Step3 30

Question 1

Vaccines that contain egg

Wich ones
Recommendation

Answer 1

Influenza
Yellow fever

Personal or family history of egg allergy is not a contraindication

If an anaphylactic reaction to egg.. administer the vaccine in the hospital setting

Question 2

If the patient has minor cold symptoms, can you administer immunizations?

Answer 2

YES

Question 3

First step in HIV in post-exposure prophylaxis if the patient refuses to get tested, results are pending or HIV status is unknown

Answer 3

Start treatment

Stop after the result is negative or continue for 4 weeks if tolerated

Question 4

Necrotizing fasciitis presentation and classification

Answer 4

Hx of minor skin trauma
Pain out of proportion, swelling, erythema,
Systemic symptoms: fever, hypotension

Type 1: Usually seen in patients with underlying diabetes and PAD
S. aureus
Bacteroides: crepitus
E. coli
S. pyogenes
Clostridium: crepitus
Pseudomonas: immunocompromised

Type II: occur in individuals with no current medical illness.
S. pyogenes is the most common organism

Question 5

Management of necrotizing fasciitis

Answer 5

Hemodynamic support

Antibiotics
Piperacillin/Tazobactam: S. pyogenes and anaerobes
Vanco: S. aureus including MRSA
Clynda: added to inhibit toxin formation

Question 6

Erythrasma vs. intertrigo

Answer 6

Erythrasma:
Corynebacterium minutisimun
Well defined borders or thing plaques with fine wrinkling
Fusidic acid cream
Clindamycin solution
Benzoyl peroxide

Intertrigo
Candida
Erythematous plaques, satellite papules, and significant inflammation
Topical antifungals: miconazole, nystatin, terbinafien

Question 7

Approach to sicca symptoms

What’s the gold standard?

Answer 7

Dry eyes, dry mouth

Confirm secretory deficiency: eg. Shirmer test (slit lamp to assess tear break up time)

Anti Jo/Anti La
ANA
Rheumatoid factor

The gold standard is salivary gland biopsy. Reserve for young patients with severe symptoms

Question 8

Treatment of xerostomia alone

Answer 8

Initial treatment is with salivary stimulation

Mechanical or topical

Question 9

Diagnosis of Autosomal Dominant Polycystic Disease

Answer 9

Renal ultrasound

Family hx but unknown genotype:
18-39: >3 cyst uni or bilateral
40-59: >2 in each kidney
>60: >4 in each kidney

Unknown family history:
Multiple (>10 cysts) in each kidney regardless of age

Genetic testing: usually saved for patients where US does not yield a diagnosis

Question 10

Management of Autosomal dominant polycystic kidney disease

Answer 10

Aggressive control of risk factors CV and CKD
ACEI preferred for hypertension
Statins

Renal transplant or hemodialysis if end-stage renal disease

Question 11

Extra external features of Autosomal dominant polycystic kidney disease (6)

Answer 11

Cerebral aneurysms

Liver and pancreatic cyst

Colonic diverticula

Ventral and hinguinal hernias

Aortic regurge

Mitral prolapse

Question 12

Laboratory findings of polymyalgia rheumatica

Answer 12

ESR >40 (sometimes >1000)

Elevated CRP

+/- Anemia

20% normal

Question 13

Clinical presentation of polymyalgia rheumatica

Answer 13

Age >50

Bilateral pain and morning stiffness >1 month

>2 of the following
Neck or torso
Shoulder or proximal arms
Proximal thigh or hips
Constitutional: fever, malaise, weight loss

Question 14

Treatment of polymyalgia rheumatica

Answer 14

Steroids
Low dose for pain
High dose for giant cell artheritis

(absence of response indicates another diagnosis is possible)