Mix7

Question 1

Patient with spasticity, bulbar symptoms, exaggerated DTR, and lower extremity muscle fasciculations:

Answer 1

ALS (upper and lower motor neuron sxs)

Question 2

Who gets PPSV23 vs PCV13+PPSV23 in adults <65 yo?

Answer 2

PPSV23 alone = chronic heart, lung, or liver Dz, DM, current smoker, or alcoholic

PCV13+PPSV23 = very high risk Pt = SCD, asplenia, CSF leaks, immunocompromised and CKD

** Everyone >65 yo should get sequential PCV13&raquo_space; PPSV23

Question 3

What blood supply is affected in lateral medullary (Wallenberg) syndrome?

Answer 3

PICA. Presents with vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temp sensation in ipsilateral face + contralateral body, bulbar weakness, and ipsilateral Horner’s.

Question 4

Distortion of straight lines to appear wavy is pathognomonic for what ophtho disease?

Answer 4

Macular degeneration

Question 5

MCC of Bilateral loss of central vision:

Answer 5

Macular degeneration. Presents with progressive and bilateral loss of central vision. Peripheral fields and navigational vision are maintained.

Question 6

How does ice pack test help confirm a Dx of myasthenia gravis?

Answer 6

Ice pack test over eyelids leads to improvement in ptosis because the cold temp inhibits breakdown of ACh at neuromuscular junction&raquo_space; increased ACh availability at nicotinic receptor. Should undergo confirmatory testing with AchR ab

Question 7

What’s the best method of malaria prevention in pt traveling to malaria endemic regions?

Answer 7

Because chloroquine resistance is common in endemic areas, should give prophylaxis with atovaquone proguanil, doxy, or mefloquine. Mefloquine should be started 2 weeks before the trip, continued during the stay, and should be continued until 4 weeks after the trip has finished

Question 8

First line treatment for polymyalgia rheumatica:

Answer 8

Low dose glucocorticoids (prednisone) is first line. Should have rapid relief, if not then consider other dx.

Question 9

Rx for mucormycosis

Answer 9

Surgical debridement and amphotericin B (voriconazole/fluconazole not effective)

Question 10

Rx for organophosphate poisoning:

Answer 10

Atropine. Organophosphate = AChEi&raquo_space; sx of cholinergic excess. Atropine = competes with ACh at muscarinic receptors.

Question 11

Palpable purpura, arthralgia, glomerulonephritis, and a Dx of HepC:

Answer 11

Mixed Cryoglobulinemia, immune complex deposition in small blood vessels&raquo_space; endothelial injury and end organ damage.

Question 12

Fatty casts are associated with:

Answer 12

Nephrotic syndrome. Hyaline casts are made almost exclusively of protein and pass along the urinary tract unchanged. Can be seen in asymptomatic patients with prerenal azotemia.

Question 13

Inflammatory disorder of recurrent high fevers, arthritis/arthralgia, and salmon colored/maculopapular rash

Answer 13

Still’s disease

Question 14

Best test for spinal stenosis

Answer 14

MRI. ** Ankylosing spondylitis is NOT spinal stenosis.