Urge Incontinence: +nocturnal Symptoms, Gets Urges All The Time DX: Cystometry: It Will Show Random Peaks RX: Anticholinergics: Oxybutynin, Tolteridine, Frequent Voidings
Urge Incontinence: +nocturnal Symptoms, Gets Urges All The Time DX: Cystometry: It Will Show Random Peaks RX: Anticholinergics: Oxybutynin, Tolteridine, Frequent Voidings
Urge Incontinence: +nocturnal Symptoms, Gets Urges All The Time DX: Cystometry: It Will Show Random Peaks RX: Anticholinergics: Oxybutynin, Tolteridine, Frequent Voidings
has the year of the comp written there this was 2007-2009 version.
1. Patient had a mi that was cocaine induced. Avoid rebount HTN (unblocked
alpha) – don’t give beta blockers. Question wanted to know what is the first thing
you gonna give them. Choices were bblockers, ccb, nitroprusside, benzo
(diazepam), aspirin. (uptodate)Patients with cocaine-related unstable angina, non-ST
elevation myocardial infarction, or ST elevation myocardial infarction are, for the most part,
managed in a manner similar to other patients with these diagnoses. One notable exception is the
use of drugs with beta receptor blocking properties, which are generally NOT recommended in
the early phases of acute coronary syndromes in patients with recent cocaine use. Aspirin,
clopidogrel, Nitroglycerin, CCB and Benzo(especially early in cocaine induced pain to control BP
and HR) I picked aspirin but if benzo is a choice (don’t remember if it was a choice) then pick
BENZO because it is used in early cocaine induced MI. other choices were like nitroprusside, b-
blocker, and aspirin.
2. A question of some one undergoing some sort of procedure and the physician gives them
midazolam,they develop some tingling and numbness around the lips asked what caused this?
Choices were midazolam and some other stuff I cant remember so I just went with midazolam.
Read on multiple sources that this is a sign of local anesthetic toxicity. So I am assuming its
right.
3. A question on Niacin deficiency, patient (young girl) had skin infections and diarrhea, no
memory problems but none of the other defiencies made sense…
4. 2 year old child has sickle cell disease and is on prophylactic penicillin daily this kid now gets a
fever of 105 runny nose and has splenomegaly, what do you want to do next? IV cefixime?
Acetominophen? Nasal decongestant? Some other choices not sure so I picked IV cef don’t
pick ceftriaxone!!!
5. A woman doesn’t make it to the bathroom on time and she pees on her shelf
its happened several times she tries to hold but cant…OVERACTIVE BLADDER
~ Urge incontinence: +nocturnal symptoms, gets urges all the time
Dx: cystometry: it will show random peaks
Rx: Anticholinergics: oxybutynin, tolteridine, frequent voidings
6. A guy broke up with his gf suddenly cannot see in one eye but all vision tests
are normal and everything else is normal what do you do? Pshyc eval? Or
reassure and return to clinic in 1 month? Other choices were all pharm
treatments so wasn’t right. Conversion disorder
7. There was a person forgot what age who needed some vaccinations he was
certainly in his 60s I think. Anyhow, he needed vacc and they gave some
serology people looked at age and went for flu and pneumo BUT if you look at
his serology he was not immune to HEPB (Hepb s antibody was NEGATIVE)so
you gonna give him that as well and that choice was last FLU+PNEUMO+HEP B
give ALL THREE don’t fall for a trap cuz they put flu and pneumo as choice A…..
8. There was a 12 year old boy, NOT 12 month don’t fall for trap….he seemed
sick but very normal kind like a flu or something, he had his flu vac already…and
they asked what else do you give him…choices were like hemop influz vacc, and
some other shit….but the last choice was reassure mom he is ok and needs
nothing and I went for it (look at timing: if >48hrs- reassurance) ( he had a
fever or something looked like flu)
~ low fever, myalgia, body aches : <48hrs osaltamavier, >48hrs supportive
9. A guy has a diabetes and he has an ulcer and they give a picture looks very
similar to this they ask what is the mechanism of how this happened…
choices were like…something wrong with sensation, vascular problem some
other choices I went with sensation
#). Another incontinence question maybe that one was neurogenic but cant
remember now
~ Neurogenic incontinence: leaky all the time, +nocturnal symptoms
Dx: cystometry, inc urine output after u put in a catheter
Rx: 1: self catheterization, 2. Cholinergics (bethanicol) 3. Alpha antagonist:
Zosins
#). Peds congenital questions-TOF and Coarctation of Aorta
#) . peds musculoskeletal / jaundice / feeding
#) Cows milk- iron deficiency anemia but kid was getting fortified cereal with iron
so not iron deficiency I think the kid was on methotrex or something so he had
folate def anemia because methotrex works with blocking DHR-folate reductase
check this, (kid who had anemia and asked whats the cause of the anemia,
straight forward question) #)
#). Goats milk- folate deficiency anemia
#). Breast Milk Jaundice- phisologic jaundice at 5 days of birth and peaks at 2
weeks you will have conjugated bilirubin that is high and you tell mom it is ok it
will go away in 12 weeks.
#). Breastfeeding failure jaundice typically occurs within the first week of life, as lactation failure
leads to inadequate intake with significant weight and fluid loss resulting in hypovolemia. This
causes hyperbilirubinemia (jaundice) and in some cases, hypernatremia defined as a serum
sodium >150 mEq/L. Decreased intake also causes slower bilirubin elimination and increased
enterohepatic circulation that contribute to elevated TB. These babies can get kernicterus.
10) Patient had asthma- FEV1 decreased, TLC inc (up arrow and down arrow)
FEV1, FVC, ratio all dec, TLC and RV are inc DLCO inc/nl
#) Psych: bipolar, cocaine induce MIquestion wanted to know management
what drug to give? B-blocker, diazepam, Aspirin,nitroprusside…
11) Steroids (also caused by levadopa, antidepressants[TCA & MAOIs]) for 3
weeks had manic episode: drug induced bipolar ( someone had manic for 3
weeks or so was on a bunch of meds asked for the caused the episode)
- MTB page 290: Psychosis and confusion secondary to
Levodopa/carbidopa, do not stop the medications. Risk of locked in with
bradykinesia. Use antipsychotic meds with fewest EPS effects. Do not
confuse with Locked in Syndrome:
#). Two kinds of eso. spasm to choose from: DES or Nutcracker esophagus.
Diffuse esophageal spasm- classic corkscrew esophagus, present with CHEST
PAIN symptoms, these chest pain symptoms may go away with nitro or may not
but always rule out cardiac cause. exacerbate with cold or hot foods/liquids. A
barium is again the first study BUT most accurate for diagnosis is gonna be
manometery. Tx with calcium channel blocker like any spastic disorders
26). Esophageal stricture- this was for sure a comp question. happens in the
lower end of the esophagus. usually due to long standing gerd.these patients
wont have any issues with fluids usually problem is only with solids and look for a
patient who eats like a big portion of steak (steak house syndrome) is assc. with
this. this is NOT plummer vinson syndrome but has a similar presentation.
Schatzki - distal. PVS - proximal. (someone had GERD and now has prob eating)
~ Strictures: hx of long GERD, dysphagia for solids only not liquids, no weight
loss, or loss of appetite
Dx: 1: barium: symmetric circumfrential narrowing of the esophagus
2: Endoscopy: to r/o cancer: it will show fibrosis/inflammation
Rx: endoscopic dilation and aggressive PPIs
#) Plummer Vinson syndrome- esophageal webs, iron def, big tongue (glossitis)
problems with solid food. This is a precursor to squamous cell cancer!
#). 20 yr old guy with mom: having hallucination so he went to hospital dr gave
him haloperidol, then guy, Guy goes blind? Having abd pain, fetal position?
Malingering: (everything was normal and he kept saying he has pain and asked
whats wrong with him)
facticious disorder- patients fabricate symptoms or self injure to assume sick role
(primary gain) Munchausen’s is a severe and more chronic form.
Malingering- patients cause of fake sx for secondary gain, financial or some
other.
Look at side effects of haloperidol: N/V/D diarrhea, headache, dizziness,
spinning, insomnia, drowsiness, restlessness
#) Hypothyrdoism, muscle rigidity, sedation, hypotension (a1 blocker).
#) Renal SE of diabetes> Inc GFR, thicking of globular basement membrane,
27) Left lower quad pain, temp: diverticulits ( straight forward question)
~ dx: CT
~ rx: uncomp: IVF, abx (floroquinoline +metronidazole), NPO
complicated: abcess, fistula, perforation:
fluid <3cm: IV Abx, and observation
Fluid >3cm: CT guided drainage + IV Abx
Perforation: resection
28) Pancreatitis: chronic alcoholic - Ransons criteria determies mortality.
pancreatitis can be caused by gall stones, alcohol, fatty meals,
hypertriglyceremia, trauma, ERCP. usually the diagnosis is with a clinical hx and
CT. Initial managmenet is with NPO, Fluids and if patient is spiking fevers
antibiotics. complication 1-2 weeks after, can be a pseudocyst which can become
an abscess. Rx is going to be to drain percutaneously if a cyst becomes and
abscess. if it is a cyst and no necrosis then leave it alone it will go away on its
own. ( comes back after few weeks)
~ pt few weeks after pancreatitis with abd pain, early satiety
dx: CT scan
rx:
< 6weeks, <6cm: observe , >6week. >6cm: drain
29). Brain picture: 60 yr old guy, white thing in middle of brain- brain tumor of
glioblastoma multiforme is what It looked like it caused the central sulcus to move
it was a picture of a white mass dead smack in the middle and should the central
line shifting choices were BRAIN TUMOR, infection, some other stuff that made
no sense. ( picture of MRI of brain and asked what it was)
~ cerebral hemispheres, GFAP +, histo: pseudopallasading with central areas of
necrosis , gross: can cross the corpus callusom (butterfly)
30). Bronze diabetes; hemochromatosis: moa: increased absorption of iron in
duodenum. Thats correct, look for family history of liver disease/cirrhosis, gene
mutation: c282y gene. MC in men>women secondary to menstruation. Can
present with diabetes or erectile dysfunction, and hyperpigmentation. Can cause
restrictive cardiomyopathy. Increase in LFTs and alkaline phosphatase. Initial
test: Increase iron and ferritin, decrease tibc. Most accurate - Biopsy! In
restrictive heard diseases the CO .. At risk for infection with vibrio vulnificus!!
( young guy with DM and stuff and asked the cause)
~ guy with DM, broze skin color, joint pain, ED, elevated LFTs and alk phos
dx: serum: inc Fe, low TIBC, high ferritin, high transferrin sat
accurate: liver biopsy
rx: phelebotomy, Deferoxamin
53. Also remember the association with pseudogout - positive birefringence,
RHOMBOID shaped (4Hs: hemochromatosis, hyperparathyroidism,
hypophosphatemia, hypomagnesemia.)
31) Multiple sclerosis; loss vision tx: corticosteroids (acute), interferon B
(relapsing and remitting) Diagnosis is NOT with lumber puncture and getting
CSF. this will aid in diagnosis but MRI is the best test to look for destruction of
white matter. CSF will show oligoclonal bands this is only supportive to
diagnosis. These patients will have a wide range of symptoms that can be in all
arrays that dont make any sense. It is very commonly assc. with MLF!!
intranuclear opthalmopelegia.-->ON THE EXAM THE SYMPTOMS HAD
RESOLVED SO GIVE INTERFERON, glatimer,
~ symp: demyelination of CNS white matter, vision probs, sensory loss, motor
weakness, gait and incontence in a relapsing and remitting manner
Dx: MRI: white plagues of demyelinated axons in the periventricular ares
CSF: oligoclonal bands of IgG
Rx: acute attack: IV corticosteroids
Maintenance and prevent relaps: INF B, Glatirmer, natalizuma, etc
32). Stroke 2 questions- first thing to do in stroke is CT( without contrast) of head
to determine if hemorrhagic or ischemic. If ischemic then give tpa if less than 3
hours, if more then three hours give aspirin and/or clopidogril if contraindications
to aspirin. 1) Asprin has proven mortality benefit in stroke patients,
<3hrs: tPA, >3hrs: asprin, or add dyprimadole or switch to clopiderol
~ what would you do next: head CT without contrast
33). SLE: markers (anti DNA DS, anti smith [specific], ANA [sensitive]), 2 yr old
girl what would she get next: Rash, arthritis, soft tissue seritis, oral ulcers,
photosensitive, neuro, ESR, renal disease, serositis.
34). Rheumatoid arthritis vs osteoarthritis RA - symmetric joint involvement--->
pannus formation, risk factor is age and HLA-DR4. morning stiffness that
improves with use, multiple symmetric joints (wrists, MCP, ankles, knees, hips).
Swan neck and boutenniere deformities. Labs show RF, anti-CCP Ab, inc. ESR,
anemia of chronic dis., synovial fluid is turbid w/ inc. WBC. Radiographs to
detect joint space narrowing. Tx NSAIDS which can be taken off with
improvement with DMARDS (methotrexate).
Dx: labs: ANA, RF, Anti CCP (specific), ESR
Xray: erosions, and osteopenia
Rx: NSAIDs, steroids
DMARDS: MTX
58. Osteoarthritis- obese and hx of joint trauma, Fam. hx., pain worsens with use.
Aaffects DIP, PIP, hips and knees (weightbearing joints). Synovial fluid, dec.
WBC count and osteophytes, XRAY joint space narrowing as well. TX is weight
reduction then NSAIDS, intra-articular steroid injection. Joint replacement in
severe cases.
Dx: all labs: nl
Xray: joint space narrowing, osteophytes, dense subchondral bone, bone cysts
Rx: weight loss, Acetaminophen, NSAIDS
35) Wide complex tachycardia - ventricular tachycardia- how to manage. Pt. is
stable and in VTACH give antiarrhytmic: Hemodynamically stable VT:
Amiodarione, then lidocaine, and then procainamide. If medical therapy fails →
CARDIOVERT Hemodynamically unstable VT: electrical cardioversion several
times, then follow with amiodarone, lidocaine, or procainamide. On exam patient
had pulse of 130 was stable didn’t ask for treatment just described a wide
complex ekg no pic with a pulse of 130 ( back to back questions to identify the
EKG)
36). A follow up question right after that was a pulse of 130 again and I believe it
was narrow complex and regular so I picked sinus tachycardia, again no picture
they just described it to you (said narrow complexes seen sinus tachy)
61. A guy was described as having bipolar they gave symptoms such as
pressured speech was up all night but then they throw a curve ball at you if you
don’t read the whole thing u will get it wrong and say that he heard voices in his
head and those voices told him to do all this extra work and stay up and all that
so that means this guy got scizho but it wasn’t a choice I think schizophreniform,
schizoaffective. was a choice instead. But def not bipolar. ( he was having dec
need for sleep and and other stuff and was asking for dx had psychosis also)
~ Schizoaffectve: psychoprenia +mood, with at least 2 weeks of psychosis with
no mood
~ depression with psychotic features: psychosis +mood all the time together
~schizphreniform: pschyosis <6mts
~ acute psychotic: pschysis >1mt
37) Herpes simplex on face kid: If it is vesicles that are grouped then it is herpes
and you would give acyclovir. BUT if it is honey crusted bullous vesicles NOT
grouped then its staph. related and give topical mucoprion. Not 100% positive if
this was herpes vs impetigo the face looked super red and there was def crusting
and stuff but red prevalent will try to find pics but I thought it was impetigo or
eripelas so went with topical mucoprion ALMOST SURE not herpes and topical
acyclovir is NEVER an answer on uSMLE from conrad…..
38) Kid had Kawasaki: IV immunoglobulin is given first! to prevent further
vasculitis and then you give aspirin.
~ high fever >104 for 5days
~ bilateral conjunctivitis, rash, cervical lymphadenopathy, strawberry tongue &
cracked lips, erythema of palms and soles, desqumating rash of hands and feet
dx: labs: leukocytosis, inc ESR, CRP,
Echo: to look for aneurysms
Rx: Immediate IVIG, high dose aspirin
39) It was a baby who had problems with feeding throwing up each and
everytime and when not feeding it was fine they ask how do u test what you
suspect? Tracheo esophageal fistula- put NG tube!! Simple and straight forward
TEF: coughing & choking with 1st feeding, risk for aspiration pneumonia
Dx: 1: NGT: it will coil up 2: xray:
Rx: IVF, ppx abx: amox-clavulinate, surgery
Duadenal atresia: biliary emesis but no respiratory symptoms, hx of
polyhydraminous
Dx: NGT: it will go down to the stomach, 2: xray: double bubble sign
Rx: IVG, surgery
40) Syphilis: pen G this is correct. if allergic then desensitize them and give
penicillin but give it. In primary syphilis you do a dark field microscopy because
VDRL and RPR will be falsely negative. In secondary and tertiary syphilis you do
VDRL/RPR and confrim with FTA-ABS. (they gave pen G and VK as ans choices
~ primary syphilis: painless ulcer rx: Pen G IM or doxy
~ secondary: rash on palms and soles, condylomata lata: rx Pen G IM or doxy
~ Tertiary: tabes dorsalis, arglyl Robertson pupil (accomudates but does not
react), aortitis (AR), gummas: rx: Pen IV (14 days), or ceftriaxone IV (14 days)
~ if pregnant no matter what phase all ways give Pen G or desensitize if allergic
41) 50 swollen testes, bullous lesions on the testes, with crepitius…what do you
do Culture the lesion? CT of pelvis? Debridement was a choice Some other
choices….i looked this up after exam it says this can be a sign of Necro Fasc.
Due to deep fascia involvement….especially the crepitus indicates infection
possibly with clostridium so since it was N fasc. Do debridement!! Laboratory
studies and blood cultures should be sent as outlined in the following sections. However, the
diagnosis of necrotizing fasciitis is established surgically, with visualization of fascial planes and
muscle tissue in the operating room, and surgical intervention should not be delayed while
awaiting results of other testing when there is clinical suspicion for a necrotizing infection.
Uptodate!! (swollen testes that had creptus and asked what to do next)
~ necrotizing faciatis: high fever, pain out of proportion, bullae, palpable crepitus, mcc: strep and
clostridia , elevated cpk,
dx: xray, CT, MRI: shows air in the tissue
rx: IVF, amox-clavulinic,(Carbepinems + clindamycin) + debriment
42). Woman urine culture that didn’t show organism but has recurrent burning
and pain then on physical exam when the physician tries to press around the
periurethral glands some purulent pus comes out - bartholin abscess. This was a
choice so I picked it, other choices were, chlamydia, and stuff that didn’t make
sense. ( woman had buring but cultures were negative)
~ pain, tenderness, dyspareunia
~ rx: I &D , culture the fluids for STDs
43). Girl has dry mouth, something by cheek bones, cant swallow, parotitis, what
do next CT, antibiotics, check anas I picked this sjogrens syndrome is what they
were hinting at.. (someone had sjorgens)
44) New born Kid had fevers and cultures are pending, mom was taking IV
ampicillin intrapartum, give kid ? amp and gentamycin you check for GBS in a
preggo lady when you are around 35 weeks! if GBS + then give intrapartum IV
penicillin as rx. If negative dont give anything UNLESS!!! her previous preg was
GBS +, OR SHE HAS A FEVER around the time of delivery.
45). Rockymountain: rash all over - patient goes camping and gets a tick bite and
gets rash everywhere usually starts at palms and soles and spreads to trunk I
think they call it centripetal rash. They say the woman also drank camp water
and some other stuff but def was RMSF rx with doxycycline ( he did a bunch of
things and asked what was the cause)
~ hx of tick bite (dermecantor tick), fever, chills, headache, severe malaise -
rash starts on wrists and ankles then go to the trunk and face
Rx: doxcycyline, chlorumphinicol if <8yrs old or pregnant
#). They gave a picture of a fundoscope in a patient who had some eye problems
and man I had to guess this one I forgot the choices but the fundoscope looked
something like this cupping??? Not sure if cupping was a choice though:
Glaucoma
46). Athroscopy surgery of knee what do you give prophylactically: vanco, clinda
or IV ceflazoin or nothing? DON’T PICK NOTHING because it wasn’t asking for
endocarditis prophylaxis read uptodate explanation below….New guidelines of
endocard prophylaxis is give ampicillin ONLY to patients with congeintal heart
defects. THIS excludes septum secondum ASD this is the only heart defect
where you dont need prophylaxis. all others you do. Dont give prophyslaxi to any
one undergoing GI or Gentiourinary procedures either. So rule of thumb if they
got heart defects!! give prophylaxis → this does not mean murmurs, if they got
AS, MR, TR or any of that they do not need prophylaxis.
UPTODATE- PROPHYLAXIS FOR KNEE PROCEDURES!!!!
Antimicrobial prophylaxis — Prosthetic joint infections (PJIs) are usually due to S. aureus or
coagulase-negative staphylococci. Surgical antimicrobial prophylaxis with IV CEFAZOLIN
is warranted for patients undergoing total hip, elbow, knee, ankle, or shoulder replacement;
acceptable alternatives include vancomycin or clindamycin (table 1) [4,13].
Evaluation
● Measure IOP with tonometry
○ open-angle glaucoma introcular pressure are 20-30 mmHg
○ angle-closure glaucoma > 30 mmHg
● Assessment of optic disc shows enlarged cup-to-disc ratio (>0.5)
Treatment
● Emergency treatment is required to prevent blindness in acute angle-
closure
●
● First line is medical
○ timolol
■ decrease aqueous humor production
○ pilocarpine
■ constricts pupil and decreases intraocular pressure
○ IV mannitol
○ glycerin
○ acetazolamide
○ epinephrine is contraindicated in acute angle-closure glaucoma
● Definitive treatment is surgical
○ laser iridotomy
~ watch out for macular degeneration: bilateral loss of central vision, cant see
straight things. Fundoscopy have focal yellow drusen deposts around the macula
77. Venous ulcers: venous ultrasound→ venous ulcers are due to insufficient
venous valves and these patients are generally truck drivers, pilots or people
who stand on their feet all day. these are also called stasis ulcers and are very
superficial ulcers. Dilated or tortous superficial veins. You want to tell these
patients to move around, elevate their legs during sleep, wear compression
stockings and ambulate. These patients may have a know hx of DVT. Differential
is superficial thrombiphelbitis,
venouse insufficiency: LE, hx of DVT and varicous veins, swollen in extremities,
relieved by elevating the LE, inc skin pigmentation around ankles and with skin
breakdown and ulceration
Dx: dopplex US
Rx: compression stocking, elevation, and wound care
Arterial insufficiency: These ulcers will present in the same area but pulses are
absent.
Symp: claudication, absent pulses, shiny, smooth legs
Dx: 1: ABI: <.9 is abn 2: CT angiogram
Rx: reduce RF: stop smoking, statin, aspirn, intense exercise, cilastizole, surgery
ang 1 inc, ang 2 dec, renin inc, ald dec, bradykind inc
Angio II levels low, Angio I levels High, kallikikrein levels high, bradykinin levels
high, renin high and aldosterone low.
Vaccinations:
#). Pancoast tumor- is a Non small cell lung cancer. BUT this is an exception you
dont do surgery first because it is too close to subclavian , you do local
rad/chemo if spread and then you can attempt surgery. Lesions may results in
shoulder and arm pain in C8 T1 AND T2 locations. Horners syndrome can occur,
weakness and atrophy of hand, ipsi ptosis, miosis, anhidrosis.
#. SVC Syndrome- facial swelling, neck vein swelling, weight gain etc. survival is
usally 6 months. Rx is to treat symptoms and underlying cause (usually cancer).
If it as SCLC, LYMPHOMA then you stent and rarely surgical bypass. If it is
NSCLC then you consider stent and early radiation therapy. DO STENT
PLACEMENT AND RAD THERAPY IF EMERGENCY. How to treat it?
Small cell: this tumor is also central and usually treated with chemo. this tumor is
assc with paraneoplastic syndrome, namely Lamb Eaton Syndrome, Cushing,
etc...
#. Thyroid: person has lump on pretracheal region of neck that moves with
swallowing, what is the test to get most accurate diagnosis: TSH levels? Fine
needle? Do needle→ although tsh levels can help tell you what it is hypo or
hyper its asking for most accurate diag not the most initial test… if they say what
is the most initial work up then TSH level and free t4 is your answer.
#. Patient had a lump on the neck on the pretracheal area that moves with
swallowing asked what is the best test for diagnosis, tsh, fine needle, direct
scope, etc..i think this was asking about thryogloassal duct cyst and how u
diagnose it?
66). Kid was born epicanthal folds, tongue protrusion,simian crease, separation
between first and second toe: check TSH in preg? Toxicology? Rubella? How
could u preventAFP levels was a choice pick that!!! This was describing downs
( asked how u could have prevented it)
67) TB pt came in from nursing home 15mm induration: chest xray neg: put him
on isoniazid Yes nursing home, docs, prisons all these guys >10 is your ppd
threshold if >10 then do xray if x ray is positive give full RIPE and if negative then
give INH PLUS B6 for 9 months. XRAY with cavitation DOES NOT MEAN IT IS
ACTIVE TB!!!! this is still considered a negative xray dont get tripped all it means
is that it is a latent infection!!
68). Kid had DM type 1: prophylactically ace inhib
113. DKA!- increased anion gap (Na- (CL+HCO3)) Normal is 8-12. metabolic
acidosis. It is one of the MUDPILES. ketones will be positive fruity breath,
glucose will be high somewhere in the range of 300-600 if greater then that
check anion gap and differntiate with HOHGNKS (hyper osm, hyper glyc, non
keot synd). DKA usually seen in type one Diabetics usually after stress like an
URI, binge drinking, starving etc...Treat these guys with IV fluids first!!!!! then
insulin and then potassium. Even if the potassium is normal u give potassium
because this is an example of pseudohyperkalemia the acidosis forced the
potassium out of cells and as soon as u correct the acidosis the potassium will go
back in and the patient will have hypokalemia leading to arrhytmia so again
treatment is gonna be in this order!! IV FLUIDS→ INSULIN→ POTASSIUM. the
reason u give fluids first is to make sure he doesnt go in to cardio collapse, high
sugar wont kill him acautely but a collapsed circulation will so give this guy fluids
first then insulin and then potassium
69). Metformin while preg, change to insulin-->yes during pregnancy you want to
keep patients on insulin rather then oral drugs. (woman already had diabetes)
115. Pancreatic psuedocyst treatment? Drainage yes you drain if cyst >6cm OR
ELSE you leave alone it will resolve on its own. if no size is given then look at
symptoms is this patient having symptoms if so then drain it. percutanouse
drainage. Approach if suspected, initial step is USG and to confirm you can do a
CT or MRI.
70) Huntington disease: 40s bad behavior, what structure is messed up?
Caudate nucleus, Autosomal dominant, anticipation, chorea CAG repeats
trinucleotide repeats. Tx chorea wth haloperidol or neuroleptics. Tx the psychosis
with haloperidol or quetapine.
117. 15-20 yr old with chest pain answer: what you do?--> If EKG is choice u do
it! because no matter the age always rule out the extreme you never know!!! If no
ekg then look for other choices and look at hx you might be missing things like
GERD, vasospasm (princemetal), HOCM a whole host of things.
118. Tourettes: kid 10 yr old, coughing excessively… yes coughing can be a
motor tic ( he was coughing, look to make sure he has two tics)
119. Kid having weird urine labs after a cold this pat was a girl who had a
pharyngitis 2 weeks ago was given antibiotics has 4 plus protein and RBC casts
and periorbital edema and some pretibial edma what is diagnosis brought it
between Minimal change and Post strep and went with psost strep cuz of rbc
casts: post strep glomerulonephritis this is a type of nephritic syndrome and
classically known as lumpy bumpy appearance on light microscopy. pt will have
subepithelial humps on Electron microp. Dont do anything just reassure cuz this
will go away on its own. (look at how to differentiate btw mm and poststrep)
72). A patient had pyelonephritis and they gave arrows for it you had to pick
based on UA finds so for example what was the WBC casts that was increased ,
inc RBC, Inc WBC, inc leukocyte esterase, inc bacteria, PH dec. etc….look them
up for pyelo: up and down arrows
73) Ptosis, miosis, and anhydrosis: small cell? Pancoast tumor?
74). Lady having bloody nipple discharge: intraductal papilloma- most common
cause of unilateral bloody nipple discharge
123. Guy had massive resp acidosis: ph 7.3, pco2 70, is this resp acidosis?
Severe exacerbation? Chronic resp acidosis w/ acute exacerbation
124. Lady got sick right after vag delievery there was small blood in her vagina
but the doctor said that’s normal lochia there was NO foul smell? What bacteria
got her sick? Staph aureus, staph epi? E coli? Candia albicans? Or Mycoplasma
pneuoma ( postpartum she got sick)
mc organism for endometritis: Polymicrobial
rx: iv clinda, iv aminoglycoside
75) A 18 year old Guy is a wrestler in school and participates in wrestling had
1x1 on butt then grew to 4x4 ulcer? What caused this? Worm, staph aureus?
Trypyton ruburum ( tinia cororis, Dx: KOH, rx: topica azol, or other antifungals)
76). Kid newborn was cyanotic at birth, blue lips, gave 100% oxygen but still 50%
on pulse ox? What u do next? Give prostaglandins to keep PDA open (intubate)
77). Pt had warm skin, shock, and vasodilation of arterioles- asked for RX
choices were A-L, it was septic shock 1. GIVE FLUIDS. 2 give pressors and 1 st
line pressor is NOREPINEPHRINE was an answer choice also pick it!
( make sure they gave IVF first then give pressors second)
78). Pt got stabbed in neck at the base and was hypotensive? What got
damaged? Jugular vein? subclavian? Exsanguination is the most common cause
of death, and the carotid artery is the structure most often involved but wasn’t an
answer choice
Zone I comprises the are between the clavicle and the cricoid cartilage (Fig 1).
This zone includes the innominate vessels, the origin of the common carotid
artery, thesubclavian vessels and the vertebral artery, the brachial plexus, the
trachea,the esophagus, the apex of the lung, and the thoracic duct.Zone II
comprises the area between the cricoidcartilage and the angle of the mandible
and contains the carotid andvertebral arteries, the internal jugular vein, trachea,
and esophagus. Thiszone is more accessible to clinical examination and surgical
explorationhan the other zones (Zone III extends between the angle of
themandible and the base of the skull and includes the distal carotid andvertebral
arteries and the pharynx. Zone III is not amenable to easyphysical examination
or surgical exploration. Most injured zone is zone 2 and most common on left!!!
79). 70 yr old guy with afib well controlled with digoxin, bowel is black they show
a picture?, ( said it was well controlled with digoxin) mesenteric ischemia is the
answer
~ mesenteric ischemia: occlusion of SMA (mc) #1 RF is atrial fib pt presents
with extreme abd pain, labs: leukocytosis , and inc lactic acid
dx: initial: abd xray: air in the bowel wall. Accurate: angiography
rx: IVF, abx, NJT, emergent laparotomy
80). Another similar separate question and talked about watershed infarct zone
transverse colon and descending colon meeting point or something like that and
asked whats the problemischemic colitis
~ Ischemic colits: old pt with hx athleclerosis, or after a procedure presents
with abd pain, tenderness lateralized to the affected part, hematechezia,
diaarhea etc.
~ dx: CT: edema, or air in the bowel wall, accurate: colonoscopy: shows segment
of cyanotic mucosa and ulceration and a sharp transition btw the affected area
and the unaffected area.
Rx: IVF, bowel rest, IV abx, if signs of perforation: colon resection
#) Parents that don’t give kids vaccinations: epinephrine?
For CROUP bark like cough caused by parainfluenzasupportive treatment
and racemic epinephrine if severe. Steeple sign
For bronchiolitis RSV supportive tx, oxygen, fluids, nebulizer,, albuterol
81). Heart failure: dobutamine (cardiogenic shock) only give when heart is not
contracting, dopamine give if patient is hypotensive and in HF when u give that
Epinephrine, know when to give each
Filling Pressure
Cardiac Output Vascular resistance
(RA and PCWP)
Septic shock Low Increased Low
Cardiogenic High Low High
Hypovolemic Low Low High
Cardiac tamponade High Low High
Papillary muscle
High Low High
rupture
82). 2 ½ yr old: know developmental milestones for this age EVERYTHING WAS
NORMAL
Climbs stairs (by 18 mo)
Cubes stacked—number
= age (yr) at 3—feeds self with fork and spoon (by 20 mo) Kicks ball (by 24 mo)
Recreation—parallel play (by 12 mo)
Rapprochement—moves away from and returns to mother (by 24 mo)
Realization—core gender identity formed (by 36 mo)
Words—200 words by age 2. (2 zeros), 2-word sentences
83)Hemophilia: guy bleeding, uncle has it? What is def? Factor 8 THEY GIVE
THIS 136. IN ROMAN NUMERAL so becareful cuz choice a) was actually factor
7 not 8 so spend time and look for factor 8 VIII Defeciency: BLEEDING TIME
WAS 6 MINUTES (normal), PT was around 12 seconds was normal and PTT
was around 55-60 seconds was prolonged when mixing studies were done with
someone elses plasma everything corrected
83). Child was falling everywhere, bad gait, knocking into things, was young,
choices were like rathkes pouch, craniopharyngoma, brain tumor in child:
astrocytoma was not a choice MEDULLOBLASTOMA
~ location: cerebellum: pt presents with falling, ataxia, nystagmus etc
138. Increased indirect bili: def of UDP gluc. Indirect hyperbilirubeninemia means
that the increased bilirubin is unconjugated this can be due to Gilberts syndrome
or Criggler Najjar. If there is hyperbilirubinemia and its DIRECT, the defects are
caused by either Dubin Johnson or Rotors syndrome
84) Varicella is usually observation ALONE! Most cases resolve on their own. If
extremely severe then give IV acyclovir. But for the most part treatment of
varicella in kids is supportive.
~ varicella: chicken pox: rash no fever, rash is gonna be vesicles on
erythematous base of different stages of healing
140. 12 weeks preg and enlarged uterus: patient had a US done and the uterus
had a gestational sac but not fetal heart tones…choices were gestastional
trophoblastic tumor, some weird stuff, but nothing with Intra uterine demise and
no levels of hcg or anything were given so I just went with gestational
trophoblastic
(there was a sac but no fetal heart tone and asked what it was)
pseudocyesis-, no acutual fetus In this rare clinical syndrome, a non-pregnant, non-
psychotic woman believes she is pregnant and exhibits signs and symptoms of pregnancy. The
diagnosis of pseudocyesis is made in a non-pregnant, non-psychotic woman who believes she is
pregnant and exhibits signs and symptoms of pregnancy. The presence of a medical condition
that causes endocrine changes excludes the diagnosis, although endocrine changes can be
present in women with pseudocyesis. Rx with insight and counseling.
85) Placenta previa: Inc risk for? Placenta accrete, 2 fold increase of congenital
malformations, post partum hemorrhage and vasa previa are all complications!
Other answer choices were amniotic embolism, and p something delayed
maturity
86). 53 yr old lady: having trouble with period they are becoming irregular:
reassurance going thru menopause
~ dx: FSH level: which is high
87). Squamous cell carcinoma in anal disease? this is the most common in HIV
patients, presents as a fungating rectal mass. They describe a patient was HIV
positive and had a mass from his rectum that was bleeding. Do adjuvant
chemo/rad therapy. For Bowens Disease (sq cell in situ) do wide local excision.
Pagets disease also do wide local excision. Answer choices were squamous cell
carci, bowens, and some other stuff. This is not bowens because bowens only
occurs on glans of penis and tip.. ( showed a pic of a anal mass)
146. Lady had sjogren syndrome with parotitis, dry mouth, and all that they
wanted to know what to do next? Give her steroids? Do CT? Do US? Check anti
nuclear levels I put that check ANA levels
89) Organophosphate poisoining: farmer, with anticholinergic symptoms( dry,
hot, mydriasis) what receptor affected by it? PERIPHERAL MUSCARINIC
RECEPTOR
~ cholinergic symptoms salivation, lacrimation, polyuria, diarrhea, bronchospasm,
miosis, dec HR,
~ rx: remove clothing, Atropin, pralidoxim
90). Girlfriend broke up with him, and he was sad and shit gave depression
symptoms what drug would u give to him? SSRI
149. Another question the person had a loss of vision in one eye after gf broke
up with him and his eye test and everything else was normal. They want to know
what to do next…Neuropsych eval? Or Reassure and come back in 3 weeks?
Other choices were all treatment so def not right…
91). Massive headache: coartacion of aorta they asked what is the mechanism of
this disease NOT treatment, so whwat is the mecahnism???, closed pda? Open
pda: Inc peripheral resistance, dec peripheral resistance,…I put increased
peripheral resistance, there were a ton of choices A-L
92) Coal worker- straight forward work related pneumoconiosis
152.A guy had a very cold leg, and no pulses, they wanted to know what test to
do next? Venous graphy? Venous duplex? No choices with artieral stuff so had
to be something venous….. know how to distinguish arterial vs venous insuff and
also what is first test to do and what is confirmation test…Arteriogram, or a US of
the artery
93) Guy had occipital pain and asked what should u check…choices were
something I forgot but I picked check elevation in ESR. Thought maybe Giant cell
and looked it up later giant cell gives this sort of occipital pain… no other choices
made sense. ( had a headache in the occipital area)
154. DVT 2 questions-> know initial test, confirm test and initial treatment and
long term treatment.
Dx: US duplex
Confirm: Angiography
Rx: Heparin, Warfarin 4-6mts
94). Sleep apnea sleeps : it was some guy who kept falling asleep during day
and felt refreshed after these small naps. Basically talked about narcolepsy and
asked for initial step….test for it (polysomnogrpahy) read question carefully
Rx: methyphinidate,dexamphitamin, and modafinal
It’s a REM sleep prob. They have dec REM latency
95) Pt pancreatic cancer in some guy in his upper 60s in body of pancreas: and
hes in palliative care cuz they cant treat the cancer body had 7mm abdom
aneurysm: do you treat the AAA or not treat bc of pancreatic cancer, or don’t
treat bc the prog is poor….uptodate says don’t treat because prognosis is poor.
96) Patient had neck thickening, and some other stuff I think they were trying to
get at that she has turners and diagnosis (45XO)
~ short girl, streak ovaries, high FSH, low estrogen
dx: karyotyping
97) Carpal tunnel syndrome. Common in secretaries - tingling and numbness in
medial 3.5 fingers, Median nerve entrapment. Initial management is wrist splint, if
refractory you can do surgery which releases the tension on median N (2
questions on this one was straight forward diagnosis the other was management)
98). Dupuytren’s contracture: lady hand picture: pathogenesis: hyperplasia of
palmar fascia: 4th and 5th contract. Surgery is only treatment. Mild disease- treat
conservative add cushion to grip areas, add handles etc..moderate try
glucocorticoid injections, severe surgery is only definite tx
160. A woman had a lot of pain on the heel of her foot she stands all day. She
had problems when she dorsiflexed her great toe.., they said they saw a spur on
the heel on x ray,what was the diagnosis..i picked plantar fasciitis I think another
choice was Achilles tendon probs etc…check this ( she had pain and spure on
the heel)
Plantar fasciitis: standing lady the deep plantar fascia (plantar aponeurosis) is a thick,
pearly-white tissue with longitudinal fibers intimately attached to the skin. Plantar fasciitis,
characterized by pain in the plantar region of the foot that is worse when initiating walking, is one
of the most common causes of foot and heel pain in adults. 6-12 months of conservative therapy
if that doesn’t work then do surgery.
#) 1 question on how to diagnose ALS- I Think I picked MRI no other choices made sense:
Electromyography with nerve conduction study , inc CPK
~ loss of all motor ( UMN, LMN) no sensory
dx: EMG,
rx; Riluzole, CPAP, PiPap
99). 1 question on how to diagnose Lambart eaton syndrome they described woman who cant
comb hair, cant get up from chair and has lung mass - I think I picked nerve conduction or EMG
~ antibodies against pre synaptic Ca channels low Ach
~ proximal muscle weakness, loss of DTR,
~dx: EMG and muscles response increases with repetitive stimulation
~Rx: plasmaphoresis and immunosuppressive therapy
Peds
Heart disease cyanotic/noncyanotic, cyanotic-Truncus arteriosus, Transposition
of great vessels, Tricuspid atresia, Tetralogy of Fallot; noncyanotic-VSD, ASD,
PDA.
#) HIV: guy had CD4 above 100 give flu vaccine? You can give flu vaccine Risks
for CD4<400 Oral candidiasis; CD4<200 PCP, CD4<50 MAC and Toxoplasma,
CD4<100 Cryptosporidium. Tx 2 of one class and 1 of another (eg Atripla) Know
preggo management, do not give efavirenz in preggos.
#). IGA def - can’t transfuse regular blood or give IVIG due to anaphylactic rxn.
100) Prophylaxis to stroke pts? Aspirin
166. Guy having heart attack, MONA
2 question on post surgery stuff: 2 weeks after
101). Question enzyme that causes masculinization- 5 alpha reductase ,no it was
actually 21 hydroxylase
103) Patient bat caves, in Ohio (anywhere along the Mississippi River)-
Histoplasmosis
(169/170)2 questions on Specificity Sensitivity, PPV, NPV, and Power
171. Kid was in the kitchen and mom came back and she saw liquid all over the
floor and had lips swollen, oropharynx with burns asked what did he ingest?
Choices where Drain cleaner, toilet bowl cleaner, dishwash soap, bleach and
something else…I put dish washing soap. drank something had ulcers- Ingestion
of caustic fluids (acid or alkali) such as drain cleaner may lead to esophageal damage and
stricture. Airway patency must be established first; then the extent of esophageal damage
should be examined by EGD when the patient is stable, typically within 24-48 hours of injury.
Injury due to ingestion of alkaline fluids such as drain/oven cleaner or perm relaxers occurs
rapidly in the first minutes to hours and is characterized by liquefactive necrosis of the
esophageal tissue. Subsequently esophageal strictures form due to scarring of the affected
tissue. The patient should NEVER be given acids such as vinegar, nor should
gastrointestinal lavage be performed, as both are likely to lead to further tissue damage.
laceration
110) Kid taking TMP-SMX for 4 months. Leukocyte count is 1000. Retic 0.1%.
Plts 25000. Low Hct. What caused this? Choices: G6PD, Aplastic anemia, forgot
other choices
(APLASTIC ANEMIA)
111) Preggo with vesicular lesion painful on vulva. Complication during
pregnancy?
Intrapartum transmission to baby
112) Low serum osmolarity. Low sodium. Cause? Causes:
SIADH, nephrogenic DI, neurogenic DI
113) Oldie with rash on right side of abdomen. Goes from midline to the
vertebrae in the back. What should she get to prevent recurring of this condition?
IV acyclovir. (oral)
114) Preggo at 27wks gestation comes in with vag bleeding. Internal OS closed,
external OS open. No contractions. U/S 3 weeks ago showed no placenta previa.
Cause of bleed? SAB – not possible after 27 weeks,
still most likely previa
115) 15yo comes for annual physical. Normal BMI. BP 150/90. What to do?
Choices:
Come back in 1 month, give ACEi, give beta-blocker, come back in 1 year.
~ ~ HTN:
dx: 3 readings separated by 3weeks of >140/90 on each arm
age >60 needs 3 readings of >150/90
rx: if +: thiazide
~ if -: weight loss, DASH diet, excercise,
116) 2. holding a baby and pain. what's wrong with the mother? – De Queverian
tenosynovitis:
#) A 55 year old woman, who had menopause 10years ago comes to you with a
complaint of vaginal bleeding in her underwear after intercourse, next step? Ans: