Primary Care

Question 1

Thiazides

Answer 1

Monitor for hyponatremia and hypokalemia
Monitor for uric acid and calcium levels
Caution: acute gout and no uric acid-lowering therapy

Question 2

ACE inhibitors

Answer 2

Do not use with ARB or direct renin inhibitor
Monitor for hyperkalemia
risk of acute renal failure if severe b/l renal artery stenosis
Cough d/t bradykinin production
AVOID in pregnancy

Question 3

ARB

Answer 3

Do not use with ACE inhibitors or direct renin inhibitors
Monitor for hyperkalemia
Risk of ARF if severe bilateral renal artery stenosis
AVOID in pregnancy

Question 4

Calcium channel blockers

Answer 4

Associated with dose-related pedal edema (F>M)

Question 5

Ethambutol

Answer 5

Optic neuritis

Question 6

Isoniazid

Answer 6

Peripheral neuropathy due to B6 depletion

Increased LFTs

Question 7

Pyrazinimide

Answer 7

Hyperuricemia, hepatotoxicity, and joint pain.

Monitor with uric acid and liver function tests.

Question 8

Rifampin

Answer 8

Orange bodily secretions, hepatitis, flu-like symptoms and poor clotting.
Monitor liver function tests and complete blood counts.

Question 9

Myeloma

Answer 9

Cancerous plasma cells lead to excess monoclonal antibodies that build-up in kidneys and bone marrow

Question 10

Lymphoma

Answer 10

Cancer of mature lymphocytes in lymphoid tissue (B-cells and T-cells that move through lymphatic system)
Hodgkins and Non-Hodgkins

Question 11

Acute Leukemia

Answer 11

Cancer of immature progenitor cells (blasts) in the bone marrow. Non-functional. Can be myeloid or lymphoid lines.
Rapid onset with high numbers of WBCs, rapid proliferation and turn over can lead to viscous, sticky blood and clotting.

Question 12

Chronic Leukemia

Answer 12

Cancer of mature, functional WBCs in the bone marrow from either lymphoid or myeloid lineage.
Slow, indolent onset

Question 13

Myeloproliferative disease

Answer 13

Cancer involving bone marrow cells that produce RBCs, platelets or fibroblasts.

Question 14

Myelodysplasia

Answer 14

Pre-cancerous disease of bone marrow where the dysplastic cells may cause abnormal or inadequate blood cell production.
Can progress to acute leukemia.
Most common in elderly.
Bone marrow tries to compensate by increasing hematopoeisis.

Question 15

Hodgkin’s Lymphoma

Answer 15

Usually starts in cervical lymph nodes - painless cervical lymphadenopathy
Contagious spread b/t lymph nodes in one local area
Rarely extranodal - local
Reed Sternberg (owl eye cells)
Pruritus
Young adults 15-34 age (but has bimodal distribution with >50)
Better prognosis
Associated with EBV/mono
Radiation + chemo

Question 16

Non-Hodgkin’s Lymphoma

Answer 16

Adenopathy and extranodal - distant spread
No contagious spread
Hepatosplenomegaly, Leukemic phase
Mid-50s
Worse prognosis
Chemo

Question 17

Lupus

Answer 17

ANA, anti-dsDNA, anti-smith, anti-histones

Txt: NSAIDs, steroids, immunosuppressants, hydroxychloroquine

Question 18

Drug-induced lupus

Answer 18

Hydralazine
Isoniazid 
Procainamide
Phenytoin
Sulfonamides
False-positive test for syphilis

Question 19

Erythema multiforme

Answer 19

Target lesions on face, trunk, palms and soles
Usually d/t infxn: herpes simplex most common viral cause, mycoplasma, lupus, hepatitis, lymphoma
Can also be caused by sulfas, PCN, barbiturates, phenytoin

Question 20

Stevens-Johnson S/o

Answer 20

Prodrome of fever, flu sx.
Mucocutaneous lesions
cutaneous lesions on face and thorax coalesce into painful erythema
Bullae, vesicles, Nikolsky sign
Palms and soles usually spared
Caused by: sulfas, phenobarbital,carbamazepine, lamotrigine, allopurinol, NSAIDs, mycoplasma pneumoniae

Question 21

Rheumatoid Arthritis

Answer 21

Patient will be a woman 40 - 50-years-old
Complaining of morning stiffness lasting > 30 minutes
PE will show symmetrical soft, red, tender, swelling in joints -MCP, PIP. Bilateral ulnar deviation at MCP, boutonniere deformity, and swan-neck deformity
Labs will show positive RF, anti-cyclic citrullinated peptide antibodies
Most commonly caused by autoimmune destruction of synovial joints
Treatment is DMARDs. Monitor CBC for bone marrow suppression

Question 22

Multiple sclerosis

Answer 22

Patient will be a Caucasian female
Complaining of pain with eye movement, monocular vision loss, sensory abnormalities
PE will show spinal electric shock sensation with neck flexion (Lhermitte phenomenon)
CSF will show ↑ IgG protein, WBC pleocytosis
Diagnosis is made by T2-weighted MRI
Most commonly caused by a demyelinating disorder
Treatment is symptomatic, methylprednisolone, interferon beta-1a
Comments: Bilateral internuclear ophthalmoplegia is pathognomonic
Vitamin D deficiency may be a risk factor for MS

Question 23

Absence seizures

Answer 23

Patient will be a child 5 - 10-years-old
Complaining of sudden mental status alteration without motor activity, blank stare
EEG would show symmetric 3-Hz spike and wave activity
Treatment is ethosuximide
Comments: no aura or postictal state

Question 24

Hypercalcemia

Answer 24

Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones)
ECG will show shortened QT interval
Most commonly caused by:
Malignancy (most common inpatient cause)
Primary hyperparathyroidism (most common outpatient cause)
Treatment is IV fluids