Things I need to know better...day 2

Question 1

Kid is exposed to chickenpox and hasn’t been vaccinated yet…has no symptoms. What should be done?

Answer 1

Just give the vaccination

VZV Ig is NOT needed

Question 2

A 3-10yo has fever, pharyngitis, and gray vesicles/ulcers on posterior oropharynx. What is going on?

Answer 2

Herpangina (coxsackie A virus)

Question 3

Youngish patient has a decrescendo early diastolic murmur at the left sternal border. What is going on?

Answer 3

Aortic regurgitation…likely a bicuspid aortic valve

Question 4

A patient has had multiple infections and bone pain (or fractures…or lytic lesions seen on x-ray) + labs show hypercalcemia, anemia, and renal impairment. What is going on?

Answer 4

Multiple myeloma –> inability to produce effective antibodies

CRAB

• Calcemia
• Renal impairment
• Anemia
• Bone stuff

Question 5

Person has pain in small joints symmetrically that gets better after a few days. What was going on?

Answer 5

Viral arthritis

Question 6

What is seen on neuroimaging of autism?

Answer 6

Increased total brain volume

Question 7

What is seen on neuroimaging of OCD?

Answer 7

Abnormalities in orbitofrontal cortex and striatum

Question 8

What is seen on neuroimaging of Panic disorder?

Answer 8

Smaller amygdala

Question 9

What is seen on neuorimaging of PTSD?

Answer 9

Smaller hipocampus

Question 10

What is seen on neuroimaging of schizophrenia?

Answer 10

Enlarged cerebral ventricles

Question 11

An HIV patient has bloody diarrhea with normal stool sample. What is going on?

Answer 11

CMV infection

Question 12

Patient comes in with polyarthralgia, tenosynovitis, and painless vesiculopustule skin lesions. What is going on?

Answer 12

Disseminated gonorrhea

Question 13

A woman has urinary frequency, constipation, and a large, irregular uterus. What is likely going on?

Answer 13

Fibroids…get an US to check

Question 14

Who should bupropion NOT be given to?

Answer 14

Epileptic patients…lowers seizure threshold

Question 15

Variant lymphocytes + smudge cells –>

Answer 15

CLL…check flow cytometry

Question 16

Pregnant woman has an asymptomatic UTI…what do you do?

Answer 16

Treat w/ amoxicillin or amox-clav

Question 17

Patient has a history of unremitting nose bleeds…has ruby papules on lips that blanch and digital clubbing…labs show increased hematocrit. What is likely going on?

Answer 17

Osler-Weber-Rendu syndrome (Hereditary telangiectasia)…autosomal dominant

Diffuse telangiectasia + recurrent epistaxis + wide spread AVMs

Question 18

Person has a fever and an early diastolic murmur heard at the left sternal border…ECG shows a 2:1 AV block. What is going on?

Answer 18

Aortic endocarditis with perivalvular abscess

Question 19

A patient with PVCs is given lidocaine…what is the risk?

Answer 19

Asystole

Question 20

What is mutated with primary polycythemia vera?

Answer 20

JAK2 in the bone marrow

Question 21

How is hairy cell leukemia treated?

Answer 21

Cladribine

Question 22

How is NHL treated?

Answer 22

CHOP

Question 23

How is CLL treated?

Answer 23

Chlorambucil + prednisone

Question 24

What are some common causes of Afib?

Answer 24

Hypertensive heart disease (most common)

Hyperthyroidism

Question 25

What are some common complications of chronic HCV?

Answer 25

Essential mixed cryoglobulinemia
MPGN
Porphyria cutanea tarda and lichen planus
Increased risk of diabetes

Question 26

What antibodies can be seen with scleroderma?

Answer 26

Anti-topo-1
Anti-Scl70 (diffuse systemic)
Anticentromere (limited systemic; CREST)

Question 27

WPW causes Afib. How should it be treated?

Answer 27

IV ibutilide or procainemide

Question 28

Infection with partially acid-fast, gram+, branching rods. What is it? Treatment?

Answer 28

Nocardia is treated with bactrim

Question 29

A guy comes in concerned about fatigue…otherwise doing fine. Has borderline risky sexual history and a blood transfusion before 1992. What should all be checked?

Answer 29

HBV, HCV, HIV

Question 30

Person gets shot and the entry wound is below the nipple line. What should be done next?

Answer 30

Exploratory laparotomy

Question 31

Person does illegal things (drugs, theft, assault), frequently lies, is aggressive/impulsive, but can be charming…which is used to manipulate people. What does this person have?

Answer 31

Antisocial personality disorder

Question 32

Person does some creepy things and has suicidality or self-mutalation and a feeling of emptiness. What does this person have?

Answer 32

Borderline personality disorder

Question 33

What is decreased in all babies that can cause jaundice?

Answer 33

Uridine diphosphogluconurate glucouronosyltransferase activity

Decreased most in Asians

Question 34

What is Boerhaave syndrome?

Answer 34

Esophageal perforation

Question 35

Stroke patient has unilateral motor impairment, but NO sensory or visual impairments. Where is the stroke?

Answer 35

Posterior limb of internal capsule (lacunar infarct)

Question 36

How should MS be diagnosed?

Answer 36

MRI with gadolinium

Question 37

When is home oxygen recommended for COPD patients?

Answer 37

PaO2 ≤ 55
SaO2 ≤ 88%
Hct ≥ 55%
Evidence of cor pulmonale

Question 38

How is GBS treated?

Answer 38

IVIG

Question 39

How is SVT or PSVT treated?

Answer 39

adenosine or vagal maneuver

Question 40

Developmental delay + short palpebral fissures, absent philtrum, and thin upper lip border. What is this?

Answer 40

FAS