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3 year old with anabdominal mass,
hematuria and HTN. WHatis the most likely diagnosis
1a
Wilms Tumor
1b
A 4 month old child presentswith nonbilious vomitingdespite changing formulas frommilk-based to soy based. Whatis the most likely etiology?
2a
Pyloric Stenosis
2b
A 60 year old male presents to theclinic for a well male exam and onDRE a hard nodule is palpated onthe prostate. Lab work up showsan elevated PSA. WHat is next stepin the management of the patient
3a
transrectal needlebiopsy
3b
60 year old male smoker isfound to have a varicocele thatdoes not empty when thepatient is recumbent? whatshould you be suspicious of inthis patient?
4a
RCC(dont biopsy, just
take out)4b
A 60 year old womanleaks urine when laughingor coughing. What are her
nonsurgical options5a
Stress IncontinenceKegel Exercises
Estrogen Replacement tothicken tissue
Pessary5b
Albuminocytologicdissociation (increased
protein in CSF with onlymodest increase in cell
count)6a
Guillen BarreSyndrome
6b
Antidote for following ODsOpiods
HeparinBenzodiazepenes
BabrituatesCO
7a
NaloxoneProtamine Sulfate
FlumazanilBicarb to alkanize urine; dialysis
100% O27b
Antihistoneantibodies are seenin what condition
8a
Drug InducedLupus
(Hydralazine)8b
At what age shouldnocturnal enuresis betreated? What are the
treatment options9a
CANT be diagnosed before 5 y/oTreatment is usually delayed until the child is at least 7 years ofage
1st line = behavioral interventionstoliet training; motivational therapy, restrict fluids before bed,nighttime chaperone, scheduled waking up bathroom breaks,enuresis alarm (most effective long term therapy)
2nd line = pharmacologicIMIPRAMINE (Tofranil) short term up to 6 weeksIndomethacin suppository
9b
At what point doesgrief/bereavement
become pathological10a
Grief becomes pathological when any of the following arefoundDepression criteria met for at least 2 weeks after the first 2months following hte lossGeneralized feelings of hopelessness, helplessness,worthlessness or guiltsuicidal ideationdistressing feelings do not diminish in intensity by 6 monthsinability to move-on, trust others, and renengage in life by 6months
10b
Categorize as low, moderate or highpotency antipsychotics or atypical
olanzapine, thioridazine, quetiapine,molindone, chlorpromazine, haloperidol,fluphenazine, laxopine, risperidone,thiothixene, trifluoperazine, clozapine,aripiprapzole
11a
High Potency: haloperidol, fluphenazine, thiothixene,droperidol
Medium: trifluoperzine, perphenazine
Low: thioridazine, chlorpromazine
Atypical: clozapine, risperidone, loanzapine,sertindole, quetiapine, ziprasidone, paliperidone,apripozle
11b
Classify the antidepressants:NotriptylineSetegilineBuproprionMirtazapineFluvoxaminedoxepinPhenelzineFluoxetineClomipramineImipramineAmitriptylineNefazodoneMinacipranDesipramineSertralineVenlafaxineParoxetineTranycypromineDuloxetineEscitalopramCitalopramTrazodone
12a
Notriptyline - TCASelegiline - MAO-IBuproprion - NDRIMirtazapine - TetracyclicFluvoxamine - SSRIdoxepin - TCAPhenelzine - MAOIFluoxetine - SSRIClomipramine - TCAImipramine - TCAAmitriptyline - TCANefazodone - SNRIMinacipran - SNRIDesipramine - TCASertraline - SSRIVenlafaxine - SNRIParoxetine - SSRITranylcypromine - MAOI Duloxetine - SNRIEscitalopram - SSRICitalopram - SSRITrazodone
12b
DIG FAST
13a
Characteristics of manic episodes DIstractibilityInsomniaGrandiosity (feelings)Flight of ideasActivity (increase in goal oriented)Speech (pressured)Taking Risks
13b
Discuss PosteriorUrethral Valves
14a
Most common obstructive urethral lesion ininfants and newborns esp malesAbnormal tissue folds in the distal prostaticurethra --> thick walled bladder and weakurinary stream and obstruction (bilateralhydronephrosis, megaureter, UTI)Diagnosed with a voiding cystourethrogramDefinitive care = transurethral ablation of theabnormal tissue or urinary diversion
14b
An elderly female with a historyof cholelithiasis presents with a5 day history of vague, recurrentabdominal pain and vomiting.What diagnosis do youimmediately suspect?
15a
Gallstone IlleusMC in elderly 70 year old femalescaused by impaction of gallstonein ileum after being passedthrough a billiary-enteric fistula
15b
Fever + Rash + elevatedCreatinine + Eosinophilia. What
is the diagnosis
16a
Acute interstitial Nephritis(drug induced - sulfa,
penicillin, nsaids,aminoglycosides))
16b
Glomerulonephritis+ bilateral
sensorineuraldeafness
17a
Alports
17b
How are sodiumlevels corrected for
high glucose18a
1.6 mEq/L for every 100mg/dl of plasma glucose(2.4 mEq/L per 100 afterglucose levels exceed 400
mg/dl)18b
How are totalcalcium levels
corrected for lowalbumin
19a
Albumin goes below4 --> Ca drops 0.8mg/dL for every 1
mg drop in Albumin19b
How can testicular torsion bedifferentiated from epididymitisin regards to onset, infection,visual changes, support,cremasteric reflex and UZ andTx
20a
TORSIONOnset = acute, abrupt and often associated with a physical activityInfection = no signs of infectionVisual Change = Testicle may be raised and horizontalSupport = No pain reliefCremasteric Reflex = absentUZ = compromised blood flowTX = Surgical detorsion with bilateral orchiopexy within 6 hrs
EPIDIDYMITISOnset = subacute and may be associated with STDs and/or anal intercourseInfection = possible signs of STD (urethral discharge, fever, dysuria, erythema)Visual changes = testicle in normal position and lieSupport = partial reliefCremasteric Reflex = PresentUZ = normal blood flow< 35 yo treat for Gonorhea/Chlamydia (ceftriaxone IM then doxycycline)> 35 yo think Enterobacteriacease and give Fluoroquinolone
20b
How do sign andsymptoms of testicular
torsion differ fromepididymitis
21a
TORSIONOnset = acute, abrupt and often associated with a physical activityInfection = no signs of infectionVisual Change = Testicle may be raised and horizontalSupport = No pain reliefCremasteric Reflex = absentUZ = compromised blood flowTX = Surgical detorsion with bilateral orchiopexy within 6 hrs
EPIDIDYMITISOnset = subacute and may be associated with STDs and/or anal intercourseInfection = possible signs of STD (urethral discharge, fever, dysuria, erythema)Visual changes = testicle in normal position and lieSupport = partial reliefCremasteric Reflex = PresentUZ = normal blood flow< 35 yo treat for Gonorhea/Chlamydia (ceftriaxone IM then doxycycline)> 35 yo think Enterobacteriacease and give Fluoroquinolone
21b
How does adjustmentdisorder with depressedmood differ from major
depressive disorder22a
3 month period anddisappear within 6
months after stressoris removed
22b
how is acute stressdisorder different
than PTSD23a
symtpoms lasting less than4 weeks = acute stresssymptoms > 4 weeks =
PTSD23b
How is BPHdiagnosed?
24a
Clinical diagnosis based on symptomatic scoring system
R/O other pathologies that may cause similar symptomsDigital Rectal Exam to detect malignancyUrinanalysis to detect hematuria indicating infection,calculi or prostatitisSerum Creatinine to detect possible renal or prerenal diseaseSerum PSA, postvoid residual, maximum urinary flow rate
24b
How is depressionmanaged in pateintswith bipolar disorder
25a
mild depression --> lithium orlamotriginemoderate --> add 2nd moodstabalizer (lamotrigine) or add anatypical antipsychotic (olanzapine,quetiapine, risperidone)severe --> consider ETC
25b
How is TCAoverdose managed
26a
ABCsActivated Charcoal 1 g/kg up to 50kg (unless ileus is present)Continuous cardiac monitoring for at least 6 hours --> if noproblems, then clear for psych evalFrequent neuro checksLab studies: TCA level, Chem 7, EKGIf ingestion < 2 hrs ago --> gastric lavageIf hypotension --> IVF (LR or NS) --> NE if ineffectiveIf QRS > 100 msec --> trial sodium bicarb then infusion ifeffectiveIf seziures --> Benzos, barbituates, and/or propofol (but notphenytoin which is ineffective against toxin-induced seizures)
26b
Hyponatremia + lowserum osmolality +
high urine osmolality27a
SIADH
27b
Immunodeficiencywith a + nitrobluetetrazolium test
28a
ChronicGranulomatous
Disease28b
In what time frame wouldyou expect to see parkinsonsymptom side effets in a a
patient takingantipsychotics
29a
4 days - 4 months
29b
In which group ofpatients is bupropion
(welbutrin)contraindicated?
30a
Eating disorders (bulemia -->electrolyte imbalances)
Seizure disorders
Drug lowers seizure threshold30b
IN whichimmunodeficiency is there
an absence of a thymicshadow on newborn chest
xray31a
DiGeorgeSCID
31b
Infectious cause ofaplastic crisis in
sickle cell disease32a
Parvo B19
32b
Newborn male has a distendedpalpable bladder and oliguria.What is the most commoncause of congenital urethralobstruction?
33a
Posterior UrethralValves
33b
A patient has signs of peritonitis andhis clinical scenario favors rupture ofthe bladder (blunt trauma to a fullydistended bladder) --> what portionof the bladder must have beeninjured to allow for a chemicalperitonitis to have developed?
34a
Dome of bladder any where else
contained in pelvicregion
34b
A patient on haloperidoldevelops fever, musclerigidity, confusion, anddiaphoresis --> drug of
choice?35a
Dantrolene
35b
A patient presents to clinic for followup and is found to have a BP of150/85. You note in the chart thatduring his last visit 1 month ago, hisBP was 145/90. What is the next stepin the management of this patient
36a
Repeat BP in 2-4weeks b/c you need 3
increase BP on 3separate occasions
36b
A patient presents with a painless,pruritic papule with regionallymphadenopathy that evolves over7-10 days into a necrotic ulcer witha black eschar. What is thediagnosis and treatment?
37a
Cutaneous Anthrax
Penicillin orDoxycycline
37b
A patient previously diagnosedwith schizophrenia arrives atthe psych ER with a severe neckspasm that forces his head to bemaintained in an unusualposition? What is the treatment
38a
Acute dystonia (torticollis inthis case) due to antipsychotics-->benztropine/diphenhydramine(both have anti-cholinergicactivity)
38b
A patient treated withhaloperidol develops asustained contraction ofthe neck muscles --> whatis the treatment of choice?
39a
Diphenhydramine orbenztropine or
amantadine (anti-cholinergic)
39b
Pediatric Patientwith Red Currant
Jelly Stools40a
Intussception
40b
Positive P-ANCA isa/w what
conditions?41a
Pauci immuneglomerulonephritis
Microscopic PolyangitisChurg Strauss
41b
A post op patient has poorurine output, a BUN of 85,creatinine of 3, clear lungs.What is next step inmanagement of this patient
42a
IV fluids (assess fluidstatus)
BUN/Cr > 20 = pre-renal clear lungs = tolerate fluids
42b
A pt presents to the ER witha very painful irreducibleinguinal mass. What is thenext step in themanagement of this patient?
43a
ORincarcerated
inguinal hernia43b
SIG E CAPS
44a
Characterisitcs of major depressive disorderSleep disturbances (insomnia)Interest lossGuiltEnergy reduction (fatigue)Concentration ImpairmentAppetite changesPsychomotor disturbancesSuicidal Ideation
44b
Tachycardia + wildfluctuations in BP +
headache + diaphoresis+ panic attacks
45a
Pheochromocytoma
45b
What are 4potassium sparing
diuretics46a
SpironolactoneAmiloride
TriamtereneEplerenone
46b
What are 5 etiologiesof temporary
hematuria47a
UTINephrolithiasis
ExerciseTrauma
EndometriosisBPH
47b
What are Ranson'sCriteria in determing the
Prognosis in patientswith acute pancreatitis?
48a
GA LAW, C HOBBSGlucose
ASTLDHAge
WBC
CalciumHctP02
BUNBase Deficit
Sequestration of Fluid48b
What are the 4 symptomsof atypical depression?what medications work
well for atypicaldepression?
49a
HypersomniaPsychomotor retardation (leadenedparalysis)HyperphagiaHypersensitivity to rejection
MAO-I work well(SSRI = 1st line for traditional depression)
49b
What are the 6Ds ofhypernatremia
causes50a
DiureticsDehydration
Diabetes InsipidusDrs (iatrogenic)
Diarrhea (and vomiting)Disease of Kidney
(hyperaldosteronism)50b
What are theavailable treatments
for a patient witherectile dysfunction
51a
1st line = phosphodiesterase inhibitors sildenafil (viagra), vardenafil (levitra), tadalafil (cialis)
2nd line = penile self injectable drugspapaverine, phentolamine, alprostadilvaccum and constriction devices
3rd line = penile prosthesis implantation
Other = androgen replacement if hypogonadism51b
What are the casuesof Euvolemic
Hyponatremia52a
PolydipsiaSIADH
Hypothyroidism52b
What are the causesof a normal anion
gap metabolicacidosis
53a
RTADiarrhea
TPN53b
What are thecharacterisitcfeatures of a
varicocele54a
Dilation of the pampiform plexus of scrotumPresents as scrotal mass, non-solid, TransilluminatesDull achy scrotal pain usually on left side Testicular atrophy on affected sideInfertility is common (present in 25% of infertilemen)Color doppler ultrasound shows retrograde flow tothe scrotumMay point to a RCC
54b
What are thecharacteristic
features of serotoninsyndrome
55a
mental status changes (anxiety, agitation, delirium,restlessness, disorientation)Autonomic excitation (diaphoresis, tachycardia,hyperthermia, hypertension, vomiting, diarrhea)Neuromuscular hyperactivity (tremor, musclerigidity, myoclonus, hyperreflexia)Ocular clonus - slow continuous horizonatal eyemovementsSpontaneuous or inducible clonusbabinski signs bilaterally (dont flex toes)
55b
What are thecharacteristic findings ofhereditary spherocytosis
56a
Jaundice and Gallstones (common with allhemolytic anemias)SplenomegalyAnemia with reticulocytosis and increased MCHCHigher incidence of pseduohyperkalemia asRBCs lyse after blood draw and intracellularpotassium leaksPeripheral smear reveals spherocytesPositive osmotic fragility test
56b
What are the classicfindings of Henoch-
Schonlenin Purpura?57a
Lower extremity palbable purpuraGI (Abd pain, intussception, guiac+ stool)Renal (Hematuria, proteinuria)Arthritis (Transient lowerextremity)
57b
What are thedefining
characteristics ofnephrotic syndrome
58a
> 3g/day of protein,Hypoalbuminemia
Hyperlipidemia58b
What are thediagnostic criteria
for adjustmentdisorder
59a
clinically significant emotional or behavioralreaction causing marked distress or impairmentin social or occupational functioningsymptoms develop in response to an identifiablepsychosocial stressor (divorce, failure at school,peer problems) other than bereavementsymptoms begin within 3 months of stressorsymptoms disappear within 6 months of thedisappearance of the stressor
59b
What are thediagnostic criterionfor schizophrenia
60a
At least 2 of the following during a one month period: (Or 1 +auditory hallucinations)delusions (irrational belief that cant be changed by rationalargument)hallucinationsdisorganized speech (incoherrence or derailment)grossly disorganized or catatonic behaviornegative symptoms (flat affect, poverty of speech, lack of emotionalreactivity)
Social/occupational dysfunction
Duration of at least 6 months60b
What are the dietaryrecs in the treatment
of nephrolithiasis61a
Hydration day and nightConsume normal diet and Ca
amountsDecrease Na intake
Decrease dietaryprotein/oxalate
61b
WHat are thedifferent etiologies
of SIADH62a
CNS disease (head trauma, brain tumor, stroke,CNS infection, pituitary surgery)Pulmonary Disease (pneumonia, tumor)Drugs (NSAIDs, antidepressants, antipsychotics,antineoplastic agents, carbamazepine, ecstasy,vasopressing, dDAVP)Other (HIV/AIDS, major abdominal or thoracicsurgery)
62b
What are the differenttreatments for acute dystonia
tardive dyskinesianeuroleptic malignant
syndrome63a
acute dystonia = anticholinergic= benztropine, diphenhydraminetardive dyskinesia = stop agent,use atypicalneuroleptic malignant syndrome= dantrolene
63b
What are thedistinguishing
characteristics of each typeof renal tubular acidosis
(RTA)64a
Type 1 - Distal - urine pH increased -Hypo K - variable bicarbType 2 - proximal - urine pH increased -Hypo K - low bicarbType 4 - hypoaldosterone - urine pHdecreased - Hyper K - normal bicarb
pH > or < 5.364b
What are theindications for
ElectroconvulsiveTherapy (ECT)
65a
severe debilitating depression refractory to antidepressantspscyhotic depressionsevere suicidalitydepression with catatonic stupordepression with food refusal leading to nutritional compromisesituations where a rapid antidepressant response is required(pregnancy)previous good response to ECTmedical condition preventing the use of antidepressants(elderly)bipolar disorder/maniaschizophrenia/psychosis (catatonic)
65b
What are the mostcommon cause offever of unknown
origin (FUO)66a
InfectionCancer
Autoimmune66b
What are the mostcommon causes ofseizures in children
aged 2-1067a
InfectionFever (febrile)
TraumaIdiopathic
67b
What are the normalranges of pH, pCO2,pO2, HCO3 for acid-
base disorders68a
pH = 7.35 - 7.45pCO2 = 35 - 45
pO2 = 75 - 105 (pCO2 x 2 = 90)HCO3 = 22 -28 (pCO2 / 2 =
22.5)68b
What are thepotential side effectsof lithium in use of tx
of bipolar disorder69a
CNS depression and tremorThyroid changes (hyper or hypo or euthyroidgoiter)Nephrogenic DI (reversible on discontinuation) --> thirst, polydipsia, polyuriaGI SE (nausea, vomiting, diarrhea, metallic tastechanges, wt gain)Teratogen (ebstein's anomaly)
69b
What are the propersteps in the evaluation ofa patient presenting with
erectile dysfunction70a
HISTORYonset and duration; symptoms of depression (SIG E CAPS); medication and druguse; psychological stressors and interpersonal conflict; situational dysfunction? ;presence of nocturnal or early morning erections (present if psychogenic)
PE:anal tone (neuro dysfunction); lower extremity sensation (neuro dysfunction),cremasteric reflex (neuro dysfunction); femoral and peripheral pulses (vasculogeniccause); penis (peyronie's disease); testes (hypogonadism); secondary sexualcharacteristics (hypogonadism); visual fields (pituitary tumor); gynecomastia(prolactinoma)
SERUM LAB TESTStotal testosterone, prolactin, TSH, +/- PSA
if vasculogenic --> cardiac stress test to assess for cardiac endothelial damage as well70b
What are the protein andLDH criteria for anexudative effusion?
71a
Protein Ratio > 0.5(pleural : Serum)LDH Ratio > 0.6(pleural : serum)
71b
What are therecommeneded
therapies fornocturnal enuresis
72a
1st try behavioralmodification (enuresis
alarm)2nd - Imipramine (short
term 6 weeks)72b
What are the riskfactors for bladder
cancer73a
Smokingschistosomaaniline dye
petroleum byproductrecurrent UTIs
cyclophosphamide (antidote = MESNA)
73b
What are thesigns/symptoms of
neuroleptic malignantsyndrome? what is tx?
74a
mental status change (agitated delirium with confusion rather than psychosis)muscular rigidity +/- tremorhyperthermia greater than 38-40 CAutonomic Instability - tachycardia, labile or high blood pressure, tachypnea,diaphoresisrhabdomylosys appearing over 1-3 days
Stop offending agent supportive care in the ICU (IVF, lower fever with cooling blankets, ice packs in theaxilla, tylenol)Reduce HTN with clonidine and/or nitroprusside (cutaneous vasodialtion canfacilitate cooling)DVT prevention with heparin or LovenoxFor agitation use BenzosDANTROLENE prevents rigidity and hyperpyrexia by inhibiting calcium release
74b
What are thesymptoms of OD
with TCAs75a
Cardiotoxicity ( tachycardia,hypotension, conductionabnormalities)CNS toxicity (sedation, obtundation,coma, seizures)Anticholinergic (mydriasis,xerostoma, ileus, urinary retention)
75b
What are thesymptoms of
serotonin syndrome76a
AMSAutonomic Excitation
Nueruomuscularhyperactivity (ocular clonus)
76b
What are the symptoms ofserotonin withdrawal
symptoms? which SSRIsare well known for causing
this when stopped?77a
dizziness, nausea, fatigue, muscle aches,chills, anxiety, irratibility that beginswithin dyas of abrupt discontinuation anddissipates over 1-2 weeks
ParoxetineFluvoxamine
77b
What are thesymptoms of TCA
overdose78a
Cardiotoxicity CNS toxicity
Anticholinergic SE78b
What are thetreatment options forGeneralized Anxiety
Disorder79a
SSRI, Venlafaxine(SNRI), Buspirone,
Beta Blocker79b
What are thetreatment options
for PTSD80a
Psychotherapy including behavioral and cognitive therapySSRI = 1st lineOther antidepressantsBENZOs should be avoided in PTSD due to lack of efficacyand potential for abuseMood stabalizers (carbazemine/valproate) improveimpulsive behavior, arousal and flashbacksalpha blockers (prazosin) improves nightmares and sleepdisturbancesAtypical antipsychotics if refractory to other thearpies
80b
What biostatic calculationlooks at individuals withand without a disease anddetermines the likelihoodof exposure to a risk factor
81a
Odds ratio
81b
What cause of aplastic anemia isassociated with thumbabnormaliites, diffuse hypo- orhyperpigmentation, cafe au laitspots and short stature?
82a
Fanconis Anemia
82b
What causes k+ shiftinto cells and thus
HYPOkalemia83a
InsulinBeta-agonistsAlkalosis (sodium bicarb (vomiting/diarrhea)HyperaldosteronismRenal tubular acidosis types 1 and 2Cell creation/proliferation
K < 3.5, T wave flattening, U wavesGRAPHIC IDEAGI losses (vomiting, diarrhea)Renal Tubular Acidosis (Types 1 and 2)Aldosterone (high)Periodic ParalysisHypothermiaInsulin ExcessCushing's SyndromeInsufficient IntakeDiuretics (loop, thiazide)Elevate B-AgonistsAlkalosis
83b
What causes K+shift out of cells andthus Hyperkalemia
84a
Low InsulinBeta BlockersAcidosisDigoxinCell Lysis (leukemia)
Serum K > 5.0, tall peaked T waves on EKG, arrhythmiasCRAMP KITCatabolism of Tissue (trauma, chemo, radiation)Renal FailureAldosterone deficiencyMetabolic AcidosisPsuedohyperkalemiaK+ sparing diureticsInsulin deficiencyTubular Acidosis type 4
84b
WHat class of diuretic iscommonly used in patientswith renal stones due tohypercalciuria in patients witha normal serum calicum level
85a
Thiazide
85b
What condition may resultfrom the rapid correctionof hyponatremia? whatare the manifestations
86a
Central Pontine Myelinosis (Osmotic Demyelination)Occurs when sodium is corrected by more than 12-20 mEq/Lover 24 hours or is overcorrected to above 140Symptoms are irreversible and typically delayed 2-6 daysafter the correction of hyponatremiaDysarthria/DysphagiaParaparesis or quadriparesisBehavioral disturbancesLethargy and ComaHead CT or MRI 4 weeks after the event reveals areas ofdemyelination
86b
What disease causesglomerulonephritis
with deafnesss87a
Alports
87b
What diuretic or class of diuretic would be most useful in thefollowing situation?a) acute pulmonary edemab) idopathic hypercalciuria (calcium stones)c) glaucomad) mild to moderate CHF w/expanded ECVe) in conjunction with loop or thiazide diuretics to retain K+f) edema a/w nephrotic syndromeg) increased intracranial pressureh) mild to moderate hypertensioni) hypercalcemiaj) altitude sicknessk) aldosteronism
88a
a) acute pulmonary edema --> Loopb) idopathic hypercalciuria (calcium stones) --> thiazidec) glaucoma --> acetazolamide or mannitold) mild to moderate CHF w/expanded ECV --> loop (Ksparing) e) in conjunction with loop or thiazide diuretics to retain K+ -->spironolactonef) edema a/w nephrotic syndrome --> Loop or metolazone g) increased intracranial pressure --> mannitolh) mild to moderate hypertension --> thiazidei) hypercalcemia --> loopj) altitude sickness --> acetazolamidek) aldosteronism --> spironolactone
88b
What drugs areknown to cause
psychosis in patients89a
LSD, PCP, Cocaine,Amphetamines, Benzo, Barb,
EtOH widrawal, Steroids
89b
What durgs areknown for causingelevated prolactin
levels90a
Atypical/Typical AntipsychoticsMethyl Dopa
Verapamil
90b
What electrolyte abnormality fits thefollowing descriptions?peaked T waves on EKGflattened T waves on EKGU waves on EKGQT prolongationQT shortening
91a
peaked T waves on EKG (hyper K)flattened T waves on EKG (hypo K)U waves on EKG (hypo K)QT prolongation (hypo Ca)QT shortening (hyper Ca)
91b
What evaluationshould take place
prior to the initiationof TCAs in children
92a
Because TCAs can cause arrhythmias (prolongedQT) the following should be preformed:screen pts history for heart disease, palpatations,syncope, near syncopescreen family history for sudden death prior toage 40, long QT syndrome, arrhythmias andhypertrophic cardiomyopathyEKG prior to initiation and again whenmedication is optimized
92b
What features characterizetardive dyskinesia that may
develop from the use ofhigh potency typical
neuroleptics93a
Lip smacking, choreaof tongue, face, neck,
trunk limbs93b
What food substancesshould be avoided when
taking MAOIs in order toavoid a tyramine induced
hypertensive crisis94a
Foods that are spoiled, pickled, aged, smoked,fermented or marinated contain tyramineFermented cheeses (cream cheese and cottage cheeseare ok)smoked or aged meats (sausage, bacon, bologna,pepperoni, salami, smoked or pickled fish)Chianti, most beers and winesSoy sauce, shrimp paste, miso soupSauerkraut, avocadosBrewer's yeast and yeast extracts (baking yeast ok)
94b
What happens ifyou ingest tyramine
while on MAOIs95a
Hypertensive Crisis
95b
What is "cradle cap"and what is the tx?
96a
Infantile or neonatalseborrhic dermatitis (crustlactea) - skin rash in scalpSeleneium sulfide shampooor topical antifungals
96b
What is DDX forRespiratory
Acidosis?97a
COPDRespiratory Depression
Neuromuscular Diseases
pH < 7.35pCO2 > 40
97b
What is definitionof primary
amenorrhea98a
absence of menses at 16 yowith everything else normal
orno 2ry sexual characteristics
by age 1398b
What is in yourDDX for Metabolic
Alkalosis99a
Vomiting DiureticsCushing's
HyperaldosteronismAdrenal Hyperplasia
pH > 7.45HCO3 > 24
99b
What is in your DDXfor Respiratory
Alkalosis100a
HyperventilationHIgh Altitude
AsthmaAspirin Toxicity
Pulmonary Embolism
pH > 7.45pCO2 < 40
100b
What is next step in themanagement of a patientwith peaked T waves on
EKG due to hyperkalemia101a
Ca-Gluconate tostabilize
myocardium101b
What ispseudohyponatremia? how
is this different fromhyponatremia andhyperosmolality?
102a
When the serum volume is expanded by a substance such aslipid or protein (multiple myeloma), the amount of sodium pervolume of serum may decrease even though the amount ofsodium per unit of water in serum is appropriate --> pseudo
This is different than hyponatremia due to HYPERosmolalityfrom elevated glucose or mannitol adminstration. In the case ofhyperosm, the increase in serum osmols pulls water out of cellsthereby diluting serum sodium. Here the plasma soidum levelis expect to fall by 1.6 mEq/L for every increase of 100 mg/dLof plasma glucose (increases to 2.4/100 after glucose levelsexceed 400)
102b
What is the biggestrisk factor for RCC
103a
Smoking
103b
What is the cause of biliousemesis in a newborn within
hours after the firstfeeding?
104a
Duodenal Atresia
104b
What is the cause ofmuscle rigidity, fever
and rhabdomyolysis in aschizophrenic patient
105a
NeurolepticMalignantSyndrome
105b
What is the classic (butrare) EKG finding inpulmonary embolism
106a
S in Lead 1Q and inverted T in
Lead 3106b
What is the classicpresentation of a
patient withhyperprolactinemia
107a
Men --> Gynocomastia, impotence,decreased libidoWomen --> Amenorrhea,Galactorrhea (rare), Infertility
Hypogonadism: Low estrogen, LowTestosterone
107b
What is the classicpresentation of post-
strepglomerulonephritis
108a
URI (strep throat) 1-3weeks prior
Brown UrineHTN
ASO + titer108b
What is the classicpresentation of pt withandrogen insensitivity
syndrome109a
46XY, androgen receptor defectPhenotypically FemaleNormal appearing females withrudimentary vaginaNo uterus, NO fallopean tubesHas testes (may be found in labia majora)Increased Testosterone, Estrogen and LH
109b
What is the classicpresentation of the mostcommon renal tumor in
children110a
Wilms TumorMost common age 2-4 y/o palpable flank massabdominal painhematuriahypertensionpossibly multiple other associated congenitalanomalies including WAGR (wilms, aniridia, GUabnormalities, retardation)
110b
What is the classicpresentation of
varicocele111a
Dilation of the pampiform plexus of scrotumPresents as scrotal mass, non-solid, TransilluminatesDull achy scrotal pain usually on left side Testicular atrophy on affected sideInfertility is common (present in 25% of infertilemen)Color doppler ultrasound shows retrograde flow tothe scrotumMay point to a RCC
111b
What is the clinicaldefinition of HTN
112a
140/90 on 3separate occasions at
least 2weeks apart112b
What is the consequence ofcorrecting hypernatremiatoo rapidly? how rapidly
can it safely be corrected?113a
Cerebral Edema12 mEq / L / day
113b
WHat is the consequence ofcorrecting hyponatremia toorapidly? how rapidly can it
safely be corrected?
114a
Central PontineMyelinosis
12 mEq/L/day114b
What is the DDXfor Hypercalcemia
(Ca > 10.5) ?115a
CHIMPANZEESCalcium SupplementationHyperparathyroidism (bones, stones, moans, groans) (fractures,nephrolithiasis, GI symptoms, AMS)ImmobilityMilk-Alkali SYndromePagets DiseaseAddisonsNeoplasmsZollinger Ellison syndromeExcess vitamin AExcess vitamin DSarcoidosis
115b
What is the DDX forHYPERvolemic
Hyponatremia based onurine soidum levels
116a
FEna < 1 --> CHF,cirrhosis, nephrotic
syndrome
FEna > 1 --> renal failure116b
What is the ddx forHYPOvolemic
Hyponatremia based onurine sodium levels
117a
Urine Sodium < 10 (Extrarenal Losses)GI losses (vomiting, diarrhea, NG tube)Fluid sequestration (peritonitis, pancreatitis)Insensible Loss (sweating, extensive burns)
Urine Sodium > 20 (Renal losses)Diuretics (thiazides)Salt-losing renal diseasePartial urinary tract obstructionAdrenal Insufficiency (inadequate mineralocorticoid,Addisons)
117b
What is the definingcharacteristic of a
hydrocele118a
Transillumination
118b
What is the differencebetween major depressivedisorder and adjustmentdisorder with depressed
mood119a
adjustment occurswithin 3 months of
an identifiablestressor
119b
What is thedifference betweenschizophrenia and
delusional disorder120a
non bizarre delusions indelusional and does nothave hallucinations or
negative symptoms120b
What is the difference between thefollowing disordersSchizotypalSchizophreniaShizoaffectiveSchizoidSchizophreniformBrief psychotic disorder
121a
personality disorder with oddthoughts/behaviorat least 6 monthsschizo + mood disorderschizod's "avoid" - personality disorderwith volunatary social isolationphreniform < 6 monthsbrief < 1 month
121b
What is the differentialDiagnosis for adult
hematuria? Discuss theworkup of hematuria?
122a
INEPT GUNIdiopathic, Neoplasm (bladder, kidney, prostate), Exercise, PCKD, TraumaGlomerular Disease (Nephritic, nephrotic), UTI, Nephrolithiasis
Thorough physical exam (UA, CBC, Chem 8, PSA)CT Scan abd/pelvis (no constrast) to r/o renal stoneCT scan abd/pelvis (w/contrast) and post-CT palin film KUB to viewradiopaque stonesIf low suspicion --> consider Tx for UTI and f/u UA in 3-5 daysIf smoker, over age 50, cyclophosphamide use, FH of Urinary tract cancer, orsuspicion for cancer --> send urine for cytoloyg and perform cytoscopyIf work up reveals no pathology consider IgA Nephropathy or Thin BasementMembrane diseaseF/U 1 year cytoscopy and renal sono
122b
What is the differentialdiagnosis for elevatedanion gap metabolic
acidosis with high serumosmolality?
123a
MUDPILESMethanolUremiaDiabetic KetoacidosisParaldehydeIsoniazid, Iron tabletsLactic AcidosisEthanol, Ethylene GlycolSalicyclate, Shock
123b
What is the differentialdiagnosis for metabolic acidosiswith a normal anion gap? Howcan serum potassium be usefulin narrowing the differentialdiagnosis
124a
Normal Anion Gap = Diarrhea, Renal TubularAcidosis, TPN
Low Serum K = diuretics, renal tubular acidosistype 1 and 2, diarrhea, Fanconi's syndrome
HIgh serum K = addison's, renal tubular acidosistype 4, potassium sparing diuretics,hyperalimentation
124b
What is the drug categoryof choice for the treatmentof the negative symptoms
of schizophrenia125a
Atypical Antipsychotics( Clozapine, risperidone,olanzapine, sertindole,
quetiapine, ziprasidone,paliperidone)
125b
What is the drug of choicein the treatment of bipolardisorder in a patient with
renal failure126a
Valproic Acid andCarbamazepine(metabolized by
liver)126b
What is theemergency treatment
for hyperkalemia?127a
Stat EKG to identify peaked T wavesRepeat K level to insure not lab error/lysisD50 1 amp IV followed immediately by 10 units R insulin IVCa-Gluconate to protect myocardium if EKG changesNaHCO3 to cause hypokalemiaAlbuterol nebulizer (drive K into cells)Kayexalate (exchanges Na for K in the gut --> excretion of K --> 24hr effect)Repeat K in 30 minConsider Lasix to increase K wasting in urineReplace Mg if it is less than 2.0Determine cause
127b
What is the first linetreatment for seasonal
affective disorder128a
phototherapy
128b
What is the formulafor anion gap? What
is normal?129a
Na - Cl - HCO3.....normal =8-12
Normal anion gap suggestsHCO3 loss
129b
What is the general treatmentfor calcium nephrolithiasis?What are odds of passing?What is expected managment?When is surgery indicated?
130a
8-9 mm stones are about 50% likely to passIf in UVJ --> 80 % likely to pass If in proximal Ureter --> 50% likely to pass
Strain urine with strainer --> bring stones to lab for analysis (if uric acid stone may require chronic urinealkalinization)Drink 3L of fluid dailyFlomax (tamsulosin)/Nifedipine may relax sm muscle and facilitate stone passage in both gendersPain Meds (NSAIDS (diclofenac), VicodinCipro if signs of UTI w/o pyelonephritis or urosepsisRepeat CT stone protocol in 4 weeks --> CT w/o contrast
10-20% of all kidney stones require surgical removalRequired if unable to pass stone after 4-6 weeks, complete urinary obstruction, persistent infection, impairment ofrenal function
Extracorporeal Shock Wave Lithotripsy (ESWL) for stones in renal pelvis or upper ureter (<3mm)Ureter sotnes --> uretrorenoscopy with possible lithotripsy and possible stent placementStaghorn calculi --> percutaneous nephrostolithotomy (drainage)
130b
What is the immature defense mechanisma) ignoring a piece of information as if it was never saidb) involuntary witholding information from conscious awarenessc) a veteran can describe horrific details without emotiond) a child abuser was himself abused as a childe) a man yells at his family when he has had a bad day at workf) homosexuals choosing to become priestsg) a closet homosexual hates homosexuals because of the way they make him feelh) using intellectual processes to avoid affected expression (dr frasier crane)i) belief that people are either all good or all bad j) expressing agression through passivity, masicism and turning against selfk) belief that external source is responsible for an unacceptable inner impulse L) changing ones character or identity to avoid emotional distressm) returning to an earlier level of maturation to avoid conflict n) offering an explanation for an unacceptable attitude, belief or behavioro) a thought that is voided is replaced by unconscious emphasis on the oppositep) turning mental conflicts into bodily symptomsq) temporarily inhibiting thinking but continuing to build more tensionr) avoiding interpersonal intimacy to resolve conflict and avoid gratifications) extreme forms can result in multiple personalitiest) chronically giving into an impulse to avoid tension for an unexpressed unconscious wish ie tantrumu) substituting a less disturbing unrealistic view of the world in place of reality
131a
a) denialb) repressionc) isolationd) identificatione) displacementf) reaction formationg) projectionh) intellectualizationi) splitting (borderline personality)j) passive agressivek) projectionL) dissociationm) regressionn) rationalizationo) reaction formationp) somatizationq) blockingr) schizoid fantasys) dissociationt) acting out u) fantasy
131b
What is the late, life-threatening
complication of CML132a
Blast Crisis
132b
What is the mostcommon cause of aortic
regurgitation in a 70year old man
133a
senile, calcified,aortic valve
133b
What is the mostcommon cause of
bloody nippledischarge
134a
IntraductalPapilloma
134b
What is the mostcommon cause ofdeath in dialysis
patients135a
Cardiovasculardisease
135b
What is the mostcommon cause of
HTN in youngwomen
136a
OCPs
136b
What is the mostcommon cause ofm&m in patients
with SLE137a
ESRD - end stagerenal disease
Renal nephritis137b
What is the mostcommon cause of
nephrotic syndrome inAfrican American males
138a
Focal SegmentalGlomerular
Sclerosis138b
What is the mostcommon food borne
bacterial GI tractinfection
139a
Salmonella
139b
What is the mostcommon inherited
cause ofhypercoagulability
140a
Factor 5 Leiden Def
140b
What is the mostcommon location of
renal stoneimpaction
141a
Ureto-vesicularjunction
141b
What is the mostcommon side effect
of olanzapine142a
Wt Gain -->Diabetes;
dyslipidemia142b
What is the mostfeared complicationof scaphoid fracture
143a
Avascular necrosis
143b
What is the most likelycause of aortic stenosisin a 50 year old patient
144a
Congenital BicuspidValve
144b
What is the most likely cause of secondaryhypertension given the following findingsa) hypertension measures in arms but low BP inLEb) proteinuriac) hypokalemiad) tachycardia, diarrhea, heat intolerancee) hyperkalemiaf) episodic sweating, tachycardia
145a
a) coarctation of aortab) renal diseasec) aldosterone secreting tumord) hyperthyroidisme) renal failure or renal arterystenosisf) pheochromocytoma
145b
What is the mostproblematic congenital
malformation associatedwith maternal lithium use
146a
Ebsteins Anomaly(Atrialization of
ventricle)146b
What is the next stepin the diagnosis ofcholecystitis when
UZ is equivocal147a
HIDA scan
147b
What is the next step in themanagement of a 65 year oldmale that presents to the ERwith inability to urinate andpainful bladder distension?
148a
Decompression of bladder with 14-18 gaugeFrench Foley catheterIf h/o BPH, may require a cath with a firm Coudetip to "power through the narrowed urethraIf unable to pass urethral cath then suprapubiccatheterization (using UZ guidance)In unable to pass urethral cath and non trainedin suprapubic cath placemnt will be availble forhours then suprapubic needle decompression
148b
What is the next step in themanagement of a child withsevere asthma exacerbationand persistently low oxygensaturation despite medication
149a
Supplemental Oxygen (O2 sat >92%)Nasal cannuliPossible intubation (O2 sat <92%, AMS, unable to speak b/cof work of breathing)
149b
What is the next step inthe management of a
woman with anuncomplicated cystitis
150a
TMP-SMX 2-4 daysno urine culture
EMPIRIC TX150b
What is the next stepin the managementof testicular torsionconfirmed with UZ
151a
Manually detorsion+ surgery within 6
hours (BLorchiopexy)
151b
What is the preferreddiagnositic test for
PE152a
CT w/IV contrastV/Q scan in renal
patients152b
What is thetreatement for
hereditaryspherocytosis
153a
Folic Acid 1 mg dailyRBC transfusions in cases
of extreme anemiasplenectomy in moderate
to severe disease153b
What is thetreatment for BPH
154a
Alternative Medicine:Isoflavones (found in soy - decrease growth of hyperplastic prostate tissue inhistoculture)Saw Palmetto (as effective as finasteride, fewer SE and decreases prostate size w/ochanging PSA values)
Medical InterventionNon-selective alpha blockers (doxazosin = cardura) (prazosin = minipress) (terazosin= hytrin) (for high BP patients)Tamsulosin (flomax) (alpha 1 blocker) (not anti-htn)5 alpha reductase inhibitors (finasteride = proscar) (dutasteride = avodart)Decrease PSA by 50% so double result if on these meds
Surgical InterventionTURP - transurethral resection of prostate (retrograde ejaculation may result)Prostatectomy
154b
What is thetreatment for
Chronic KidneyDisease
155a
Stop SmokingBP aggressive control to < 130/80...Most require > 3 medications(ACE-I or ARBs unless pt is hyperkalemic), (beta blockers) (Loop)(Dihydropyridine CCB), (Clonidine Patch), (Minoxidil in refractory cases)DM aggressive control to HgbA1C < 6.5% with insulin and oral agents (notmetformin --> lactic acidosis)Lipid aggressive control with statins to LDL < 100Anemia agressive control to Hgb 11-12 (For every decrease in Hgb of 0.5 g/dL,increase risk of LVH by 32%) (usually requires iron and epo)Vit D replacementPhosphate Binders (Phos-Lo)Daily ASA
155b
What is thetreatment forepididymitis
156a
< 35, gono/chlam,ceftriaxone/doxy
> 35, enterobac, tmp-smx/quinolones 10-14 days
(prostatitis 4-6 weeks)156b
What is thetreatment for
nephrogenic DI157a
HCTZ (+amilorideif Li toxicity)
Indomethacin157b
What is the treatmentfor nephrogenic diabetes
insipidus caused bylithium toxicity
158a
HCTZ + Amilorideclose the Na channel at thecollecting tubules directly
affected by Lithium158b
What is thetreatment for
prostatitis159a
1 month treatment ifover 35
(bactram/quinolone)159b
What is thetreatment for
serotonin syndrome160a
discontinue all serotonergic agents --> symptoms resolve in 24 hoursSupportive care to normalize vital signs (oxygen, IV fluids, cardiac monitoring,esmolol or nitroprusside if tx for tachycardia needed)sedations with benzosif temp > 41.1 degrees C --> sedation, paralysis and ET tube --> mechanicalcooling (ice, cooling blankets, misting fans), paralysis should releieve thehyperthermia which is caused by muscle activityif agitation despite benzos --> serotonin antagonist (Cyproheptadine)After resolution of symptoms assess need to resume serotonergic agent
160b
What is thetreatment for
superior vena cavasyndrome
161a
Radiation todecrease tumor size
161b
What is thetreatment for tardive
dyskinesia162a
d/c drug and switchto atypical
162b
What is thetreatment for
urethritis in men163a
ceftriaxone + doxyfor 10 days
163b
What is thetreatment for uricacid renal stones
164a
Alkalinize urine(sodium bicarb or
sodium citrate)164b
What is thetreatment of choice
for OCD165a
SSRIClomiprimine
165b
What is the tx for anMI due to cocaine
overdose166a
Give Atavan/Lorazepam, CaChannel Blockers
(B-Blocker DOC for non-cocaine MI)
Over age 35 get cardiaccatheterization
166b
What is the tx for the followingdiarrheal illnesesEntamoebia HistolyticaGiardia LambliaSalmonellaShigellaCampylobacter
167a
MetronidazoleMetronidazole
Flouroqinolone or TMP-SMXFlouroquinolone or TMP-SMX
Erythromycin167b
What is the Tx forVfib
168a
IMMEDIATE cardioversion360J Cardioversion --->
Epi or Vasopressin --> Epi--> Epi
168b
What is treatment ofchoice of mania with
psychosis169a
Atypicals -->Haloperidol
169b
What lab changes will beseen in a patient with
hyperaldoseteronemia?170a
Decreased K (HYPOkalemia); Increased Na
(HYPERnatremia), Metabolic alkalosis
Increase 24 hour urinealdosterone
170b
What labwork isincluded in the work upfor erectile dysfunction
171a
Total testosteronePSA
Prolactin TSH
171b
What medicalconditions can cause
severe depression172a
HypothyroidismHyperparathyroidsm
ParkinsonsStroke (ACA)
CNS CAPancreatic CA
172b
What medicationsare known for
causing erectiledysfunction?
173a
Most antidepressants especially SSRISpironolactoneSympathetic blockers: clonidine,guanethidine, methyldopaThiazide diuretics: Beta blockersKetoconazoleCimetidineAntipsychotics (increased dopamine)
173b
What medications areknown for causing
Hyperkalemia?hypokalemia?
174a
Hyper: K+ sparing diuretics,ACE-I, ARBs, Beta blockers, dig
Hypo K: loops, thiazides,acetazolamide Insulin, BetaAgonists (albuterol)
174b
What medications areknown for causing
symptoms of depressionin patients
175a
Sedatives (alcohol, benzos, antihistamines)Stimulant withdrawalmethyl dopa 1st generation antipsychotics (haloperidol)Antinausea drugs including Metoclopramide andprochloroperazineSteroids (can cause mania or depression) Insufficient thyroid replacement --> hypothyroidismalpha interferon (used in viral hepatitis treatment)
175b
What medications arenecessary in patientswith ESRD (end stage
renal disease)176a
StatinsVit D
Iron SupplementEPO
Aspirin Loops
ACE/ARBsPhosphate Binders
176b
What medicationsare used in the
treatment of BPH177a
non selective alpha blockertamsulosin (no htn)
5 alpha reductase inhibitor
177b
What medicationsare used in the
treatment ofWegners
178a
Corticosteroids andCyclophosphamide
178b
What medications can beused to rapidly correct
hyperkalmeia by shiftingpotassium into cells
179a
InsulinBeta Agonists (albuterol)
Loop Cayexalate
179b
What might you seeon neuroimaging of a
patient withschizophrenia
180a
Increase 3rd/lateralventricular size
Decrease cortical volume
180b
What neurotransmitter changes do you see withthe following diseases?anxietydepressionmaniaalzheimershuntingtonsschizophreniaparkinsons
181a
anxiety - increase NE, decreased Ser, Gaba/Glydepression - decreased NE, dopa, Sermania - increased NE, Seralzheimers - decreased AChhuntingtons - decreased ACh/gabaschizophrenia - increased dopamineparkinsons - decreased dopamine, increased ACh
181b
What organism isknown for causinginfection in burn
victims?182a
Pseudomonas
182b
What rash presents withherald patch followed bya Christmas tree pattern
183a
Pityriasis Rosea
183b
What scale can be usedto detemrine a patients
risk for suicide?184a
SAD-PERSONS ScaleSex (men = 1 pt)Age (<19 or > 45)Depression Prior AttemptsEtOHRational Thought Process (psychotic symptoms)Support LackingOrganized PlanNo spouse/familySickness
0-2 pts = outpatient follow up3-4 = supervised/supported outpatient follow up5-6 = consider hospitalization7-10 = generally requires hospitalization, may need commitment involuntary
184b
WHat should alwaysbe done prior to
Lumbar Puncture185a
assess ICPespecially
papilledema185b
WHat size calcium renalstone has a 50% likelihoodof passing without surgical
intervention186a
8-9 mm
186b
What skin blisteringdisease has a positive
Nikolsky Sign187a
Pemphigus Vulgaris
187b
What two disorders shouldcome to mind when a neonate
has meconium ileus
188a
HirschsprungsCF
188b
What type of acuterenal failure would
you suspecti n patientwith FEna < 1%
189a
Pre Renal(Hypovolemic/Shock)
189b
What type of diuretic is the following druga) triamtereneb) hydrochlorothiazidec) spironolactoned) ethacrynic acide) metolazonef) furosemideg) torsemideh) acetazolamidei) bumetanidej) chlorothiazidek) mannitoll) chlorthalidonem) amiloride
190a
a) triamterene = K+ sparing, non-aldosteroneb) hydrochlorothiazide = thiazidec) spironolactone = K+ sparing, aldosterone antagonistd) ethacrynic acid = loop, non-sulfae) metolazone = thiazide (used in cirrhosis)f) furosemide = loopg) torsemide = looph) acetazolamide = carbonic anhydrasei) bumetanide = loopj) chlorothiazide = thiazidek) mannitol = osmoticl) chlorthalidone = thiazidem) amiloride = k+ sparing
190b
What type of oralcontraceptive can be
given to lactatingwomen
191a
Progestin Only Estrogen suppress
milk production191b
What type of vasculitis fits the following descriptiona) weak pluses in upper extremitiesb) necrotizing granulomas of lung and necrotizing glomerulonephritisc) necrotizing immune-complex inflammation of visceral/renal vesselsd) young male smokerse) young asian womenf) young asthmaticsg) infants and young children; involved coronary arteriesh) most common vasculitisi) a/w hep B infectionj) occlusion of ophthalmic artery can lead to blindnessk) perforation of nasal septuml) unilateral headache; jaw claudication
192a
a) Takiyasub) Wegnersc) PANd) Bergerse) takiyasuf) churg straussg) Kawasakih) Temporal Arteritis (giant cell)I) PANJ) Temporal ArteritisK) WegnersL) Temporal Arteritis
192b
What urine and serum osmolality wouldyou expect to see with the following causesof euvolemic hyponatremia?1) SIADH2) Psychogenic Polydipsia3) Thiazides4) Alcoholism5) Hypothyroidism
193a
1) SIADH (FEna > 1, Una > 20, Uosm Increased >100)2) Psychogenic Polydipsia (FEna < 1, Una < 20 ,Uosm< 1003) Thiazides (Hypo or Eu) (Una increased, Uosmincreased)4) Alcoholism (partial diuretic, Una < 20 /Uosm <100)5) Hypothyroidism (FEna > 1, Una/Uosm increased
193b
What volume status would you expect ot find in apatient with hyponatremia due to the followingcauses1) Thiazide Diuretics2) SIADH3) Hepatic Cirrhosis4) Addison's Disease5) Hypothyroidism6) Renal Failure7) Psychogenic Polydipsia
194a
1) Thiazide Diuretics - Dehydration (FEna > 1) orEuvolemic2) SIADH - Euvolemic (FEna > 1)3) Hepatic Cirrhosis - Fluid Overload (FEna < 1)4) Addison's Disease - Dehydration (FEna > 1)5) Hypothyroidism - Euvolemic (FEna > 1)6) Renal Failure - Fluid Overload (FEna > 1)7) Psychogenic Polydipsia - Euvolemic (FEna <1)
194b
What would you suspect inan ER patient with blood in
the urethral meatus or ahigh riding prostate?
195a
Trauma to urethraBladder Rupture
(dont place a foley)195b
Whats the mature defense mechanisma) Voluntarily choosing not to think about bad newsb) indiana jones using comedy to express feelings ofdiscomfortc) arsonist donates money to fire departmentd) using ones agression to succeed in business venturese) realistically planning for future discomfortf) consciously postponing inner conflict until a big project iscompletedg) redirecting impulses to a socially favorable object
196a
a) Suppressionb) humor
c) altruismd) sublimatione) anticipationf) suppressiong) sublimation
196b
When would you suspectthrombocytopenia due toheparin use? What is themost feared complication
of HIT?197a
platelt count drops by morethan 50%
HIT --> hypercoaguable --> DVT/PE/Ischemic Stroke
197b
Which Antibiotics shouldbe avoided during
pregnancy due to potentialteratogenic effects
198a
TetracyclineFlouroquinolonesAminoglycosides
Sulfonamides198b
Which antidepressant matches the following:SE = priapismlowers the seizure thresholdworkds well with SSRIs and increases REM sleepAppetitie stimulant that is likely to result in WtgainCan be used for smoking cessationcan be used for bedwetting in children
199a
TrazodoneBuproprionTrazadone
MirtazapineBupropion
Imipramine199b
Which antidiabeticagent is a/w lactic
acidosis200a
Metformin
200b
Which drugs should notbe taken with SSRIs
becuase of risk ofserotonin syndrome
201a
SSRIsSNRIsMAOIsL-Dopa
St Johns WortTryptophan
Cocaine/amphetaminesEcstasy
201b
Which Genetic disorder isassociated with multiple
fractures and is commonlymistaken for child abuse
202a
OsteogenesisImperfecta Type 1
202b
Which glomerular disease would you suspect most in a pt with the following findings
1) most common nephrotic syndrome in children2) IF: granular pattern of Immune complex deposition; LM = hypercelleluar glomeruli3) IF = linear pattern of immune complex deposition4) kimmelsteil-Wilson lesions (nodular glomerulosclerosis)5) most common nephrotic syndrome in adults6) EM: loss of epithelial foot processes7) nephrotic syndrome a/w hep b8) nephrotic syndrome a/w HIV9) anti-gbm antibodies, hematuria, hemoptysis10) EM = subendothelial humps and tram track appearance11) nephritis, deafness, cataracts12) LM = crescent formation in the glomeruli13) LM = segmental sclerosis and hyalinosis14) purpura on back of arms and legs, abdominal pain, IgA nephropathy15) apple green birefringence with congo red stain under polarized light16) Positive ANCA17) anti-dsDNA antibodies18) EM = spike and dome pattern of the BM
203a
1) minimal change2) post strep nephritis3) goodpasture4) diabetic nephropathy5) membranous glomerulonephritis6) minimal change7) membranoproliferative8) focal segmental9) goodpastures10) membranoproliferative11) alports12) crescentic/rapidly progressive13) focal segmental14) henoch scholen purpura15) renal amyloidosis16) crescentic17) lupus nephritis18) membranous
203b
Which hernia carriesthe highest risk of
incarceration?204a
Femoral(more common in
women)204b
Which lipid lowering agent matches the followingdescription?a) SE = facial flushingb) SE = elevated LFTs, myositisc) SE = GI discomfort, bad tasted) Best effect on HDLe) Best effect on triglycerides/VLDLf) best effect on LDL/cholesterolg) binds C Diff Toxin
205a
a) niacinb) statins/fibratesc) cholestyramine (bile acid binding resin)d) niacine) fibratesf) statinsg) cholestyramine
205b
Which neurolepticsare known for theirextrapyramidal side
effects206a
High potency (haloperidol, droperidol,
fluphenazine,thiothixene)
206b
Which type of lung cancer is a/w the followingparaneoplastic syndromeelevated ACTH --> gluccocorticoid excess -->Cushing's syndromeelevated PTH-rP --> hypercalcemiaelevated ADH --> SIADH --> hyponatremiaAntibodies to presynaptic Ca channels -->Lambert eaton
207a
Small cellSquamousSmall CellSmall cell
207b
Which vaccinesshould not be givento an HIV + person
208a
Dont give Live VaccinesVaricella ZosterInfluenza IntranasalOral PolioBCG (Tb)AnthraxYellow FeverOral Typhoid/Smallpox
CAN GIVE MMR!!! (If CD4 > 200)
SHOULD GIVE: Influenza, Hep B, Strep PneumoMen having sex with men should also have Hep A
208b
Young black malepresents with painless
hematuria. What do yoususpect?
209a
Sickle Cell Trait
209b
A young female withamenorrhea,
bradycardia, andabnormal body image
210a
Anorexia Nervosa
210b
