Answer 7

Laryngomalacia = inspiratory stridor only. Stridor worse when supine and improves when prone.

Vascular ring = Biphasic (inspiratory and expiratory) stridor that improves with neck extension. Vascular rings are due to abnormal development of aortic arch

Question 8

Aside from serum B12 [ ] , what other test should be ordered in the case of suspected

Answer 8

Should also order serum MMA levels because they are more sensitive in detecting Vit B12 deficiency than serum B12 levels alone.

Question 9

Timepoint differentiating postpartum blues vs postpartum depression

Answer 9

Post partum blues shows up 2-3 days after birth and lasts < 2 weeks.

Postpartum depression shows up within 4-6 weeks after delivery (can be up to a year) and last >2 wks.

Question 10

Aplastic anemia vs aplastic crisis in SCD:

Answer 10

Aplastic crisis = acute drop in Hb with low retic count (no splenomegaly) most often due to parvo B19 infection&raquo_space; Sudden stop in erythropoiesis

Aplastic anemia = full pancytopenia due to BM failure. Can be congenital (Fanconi anemia) or acquired (drug induced/autoimmune)

Question 11

Pt with Parkinsonism displays impotence, orthostatic hypotension, gastroparesis, and abnormal sweating:

Answer 11

Shy Drager syndrome. Parkinsonisim with autonomic dysregulation. May have bulbar dysfunction and laryngeal stridor&raquo_space; death.

AntiParkinson’s drugs are ineffective. Rx = intravascular volume expansion with fludrocortisone, salt supplementation, and alpha-adrenergic agonists.

Question 12

Antiplatelet factor 4 antibody is assoc with what Dz?

Answer 12

HIT

Question 13

Rx for acute asthma exacerbation:

Answer 13

Albuterol (SABA) + Ipratropium (Antimuscarinic) + IV Methylprednisolone (glucocorticoid) + Steroid taper

Question 14

Antinuclear Ab and anti-dsDNA Ab are pathognomonic for what disease?

Answer 14

SLE

Question 15

Anti CCP Ab is assoc with what disease?

Answer 15

RA

Question 16

What are 4 major long term side effects of Li3+ use?

Answer 16

Nephrogenic DI, CKD, Thyroid dysfunction, and Hyperparathyroidism

Question 17

Compare presentation of Mallory Weiss vs Boerhaave syndrome:

Answer 17

Mallory Weiss = incomplete mucosal tear at GE junction. Due to protracted vomiting. Self limited hematemesis and pneumomediastinum.

Boerhaave = esophageal perforation. Spontaneous rupture of esophagus with prolonged straining/vomiting. Suprasternal crepitus and retrosternal pain due to pneumomediastinum and contamination of mediastinum with gastric contents. Presents with fever and leukocytosis.

Question 18

What’s the big concern about TCA overdose?

Answer 18

QRS prolongation. Causes cardiotoxicity due to blockade of cardiac fast Na+ channels&raquo_space; QRS prolongation&raquo_space; ^ risk for ventricular arrhythmia.

Can also cause AMS, seizures, tachycardia, HoTN, and anticholinergic effects (dilated pupils, flushed skin, hyperthermia)

Question 19

Metolazone is a thiazide diuretic sometimes used in Pt with decompensated CHF. It can cause electrolyte abnormalities such as (3):

Answer 19

HypoK, Hypo Mg, hypochloremic alkalosis

Question 20

What arteries are predominantly affected in fibromuscular dysplasia?

Answer 20

Renal and ICA

Question 21

Projection vs displacement:

Answer 21

Displacement = transference of upsetting emotion to safer alternative

Projection = attribute one’s own feelings to someone else

Question 22

Why are PTT and PT not representative of the clinical picture in Antiphospholipid syndrome?

Answer 22

LA (lupus anticoagulant) is found in ~30% of cases with APS. Prolonged PT and PTT is artifact in lab because it binds all phospholipids in the assay. In real life if it causes venous thromboembolism. Prolonged PTT is an indirect indicator for the presence of LA. Specific confirmatory tests include diluted Russell viper venom test and the kaolin clotting time.

Question 23

Major side effect of cyclophosphamide?

Answer 23

Bladder cancer. Can also cause acute hemorrhagic cystitis, sterility and myelosuppression. These effects are due to acrolein (metabolite of cyclophos). Rx = Mesna and ^ fluid intake.