Step3 13

Question 1

Patient with positive proteins on UA. Why is this not Multiple Myeloma

Answer 1

Light chain proteins are not detected in routine urine test

Need to run electrophoresis or order a Bence Jones urine proteins

Question 2

Analgesic effects on the Kidney

Answer 2

Interstitial nephritis: minimal change with inflammatory infiltrate on biopsy

Analgesic induced nephropathy: commonly due to NSAID (reduced GFR due to prostaglandin inhibition)

Question 3

Diagnosis of subclinical hypothyroidism

Answer 3

High TSH (verified on repeat lab)

Normal T3 and T4

+/- symptoms

Question 4

Indication for treatment of subclinical hypothyroidism

Answer 4

1) >10ug/dl

2) 7-9.9 ug/dl
<70 Treat
>70 Treat if convincing symptoms

3) Upper normal limit-6,99
<70 Treat if convincing symptoms, goiter, or elevated antibody titters (anti-thyroid peroxidase)

Question 5

When do you order a radionuclide thyroid scan?

Answer 5

For dxx for HYPER thyroid

Diffuse: Graves

Focal: nodular thyroid disease

Question 6

Pregnancy complications due to hypothyroidism

Answer 6

Miscarriage
Severe preeclampsia
Preterm birth
Low birth weight
Placental abruption

Question 7

Pretibial myxedema is common in which type of thyroid disease?

Answer 7

Graves (hyper)

Question 8

Dxx in LP between traumatic LP vs. Subarachnoid hemorrhage

Answer 8

SAH:
Xantocrhomia (happens after 12hr of blood cells on the subarachnoid space)

Traumatic LP:
>6000 RBC/mm3

Question 9

Signs of partial vs. complete small bowel obstruction on Xray and its management

Answer 9

If there is air in the large bowel /colon, it is partial

Partial: observe for 12-24hrs
Complete: surgery

Question 10

Varicose veins treatment

Answer 10

Leg elevation + compression stoking (always try this first)

Sclerosing therapy

Surgery

Question 11

Risk factors (4) and management of cryptorchidism

Answer 11

Prematurity
Low birth weight
Small for gestational age
Genetics

Surgery before age 1 (usually don’t descent after 6months)

Question 12

SLE antibodies

Answer 12

ANA highly specific (but + in other connective tissue disorders)

anti-dsDNA: more sensitive and specific of all of them. Correlate with disease activity

anti-Smith: specific, not sensitive

Question 13

Limited vs. Diffuse scleroderma

Antibodies
Pulmonary disease

Answer 13

Limited (CREST)
Anticentromere
Pulmonary hypertension (intimal thickening)

Diffuse
Anti-Scl 70
Pulmonary interstitial fibrosis (narrowing vessels)

Question 14

Antimitochondrial antibody

Answer 14

Primary biliary cirrhosis

Question 15

Use of hydroxychloroquine in SLE

Answer 15

Arthritis
Serositis
Skin symptoms

Question 16

Treatment for severe SLE

Answer 16

High dose steroids

Cyclophosphamide

Methotrexate

Question 17

Hypertension in scleroderma

Pathophysiology
Treatment

Answer 17

Thickening of arterioles in the kidney activates RAAS

ACE inhibitor (preferable captopril) + nitrates

Creatinine may elevate after initial treatment due to ACEI reduction in GFR, keep an eye on it. Do not stop

Do not drop BP too fast with nitrates so you don’t worsen renal function