pance prep 2

Question 1

what organism is MC cause of epididymitis ?

Answer 1

men < 40: chlamydia , followed my gonorrhea

men > 40 : E coli

Question 2

defining menorrhagia

Answer 2

excessive cyclic uterine bleeding (>80mL) that occurs at regular intervals over several cycles, or prolonged bleeding that lasts for more than seven days

Question 3

avg blood loss in a period

Answer 3

30-40 mL (upper limit 60-80mL)

Question 4

what medication is best to treat both male-pattern baldness and erectile dysfunction from BPH

Answer 4

finasteride (a 5-alpha- reductase inhibitor)

- BLOCKS the conversion of testosterone into DHT which prevents baldness and lowers prostate volume

Question 5

sildenafil has what MOA and what is its use?

Answer 5

PDE-5 inhibitor for erectile dysfunction and urinary symptoms from BPH

Question 6

what antiarrhythmic can cause symptoms of hypo or hyperthyroidism?

Answer 6

amiodarone (structurally similar to thyroid hormones)

Question 7

immunity from resolved Hep B infection versus immunization has what difference?

Answer 7

from infection: hep B core antibody positive

Question 8

first line txt for minimal change disease

Answer 8

steroids: the most common cause of nephrotic syndrome in children. It presents with edema, proteinuria and hypoalbuminemia

Question 9

mom positive for hep B + C, can she breastfeed?

Answer 9

E. While breastfeeding is encouraged, if her nipples become cracked or bleed, she should temporarily stop nursing until they are healed

Question 10

MC cause of primary hyperaldosteronism? what lab values result?

Answer 10

bilateral adrenal hyperplasia

blood: high Na+, low K+ and renin
aldosterone: renin ratio >25

Question 11

how do you differentiate primary from secondary hyperaldosteronism?

Answer 11

1. high aldosterone and low renin (ratio >25)

2. normal aldosterone and high renin

Question 12

what causes secondary hyperaldosteronism?

Answer 12

activation of RAAS (renal artery stenosis, aorta coarctation etc)

Question 13

locations for most peptic ulcers?

Answer 13

lesser curve of stomach and duodenal bulb

Question 14

tetany from hypoparathyroidism can be treated how?

Answer 14

involuntary muscle spasm : txt with IV calcium gluconate

Question 15

MC location for Crohn’s disease ?

Answer 15

distal ileum

Question 16

bald patch with “Exclamation point hairs” : Dx and txt

Answer 16

alopecia areata, steroids

Question 17

treatment for suspected prostatitis?

Answer 17

• if febrile - IV abx till not febrile ( aminoglycoside + ampicillin)
• afebrile - culture UA
• do not do empiric abx b/c can lead to chronic prostatitis

Question 18

1 cause of neonatal morbidity and morality

Answer 18

premature labor (regular contractions + dilation > 37wks)

Question 19

txt for pituitary prolactin - secreting microadenoma (<10 mm)

Answer 19

medical treatment: bromocriptine (Sx removal only if medication fails)

Question 20

preclampsia criteria

Answer 20

high BP on two occasions + proteinuria > 1+

Question 21

what is fournier’s gangrene and what condition is if MC assoc with?

Answer 21

necrotizing fasciitis or gangrene affecting the external genitalia or perineum
DM

Question 22

new rise in creatinine and urea nitrogen as well as the decrease in the eGFR most likely indicates

Answer 22

dehydration

Question 23

MC type of thyroid CA

Answer 23

papillary

Question 24

MC cause of adult nephrotic syndrome. what causes it? MC symptoms?

Answer 24

Membranous glomerulonephritis (idiopathic, infection, CA, meds, autoimmune, etc) 
MC symptom: slow onset and edema

Question 25

Membranoproliferative glomerulonephritis

Answer 25

chronic immune mediated disease that primarily affects children and young adults. It presents with varying severity ranging from asymptomatic hematuria on urinalysis, to gross hematuria, nephrotic syndrome, or azotemia.

Question 26

Focal segmental glomerulosclerosis

Answer 26

MC: young African American men.
asymptomatic proteinuria, or symptoms of nephrotic syndrome (edema, proteinuria, HTN)
- idiopathic or HIV infection or drug use.

Question 27

molar pregnancy with gestational trophoblastic neoplasia need imaging for what possible metastasis?

Answer 27

lung - CXR

Question 28

pyelonephritis with resolved symptoms after appropriate abx BUT persistent fever make you think of what?

Answer 28

perinephric abscess - need renal US +/- drainage for source control

Question 29

membrane rupture, painless vaginal bleeding and fetal bradycardia.

Answer 29

triad of vasa previa

Question 30

txt for placenta accreta

Answer 30

planned cesarean hysterectomy

Question 31

36 weeks with positive GBS culture

Answer 31

Treat the woman with penicillin G at the onset of labor and continue treatment through delivery of the infant

Question 32

follicular phase vs ovulatory phase

Answer 32

follicular: day 1-13,
ovulatory: day 14- 27

Question 33

luteal phase

Answer 33

luteal:C. Decrease in estradiol and increase in progesterone

coincides with secretory phase

Question 34

what hormone increases at the end of follicular phase?

Answer 34

FSH and LH (surges)

Question 35

LH:FSH ratio in PCOS is increased or decreased?

Answer 35

increased

Question 36

subacute thyroiditis (De Quarevein’s thyroiditis)

Answer 36

MC cause of painful thyroid.
acute inflammatory disease of the thyroid probably caused by a virus. fever and thyroid tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism then euthyroidism (recovery in two weeks)

Question 37

Dx of subacute (De Quervain’s) thyroiditis

Answer 37

elevated ESR and CRP, low iodine uptake

thyroid levels vary based on stage of dz

Question 38

txt for infected breast abscess

Answer 38

US FNA

Question 39

what pts require the pneumococcal vaccine before age 65? what is the schedule of vaccines

Answer 39

immunocomprimised (includes ESRD) - ages 19 +

PCV 13 followed by PPSCV 23 8 weeks later

Question 40

. Loss of appetite, nausea and vomiting, headaches, fatigue, new-onset seizures, and muscle cramps indicate

Answer 40

acute, severe hyponatremia with levels usually below 120 mEq/L

Question 41

first sign of chronic renal failure

Answer 41

proteinuria