STEP 3

Question 1

LEUKEMIA - adult
HIGH WBC
bcr/abl traslocation (t[9;22])
splenomegaly
very low LAP

Answer 1

CML

• tyrosin kinase inhibitors first
• young, stable, good donor –> can try BMT

Question 2

High LAP (leukocyte alkaline phosphatase) means ?

Answer 2

leukemoid reaction

Question 3

What precipitates TdP?

Answer 3

• premature ventricular beats with compensatory pause
• bradyarrythmias (sinus brady or freq pauses)
• low Mg or K
• hypothermia

Question 4

Cannot extend knee (kick it out), anteromedial thigh/medial calf/arch of foot sensory loss, loss of knee jerk

Answer 4

Femoral nerve injury (saphenous branch for sensation + quads)

Question 5

Lower leg weakness (including hamstrings), sensation spared (ant + post) above the knee, loss of ankle jerk

Answer 5

Sciatic nerve injury

Question 6

Intensely pruritic papules/vesicles on extensor surfaces and buttocks/back

Answer 6

Dermatitis herpetiformes

Question 7

Pruritic erythematous patches (acute) or lichenified plaques (chronic), on extensor surfaces in children/adults (flexor surfaces in infants)

Answer 7

Atopic dermatitis
tx: oral antihistamines, emollients (hydrate skin), avoid extremely hot/cold places
if those don’t work: topical steroids
face/eyelids: topical tacro

Question 8

Tight glycemic control helps reduce ___ complics

Answer 8

microvascular

no firm link suggesting reduction of macrovascular complications like MI, stroke, PAD

Question 9

Indications for hospitalization with anorexia

Answer 9

HD instability
arrhythmia
severe bradycardia
acute food refusal
lyte abnormalities
suicidality

Question 10

Sx of and tx for refeeding syndrome

Answer 10

Sx: fluid shifts - pulm/peripheral/cardiac edema, cardiac things
Tx: thiamine should be given. PO > IV phos

Question 11

Medicare Parts A, B, C, D

needs to be 65+

Answer 11

A: inpatient services, hospice
B: outpt physician services/surgery/lab tests, preventative care, hospital OBS
C: “Medicare Advantage” ; private
D: Rx meds

Question 12

Dyspepsia vs GERD

Answer 12

Dyspepsia: epigastric discomfort/fullness, n/v, heartburn
*causes = PUD, H pylori, NSAID use
GERD: retrosternal burning, reflux

Question 13

Sjogren causes __ lymphocyte activation. Associated with __ lymphoma.

Answer 13

B

B cell non Hodgkins

Question 14

Does hypocalcemia cause HYPO or HYPER -reflexia?

Answer 14

HYPERreflexia

Question 15

Indications for C section with twins

Answer 15

Monoamniotic (one placenta)
Malpresentation
Non reassuring FHR tracing

Question 16

Treatment for Chlamydia + gonorrhea

Answer 16

Gonorrhea ONLY: single dose CTX

Both: CTX + PO doxy

Question 17

Why is there an increased risk of DM post transplant?

Answer 17

• GC cause wt gain, decreased insulin sensitivity
• Calcineurin inhibitors: impaired insulin secretion
• Improved renal fxn: increased insulin excretion + more GNG

Question 18

Post exposure ppx after pertussis?

Answer 18

azithromycin, erythromycin (macrolides)

*if given before 2 wks age, contributes to hypertrophic pyloric stenosis

Question 19

Aspergillus - classic triad + tx?

Answer 19

Triad: cough, pleuritic cp, hemoptysis
Tx: voriconazole

Question 20

MC extra-articular manifestations of ankylosing spondylitis?

Answer 20

uveitis
aortic regurg / MVP
IgA nephropathy
restrictive lung disease / apical pulm fibrosis

Question 21

When can minors provide their own consent?

Answer 21

pregnancy
STI
life threatening 
contraception
mental health/substance use disorder tx

Question 22

A/c req’d for mechanical valves?

Answer 22

lifelong a/c (warfarin) + antiplt (ASA)

Question 23

right heart failure after CABG …

Answer 23

constrictive pericarditis

Question 24

Sulfonylurea OD (glyburide) … antidote?

Answer 24

• causes hypoglycemia
  1. dextrose
  2. octreotide

Question 25

Ppl who get a DVT while on menstrual hormone therap … what do you do?

Answer 25

Discontinue MHT and start SSRI/SNRI (ie escitalopram)

Question 26

Diarrhea + microcytic anemia + high eos

Answer 26

Hookworm infection
(can have transient cough)
dx: examine stool for eggs

Question 27

Progression of hyperkalemia cardiac changes

Answer 27

peaked T waves –> PR and QRS prolongation –> loss of P waves –> wide QRS with a sine wave