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Question 1

If DQ2 & DQ8 negative, what can you NOT have?

Answer 1

Celiac

Question 2

What physical exam finding is consistent with constrictive pericarditis?

Answer 2

Rapid X and Y descent

Question 3

The absence of what three clinical signs can help rule out meningitis?

Answer 3

fever, stiff neck, AMS

Question 4

Define LR

Answer 4

LR = probability of finding in patient with disease/probability of finding in patient without disease
LRs are a stable measure of a diagnostic test that is based on both the sensitivity AND specificity of the test. They provide an alternative way of describing the performance of a diagnostic test. They can be used to calculate the post-test probability of disease after a positive or negative test.

Question 5

Define Cincinnati Pre Hospital Stroke Score

Answer 5

Acute facial paresis, arm drift, abnormal speech. LR for ≥1 finding = 5.5. Absence of all 3 findings LR = 0.39

Question 6

If received BCG in past, what can be done to rule out latent TB?

Answer 6

Interferon gamma release assay

Question 7

Name the ECOG categories

Answer 7

0 - no restriction
1 - limitation of strenuous activity, normal activity OK
2 - OK for self care, no work activity, up > 50% waking hrs
3 - limited self care, in bed > 50% of waking hrs
4 - bed ridden

Question 8

A murmur is described as: a mid-systolic click with late systolic murmur. What happens when heard with patient standing/valsalva?

Answer 8

Classic for MVP, on standing preload drops, decrease in LV filling, therefore exaggerating MVP murmur. Click will be earlier, and murmur longer.

Question 9

What is the best test to rule out aortic dissection (and LR for bonus points)?

Answer 9

Normal CXR, LR -0.3

Question 10

Pt. with severe, symptomatic AS. Risk of surgery calculated to have >50% mortality. Prooceed to surgery?

Answer 10

No. Offer TAVR (2012 ACCF/AATS/SCAI/STS guidelines)

Question 11

Which of the following, if present, does not increase the probability that this is malaria? Headache, dyspnea, jaundice, splenomegaly, fever. And what has the highest LR

Answer 11

Dyspnea LR +0.11. headache LR + 1.8, Fever LR +5.1 and splenomegaly LR + 6.5

Question 12

Most common bacterial and viral cause of traveller’s diarrhea?

Answer 12

E. coli, rotavirus

Question 13

What are the components of the HIT score?

Answer 13

thrombocytopenia, thrombosis, timing, causes (none)

Question 14

How do you calculate NNT?

Answer 14

1/ARR

Question 15

What are the components of the CAM score?

Answer 15

AIDS acute onset and fluctuation, inattention, disorganized thought, somnolence/AMS

Question 16

Management of Goodpasture’s?

Answer 16

steroids, cyclophosphamide, plasmapheresis

Question 17

What finding suggests infected ulcer?

Answer 17

Pain LR 11

Question 18

Criteria for LVH (Sokolow)?

Answer 18

Sum of S wave in V1 and R wave in V5 or V6 ≥3.5 mV (35 mm) and/or R wave in aVL ≥1.1 mV (11 mm) (sometimes ≥1.3 mV [13 mm] is used)

Question 19

In patients with egg allergy, what type of influenza vaccine is contraindicated?

Answer 19

live attenuated as its safety has not been studied. CDC does say egg-based vaccines OK

Question 20

What two organs need to be monitored every six months for those on amiodarone?

Answer 20

hepatic (ALT/AST) & TFT Q6M

Question 21

Criteria for Still’s

Answer 21

4 major: fever, arthralgia, maculopap rash, high WBC
5 minor: sore throat, LAD, HSM, LFTs, neg RF and ANA
Need 5 criteria, with at least 2 major

Question 22

Absolute contraind. to lysis in STEMI?

Answer 22

h/o intracranial hemo., ischemic stroke w/i 3/12, cere. vasc. abn/cere. malig., s/sx of ao. dissection, bleeding diathesis/act. bleeding, closed head/facial trauma w/i 3/12

Question 23

Relative contraind. to lysis in STEMI?

Answer 23

chronic, severe HTN OR BP>180 - 110 on pres., ischemic CVA >3/12, dementia, intracran. path., CPR>10min, major sx w/i 3/52, internal bleeding 2-4/52, act. PUD, noncompress. vasc. punc., preg, warfarin, prior expo. STK

Question 24

Barrett’s with no dysplasia, what dose PPI?

Answer 24

Regular dose

Question 25

What is the acceptable rise in creatinine with ACE-I?

Answer 25

25-30%

Question 26

Beta blockers are not recommended in what group as monotherapy in HTN w/o other compelling indications?

Answer 26

> 60 years old

Question 27

ACE-I are not recommended in what group as monotherapy in HTN w/o other compelling indications?

Answer 27

Blacks

Question 28

A delayed hemolytic transfusion reaction occurs when and is thought to be due to what incompatibility?

Answer 28

Anywhere from 3-21 days post, and Rh or Kidd incompatibility

Question 29

MEN1 tumors?

Answer 29

parathyroid, pituitary, pancreas

Question 30

MEN2a tumors?

Answer 30

parathyroid, medullary thyroid, pheochromocytoma

Question 31

MEN2b tumors?

Answer 31

medullary thyroid, pheochromocytoma, mucosal and gastrointestinal neuromas

Question 32

What is the recommended treatment for syphilis?

Answer 32

long acting benzathine penicillin G 2.4 mill U SQ * 1

Question 33

NMS symptoms?

Answer 33

FARM - fever, auto instab, rigid, MS change

Question 34

Medically managed NSTEMI, EF 50%. What will decrease mortality: nitrate, plavix, smoking cessation, spiro?

Answer 34

Plavix, spiro if EF decreased/CHF

Question 35

What are the landmarks of the spinal cord?

Answer 35

cord ends at L1-2, L4 cauda ends

Question 36

What is true about the MOCA compared to MMSE?

Answer 36

More sensitive (LR 9.6), both specific

Question 37

What is most suggestive of hyperaldo?

Answer 37

Hypokalemia

Question 38

Class I indications for MV surgery for MR?

Answer 38

Severe + symptomatic (acute or chronic)

Severe + asymptomatic + LVEF 30-60% and/or LVESD > 40

Question 39

Young man, mass, + bHCG +AFP?

Answer 39

non-seminoma

Question 40

Young man, mass, + bHCG

Answer 40

seminoma

Question 41

What are the biochemical - serum and urinary of Barter’s?

Answer 41

hypokalaemia, alkalosis, normal to low blood pressures, and elevated plasma renin and aldosterone. high urinary potassium and chloride despite low serum values

Question 42

Gitelmans affects which transporter?

Answer 42

NaCl (like a thiazide diuretic)