NBME rare

Question 1

Nodules at DIJ
Brown skin color
Elevated blood sugar
Liver involvement
What kind of cardiomyopathy?

Answer 1

Heberden nodes
Hemochromatosis
Dilated CM

Order serum ferritin concentration

Question 2

Most common symptoms of Hemochromatosis?

Answer 2

Liver function abnormalities
Weakness / lethargy
Skin hyperpigmentation
DM
Arthralgia

Question 3

Liver involvement
Neurological involvement
Psych

Answer 3

Wilson Disease

- AR impaired copper transport

Question 4

Liver disease in kids aged 9-13

Answer 4

Wilson disease (kids + young adults)
 - liver is initial site of copper accumulation

Low level of serum ceruloplasmin

Question 5

Kayser-Fleischer rings vs. Heberden nodules

Answer 5

Wilson vs. Hereditary Hemochromatosis

Question 6

Cough
Fever (but not always in elderly)
Dyspnea
Chills
Normal lung exam

Answer 6

Pneumonia
- elderly/COPD - have low threshold for CXR

Normal lung exam does NOT rule out pneumonia

Question 7

Egophony

Answer 7

Patient says “eeeeeee” which will change to “aaaaa” over areas of consolidation (voice of a goat - sounds like bleating)

Fairly specific for pneumonia

Question 8

What 2 things to consider if upper lobes are consolidation on CXR?

Answer 8

TB

Aspiration pneumonia

Question 9

What 3 things increase likelihood of aspiration pneumonia?

Answer 9

Alcoholism
Drug abuse
Neurologic impairment

Question 10

What 5 tests should be run in pneumonia?

Answer 10

CXR
Blood cultures
Sputum cultures
Sputum gram stain
Urinary tests

Question 11

CURB-65 for ???

Answer 11

Confusion Uremia > 20 RR > 30 BP < 90 Age > 65

Pneumonia hospital/icu admission
ICU for scores 3+

Question 12

Preferred abx for outpatient CAP treatment?

Answer 12

Macrolide: azithromycin

Question 13

Inpatient abx for CAP treatment?

Answer 13

Respiratory fluoroquinolone (levo/moxi)
-OR-
Macrolide + beta-lactam (ceftriax, cefotax, amp-sulb)

Question 14

Good abx for aspiration pneumonia?

Answer 14

Clindamycin
-add-
Azithromycin + Ceftriaxone

Question 15

CXR shows diffuse, bilateral pneumonia. Why?

Answer 15

HIV – PCP pneumonia - P jirovecii

- especially when CD4 < 200

Question 16

How treat PCP pneumonia?

Answer 16

TMP-SMX

Question 17

What is a Ghon complex?

Answer 17

The 1st lesion of primary TB
Granuloma - often in lower lobes
Prominent infected/calcified mediastinal/hilar LN

Question 18

Day 3 of hospitalization: agitation, tachycardia, visual hallucinations. Treatment?

Answer 18

Alcohol DT’s

- give benzodiazepines

Question 19

Abrupt onset of febrile respiratory illness
(like being hit by a train)
Severe myalgias, diffuse pain
Respiratory symptoms (cough, rhinitis, pharyngitis)
Fever usually peaks 12 hours, can be very high

Answer 19

Influenza
- December to May

Airborne - large droplets

Question 20

Are the following symptoms of Influenza?

• GI symptoms
• Diarrhea vomiting
• HA
• Cough
• Sore throat

Answer 20

Yes to cough, HA, sore throat

NO to nausea/vomiting

Question 21

3 reasons for cavitation on CXR?

Answer 21

TB
Staph aureus
Klebsiella pneumoniae

Question 22

How cover for anaerobes?

Answer 22

Clindamycin
Gentamicin/aminoglycoside
Piperacillin
Cefepime