Practice Test 1

Question 1

How long do you need to be on TPN before you can develop cholelithiasis?

Answer 1

Generally need to be on it for > 2 wks. Central line infections (Coag Neg Staph and S aureus) are more common risks assoc with TPN than cholelithiasis.

Question 2

How does ethylene glycol cause AKI?

Answer 2

Antifreeze causes AG metabolic acidosis and AKI. Ethylene glycol is metabolized to glycolic acid which is converted to oxalic acid. Oxalic acid bind Ca2+&raquo_space; hypoCa and Ca oxalate stones in urine&raquo_space; tubule obstruction

Question 3

Initial erythematous/edematous lesion that becomes a painless black ulcer. Dx and Rx?

Answer 3

Dx = Ecythema gangrenosum. Look out for pseudomonas infection. Can invade the media and adventitia of the blood vessels

Rx = antipseudomonal penicillins / cipro

Question 4

Decreased heart sounds, JVD, and low BP taken together are signs of:

Answer 4

Pericardial tamponade (becks’ triad).

• Pt may present w/weakness, dizziness, and syncopal events.

Question 5

Is COPD considered an obstructive or restrictive disease?

Answer 5

COPD (emphysema/bronchitis) is an OBSTRUCTIVE Disease and has decreased FEV1&raquo_space; Low FEV1/FVC

Question 6

What are the paraneoplastic syndromes assoc with SCLC?

Answer 6

SCLC present as a Sentral mass and are assoc with Smoking. Can produce SI-ADH (HypoNa) or ACTH (Cushings). May be evidenced by hyperpigmentation from POMC

** SCC can cause PTH-rp&raquo_space; Hyper Ca

Question 7

How long do you have to wait to consider a protracted active phase as an arrest of active phase of labor?

Answer 7

4 hrs for adequate contraction or 6 hrs without adequate contraction. If < 4 hrs, consider oxytocin to increase strength of contractions as this is still protracted phase. If still progresses to arrest of active phase, then C section is required.

Question 8

Rx for Afib by CHADS-Vasc score:

Answer 8

0 - aspirin
1 - Rivoraxaban, apixaban
2+ - warfarin or NOAC (axabans)

Question 9

Unique effusion characteristics of TB infection:

Answer 9

Yellow Exudative effusions w/very high protein levels (>4g/dL), lymphocytic leukocytosis, and low glucose levels (<60mg/dL). Very high LDH (>500 U/L) and low pH.

Question 10

How do you give pneumococcal vaccine for new AIDS patient?

Answer 10

PCV13 once&raquo_space; PPSV23 8 wks later and again at 5 year intervals.

Question 11

Patient has lung cancer. Develops facial swelling, HA worse on leaning forward, and JVD without peripheral edema. What’s the Dx?

Answer 11

SVC syndrome.

Question 12

Rx for SBP:

Answer 12

IV abx: CTX or fluoroquinolones.

Dx confirmed when ascitic neutrophil count is > 250/mm3. Cultures would show G(-) but can be negative.

Question 13

Bullous pemphigoid is due to autoantibodies against:

Answer 13

hemidesmosomes (linear IgG at basement membrane).

Rx = high potency topical glucocorticoids for severe Dz or dapsone + nicotinamide for mild Dz.

Question 14

Presentation of polymyositis vs polymyalgia rheumatica:

Answer 14

Polymyositis = proximal muscle weakness w/elevated liver enzymes. AutoAb of ANA and Jo1. Muscle biopsy shows infiltration of endomysium by Mac and CD8 L

Polymyalgia rheumatica = typically older pt (>50yo) with stiffness > pain in shoulders, hip girdle, neck. Assoc with temporal arteritis. ^ ESR/CRP. Rapid improvement with glucocorticoids.

Question 15

What are the three most common risks assoc with gestational DM?

Answer 15

Infants of DM moms, regardless of pre-gestational or gestational DM, are at increased risk for macrosomia, RDS, and preterm delivery

Question 16

What are the criteria for a Lupus Dx?

Answer 16

SOAP BRAIN MD

Serositis (pleuritic chest pain, pleural effusion, pericardial effusion)
Oral ulcer
Arthritis (symmetric polyarthritis)
Photosensitivity

Blood (anemia/thrombocytopenia) 
Renal Failure 
ANA Ab 
Immunologic 
Neuro (seizure/cognitive dysfunction)

Malar Rash
Discoid rash

Need 4 of the 11

Question 17

Rx for lupus flare:

Answer 17

Prednisone if flare. Hydroxychloroquine to reduce flare occurrence.

Question 18

Best screening test for primary hyperaldosteronism:

Answer 18

Aldo/Renin ratio. A PAC/PRA ratio > 20 suggests primary hyperaldosteronism. Typically due to bilateral adrenal hyperplasia or unilateral adrenal adenoma. Causes ^ resorption of Na and H20&raquo_space; HTN and HypoK.

1st test = PAC/PRA ratio
2nd test = Salt suppression test

Question 19

How do you manage primary hyperaldosteronism?

Answer 19

If unilateral go to surgery

If bilateral, can be managed with aldosterone antagonists (spironolactone and eplerenone)