Urge Incontinence: +nocturnal Symptoms, Gets Urges All The Time DX: Cystometry: It Will Show Random Peaks RX: Anticholinergics: Oxybutynin, Tolteridine, Frequent Voidings

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When you put in your CIN number the screen that immediately comes after that

has the year of the comp written there this was 2007-2009 version.

2007/2009 Comp READ ALL THE EXPLANATIONS most were looked up on


uptodate and DON’T JUST PICK HIGHLIGHTED ANSWERS LOOK SHIT UP IF
UR NOT SURE. Also look at all the choices on the exam, often many times they
give the most obvious answer as choice a, b or c and then towards the end they
have better answers, so look at all the choices even if the question is mad easy.

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 MIquestion 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:

12). Adenomyosis –endometrial invasion of myometrium, patient experiences


worse pain on menstruation with normal to heavy bleeding, ultrasound for dx,
symmetrical enlargement of uterus as opposed to that seen by tumor or fibroids.
Management: pain meds with OCP/IUD, severe and no wish for preg… Hysterec.
(said endometrial invasion and gave all the signs and asked dx)
~ Symmetric uterine enlargement (regular) (<12 weeks in size), soft boggy, no
mass affect, heavy menses, pelvic pain
~ DX: US
Accurate: MRI, hysterectomy with pathology
Rx: GnRH agonist, OCP , severe: hysterectomy
#) Use of Metformin in Prediabetic Patients:
~ 2 FS: >125, HbA1C >6.5, random + symptoms of DM >200, 2hr GTT >200:
any +: metformin
no +: but BMI >35 + FB 110-125: metformin
otherwise: life style modifications

13) Gas embolism- barotrauma including arterial air embolism, decompression


sickness -scuba diver, nitrogen narcosis.Management with 100% O2 to widen
the pressure gradient for Nitrogen to reabsorb, and hydration to decrease vasc.
obstruction and inc. collateral flow, trendelenburg position decreases the risk of
cerebral emboli but increases risk of cerebral edema, supine is a good
compromise. Signs of air embolism include a gasp or cough when the bolus of air
enters the pulmonary circulation, a sucking noise as air is sucked into the
intravascular space, a mill wheel murmur (a churning sound heard throughout the
entire cardiac cycle), tachypnea, tachycardia, hypotension, wheezing, crackles,
respiratory failure, a change in mental status, focal neurological deficits, crepitus
over superficial vessels, livedo reticularis, and bubbles within retinal arteries.
There may also be signs of acute right heart failure, such as an elevated jugular
venous pressure. – crepitus
14). Patient was 37 Weeks, preeclampsia, new onset HTN (160/110) with urine
prot. 4+, she is contracting every 3 minutes and baby head station is -1, what do
you do ?Choices were, control bp, artificial rupture her membranes, give her
steroids, or give her tocolytics?? Give steroid for baby’s lung maturation, MgSO4
for seizure prophylaxis. Definitive tx is delivery of baby. However avoidance of
premature delivery is best for baby. Hydralazine for BP mgmt, methyldopa as
well. NO ACEIs (teratogen) – 4 cm dilated, amniotomy (she was at term and
dilated and has preeclampsia AROM so you can deliver)
15) A woman was taking acetaminophen for something for 5 days constantly and
she doesn’t drink alcohol, isn’t fat, doesn’t have dm, is not on OCPs the woman
has some liver problems and they want to know what the diagnosis is but they
give some labs only labs I remember mild elevation of AST/ALT to about 80s
definetly not higher then that….so im thinking acetaminophen caused this other
choices where Non alcoholic steatois, cholangiocarcinoma, schiztosoma related
liver disease etc… I didn’t think non alcoholic because ast/alt is usually 100-200
range and u would see hx of obese patient or patient with diabetes or something
else to hint fatty liver…( she had elevated LFTs but she was not fat but had been
taking acetaminophen for 5 days)
16) It was a question that had like a 5 year old kid and he gets asthma and they
say they recently got pets and dad quit smoking like 3 months back and then
they want to know what put this kid at risk for asthma.Kid had asthma, what
causes inc risk: family history, urban city, smoke, pets -No not family hx because
it has not been proven. The only proven entity is SMOKING or SECOND HAND
SMOKE. pet danders are not risk factors either they are just strongly assc.. the
only proven aspect is smoke. Gender, Atopic Diseases, Active Smoking and
Exposure to enviornmental tobacco, Big BMI, prenatal and perinatal
factors→ maternal age, smoing, diet, medication use have all been
implicated in development of childhood asthma. ONLY THE BOLD ARE
PROVEN RISK FACTORS OF ASTHMA (RF for asthma was what they were
asking for?)
17) Circumsion 16 yr old – ask parents for any procedures except pregnancy and
STDS you need permission if 16.
~ no need for consent: STDs, prenatal care, drug abuse, contraception,
emergency trauma
~ emancipated minor: married, military, have children, self-living
18) Basal cell carcinoma – what do you do to dec chance of kid from having it:
protective clothing, sunscreen SPF 30 locally invades, mohs biopsy or shave
biopsy can be done. rolled up waxy edges, with telengactasia. Recurrence rates
less than 5%. 
#) A guy was a farmer for many years and in his 50s to 60s had a lesion on his
chest that was described as an ulcer that was shiny with rolled edges and had
telangectasias basically they were telling you it was basal cell and wanted to
know what kind of biopsy you would do?WIDE EXCISION WITH NARROW
MARGIN other choices were punch, incisional and forgot the rest. )
~ BCC: shiny, rolled edges, telangectasias:
dx: punch biopsy or shave biopsy
Rx: if its on the face: Mohs surgery, if on the trunk or extremities: excision with
3-5 cm margins
~ Melanoma: ABCD
dx: wide excision with narrow margin,
rx: excision resection
~ SCC: rough scaly nodule, non healing painless ulcer (keratin pearls)
dx: excisional biopsy
rx: surgical resection
19) Bilateral tubes tied:pt with OBYN probs and had her tubes tied: ectopic
preg→ ectopic preg hcg levels should not double and they should be in the rage
of 1000-1500, also the most common location for an ectopic is the fallopian tubes
the ampula. Do USG to make sure no IUP is present, also after you give
methotrexate u gotta do serial hcg measurements to make sure preg is
terminated. (lady had tubal ligaion and now has problems and asked for the dx)
#) Hep B and have to get liver transplant, looks like polyarteritis nodosa,
complication: vasculitis is answer. this is correct but also look for other
complications usually PAN is highly assc. with Polymyalgia rheumatica...and high
ESR not a definite but a possibility. PAN can involve any organ except lungs!!
treatment is usually steroids to prevent vasculitis. Most accurate dx test is
BIOPSY choices were allograft reaction,vasculitis,allergic rxn. ( pt had a liver
transplan and was failing now and asked for what it is) allograft rejection
~ PAN: ass. Hep B,C
symp: renal: glomerulonephritis: (hematuria, anemia + ANCA)
Neuro: foot drop, strokes in a younge pt
GI: abd pain, NV
Skin: palpable purpura, livedo reticularis, ulcers
Dx: biopsy
Rx: steroids
20). Patient had young like 20s and had abdo pain and glcose was up don’t
remember how high somewhere in 250s they don’t mention ketones but give you
labs to calculate the osmotic gap sodium was like 130s and K was like 4.4 and
101 was Cl and the gap came to about 30 so it was def high and that was
increased…I was kinda debating could this be lactic acid? Ethylene glycol cuz
they didn’t mention ketones but osmotic gap was clearly high and the glucose
was high and no mention of cheap alcohol or homeless or athlete so I went with
DKA..
~ DKA: PH <7.3, glucose >250, HCO3: <15 metabolic acidosis with anion gap
~ Rx: IVF, Regular insulin
#). An athlete was working out or something and had rhabdomyolysis and high
levels of cpk I forget what the exact question was but something to do with renal
failure and its causes know how myoglobin and cpk and all that affects renal
system and stuff….
Dx: urine myoglobin levels
Rx: IVF, mannitol, electrolyte
21). 11-14 yr old obese: pinning of femoral is Tx for Slipped Capital Femoral
They will usually mention that the leg will be externally rotated. Epiphysis SCFE
diagnosis is done via radiology, AP and lateral xray of both legs showing
posterior and inferior displacement! if no treatment is done with pinning you can
get avascular necrosis . this patient usually complains of limp pain.
~ SCFE: teen with obesity and leg and knee pain
~ Dx: xray
~ Rx: surgical pinning
22) Differential diagnosis of painful limp in ages 2-8/not obese: legg calv perthes
-- Avascular necrosis of fem Head. Tx for this is nsaids and rest. UNLESS
leuckocyite count is high (18,000 leukocyte count) and fever present then pick
septic arthritis (kid had fever and high leukocyte count and joint pain and asked
for the cause)
~ septic arthritis: any age, kid with joint pain and fever
dx: arthrocenthesis
rx: drainage + Abbx
35. Develop Dysp of HIP- do diagnosis with USG. uneven gluteal folds on
physical exam. bartoloni and ortlani tests are positive. you will here a clunk of
phsyical exam. these pateitns are young. usually diagnosed in babies. Diagnosis
with ULTRASOUND if you are not sure. tx is to stabilize the hip with Pavlik
harness. Mgmt with pavlik harness under 6mos. Then 6-15mos. use spica cast.
15-24 mos. open reduction followed by spica cast. MC in females
#). Heme: vit b12 and folate - you see a megalobastic anemia, hypersegmented
neutrophils (multilobed)
how to distinguish b12 vs folate def: B12 both levels of methylmalonic acid and
homocysteine are high and vibration and proprioception will be affected -
Subacute Combined Degeneration. b12 related damage can become irreversible.
(someone had megaloblastic anemia and asked how to differentiate it)
#). Folic acid def only homocystine levels are high...and less or no effects on
peripheral nerves.
23) Alcoholic, isoniazid b6→ alcoholic can have megaloblastic anemia and other
vitamin def as well. Most common in alcoholics is Hypomagnesemia!! this low
level of magnesium will inhibit PTH from doing its work and you will get low levels
of calcium also!! These patients are treated with Thiamine first then glucose to
prevent wernickes (triad of opthalmopelegia, ataxia, memory issues) dont let the
patient get to korsakoff because it is irreversible patients will get anterograde
amnesia they wont form new memories and will confabulate. in alcoholics you
will damage the mamillary body. Pt will also experience DT it can occur
anywhere from 1-10 days after last drink . classic scenario is a patient who had
surgery and now has confusion and tremors think DT cuz prior to surg this
patient got no alcohol. treat this guy with benzo!! you dont want him to have a
seizure and then taper the dose. Naltrexone can be used for chronic alcoholics
and also dilsulfiram which inhibits aldehyde dehydrogenase. MOST effectov treat
is to get this patient into AA a support group!! Dont give any long term anti-
epileptic medications for alcohol withdrawal seizures, choose an acute
medication. (alcoholic and how to treat)
~ give Thiamine before glucose
24). Anemia had rheumatioid arthritis: Anemia of Chronic Disease mcv normal or
can become microcytic(<80) between 80-100 it really depends on how long this
has been present!, Decreased TIBC, Decreased Iron, and transferrin saturation
was 10% which was indicating low…Normal or Increased Ferritin. Treat the
underlying condition to correct the anemia, unless its secondary to renal failure
you can give EPO. The pleural effusion values in a patient with rheumatoid arth
→ look for a low glucose!! (gave all the lab values and asked for the cause of
anemia)
~ ACD: Fe low, TIBC low, ferritin inc, % sat near nl/inc
25) Achalasia: narrowing at LES This is is a disorder of aperistalsis where the
tone of the LES is greatly increased and there is impaired relaxation. this causes
a classic birds beak on barium swallow. The first test is going to be barium
swallow. The most accurate test is manometry. Hx with problems in solids and
liquids both. No spasms will be seen. Treat achalasia with anything that will
dilate! Pneumatic dilation or botulinum injection will relax LES
~ pts young with no hx of smoking or alcohol, dysphagia for solids and liquids at
same time
dx: 1) barium: birds beak: dilated proximal, narrow distal
Accurate: manometry: Inc pr at LES and dec peristalsis
Rx: Penumatic dilation, or myotomy

#). 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].

Antimicrobial therapy should be administered within 60 minutes before surgical incision to


ensure adequate drug tissue levels at the time of initial incision. If the preferred agent is
vancomycin or a fluoroquinolone, administration should begin 120 minutes before surgical
incision because of the prolonged infusion times required for these drugs.

73. Eye questions!!! Lost vision 3-4 q’s


#). Amaurosis fugax- this is a type of TIA, it is a warning that the patient is gonna
stroke. symptoms are brief and sudden painless loss of vision in one eye for a
few minutes and then vision returns. you need to do a carotid usg and check to
see how stenosed they are. >70% plus symptoms warrants a need for
endarterectomy. 50% stenosis you dont do anything except put them on aspirin
and if they got contrainds then clopidogrel is next best.
#). Glaucoma- can be open angle or closed angle. DO NOT GIVE epinephrine or
pressors in closed angle you will exacerbate and cause them to lose their vision.
here are two distinct types
● chronic open-angle glaucoma
○ most common type of glaucoma (95%)
○ leading cause of blindness in African Americans
○ caused by chronic disease
○ symptoms caused by intraocular pressure affecting the optic nerve
● acute angle-closure glaucoma
○ accounts for 5% of glaucoma cases
○ caused by defect in Schlemm's canal (responsible for draining the
aqueous humor)
○ leads to increased IOP
○ tonometer pressures greater than 21
○ can also be caused by mydriatics
● Symptoms
○ open-angle
■ insidious onset of peripheral vision loss
■ decreased night vision
■ reduced color-vision clarity

○ angle-closure
■ acute onset of blurry vision
■ mild to severe pain
■ halos around lights
● Physical exam
○ open angle
■ no distinct physical exam findings
○ angle closure
■ steamy appearing cornea
■ absent pupillary light response
■ mid-dilated, fixed, and irregular pupil
■ eyeball firm to pressure

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

● Retinal detachment- Painless and unilateral. appearance of many floaters,


dark curtain over field of vision, peripheral leading to central vision loss.
risk fctrs, trauma, surgery, fam hx, severe myopia. picture of retinal
detachment. Rx: Surgical
○ laser reattachment of the retina
47) Patient on exam had difficulty driving at night saw halostried to make you
think glaucoma, BUT THEN SAYS FUNDOSCOPY SHOWS YELLOWING OF
LENS!!! THIS IS CATARACTS…AND CATARACTS WAS A CHOICE!!!

~ 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

Important USMLE Concepts

• Characteristics of the three ulcer types:

◦ Arterial—pain at night, relieved by dependency on


extremity. Chronic ischemia and history of intermittent
claudication. Hairless pale skin, absent pulses.

◦ Neurotropic—punched-out ulcer with a deep sinus.


Usually over pressure point/callus. Neuropathy results in
hypesthesia/diminished position sense. Ulcers are painless.

◦ Venous—typical location is in inner ankle region.


Venous hypertension is present. Mild pain, relieved by elevation.

• First step in diagnosis: Doppler duplex scan

• Best diagnostic test: angiography (arteriography or venography,


according to the case)

Arterial / venous disease differences


#). Guy had absent pulses, cold feet what are you gonna do? Venous graph?
Duplex sound? Some other choices Arteriogram
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
#)Thyrogloassal duct cyst was described as a pretracheal mass that moves with
swallowing and wanted to know how to diagnose? US was not a choice, choices
were TSH Levels, or FNA Iodine 131 scan, direct laryngoscope ( mass was
moving when he was swallowing)
~ thyroglossal duct cyst: cyst that moves with slowing
dx: thyroid scans and thyroid function test preoperatively ( may have thyroid
ectopia) Rx: surgical resection
~ for any hard thyroid nodule: next step TSH levels if TSH is nl/high FNA
TSH is low: 123 scinitigraphy and proceed from there
48) Lady went swimming in creek: pseudomonas- this patient can have
symptomes of otitis externa. discharge from ear, pain on movement of ear, fevers
or even have syomtoms of otitis media. If the creek is fresh water and patient has
neuro issues think Nigeria Floweri which is found commonly in fresh water lakes
and creek.
Dx: clinical Rx: topical Abx ( oxflaxacin, ciproflox, polymisin) + topical steroids to
reduce swelling
49). Another question was patient had otitis externa what is treatment bought it
down between Topical antibiotics and myringotomy with tubes?? Picked topical
antibiotics figured I would do this first then surgery and shit like that
50). Ulcer on 14-month-old neck, this baby had werdig Hoffman syndrome
(floppy baby syndrome) and then had ulcer on the neck/capit…answer choices
were long but remember decubitis ulcer as a choice and picked it.( floppy baby)
Floppy baby:
werding Hoffman: degenearation of ant horn loss of motor Rx: supportive
Infant botulinism: inhaled or eat spore: sudden onset of floppiness, dx: toxin in
feces, rx: respiratory support, supportive care
51). Primariy biliary cirrhosis- is assc. with anti mitochondrial antibiodies. it is
autoimmune. Assc. with other autoimmune conditions.
~ women in 40s with pruritis, fatigue, xanthomas
labs: elevated alk phose, elevated cholesterol
dx: serum: antimitochondrial an, biopsy most accurate
rx: urosodeoxycholic acid, liver transplantation is currative
52). Guy had EF 40%, he was about go into surgery for a lobectomy of left lung,
ABG O2 60s and other really bad resp values forgot them and he had chronic hx
of DVTs..what is a contraindication to the surgery? Echo results? ABG results?
Some other weird choices between echo and abg!! I put abg….on uptodate it
says EF <35 is contraindication NOT 40! So ABG is def right
CI to surgery: EF <35, recent MI deffer for 6 mts, stop smoking for 6-8 weeks
before surgery
87. Myasthenia Gravis and really messed up RESP ACID ph7.1, pco2 70s hco3
not compensating at 23 why is this happening? Chronic disease related
acidosis? Severe exacerbation? Severe resp acid? Or just resp acid? (look at
HCO if its hight then its compensated so it would be chronic disease related if not
then exacerbation)
Myasthenia crisis: respiratory problems
Dx: antibodies, EMG
Rx: for crisis: 1) intubate, or plasmaphoresis + steroids or IVIG +steroids
53). primary sclerosing cholangitis – ulcerative colitis, these patients have
PANCA that is postive. sclerosed bile ducts and hepatic ducts. UC involves the
entire colon and RECTUM and can have derm pyo gangrenosum also. In any
IBD the first treatment is Mesalamine over Sulfasalizine because sulfa has more
adverse effects. Def treatmet of UC is colectomy. UC only involves the mucosa
and submucosa it is not transmural. Lead piope appearance loss of haustra and
crypt abcess and ulcers can be seen. It is more assc with colon cancer. it is also
assc. with beading and string of pearl sign of intra and extra heptaic bile ducts on
ERCP. for primary sclerosing cholangitis DO ERCP. There is an increased risk
for cholangiocarcinoma in these patients.
Dx: MRCP, ERCP, RX: urodeosxycholic acid
54). Ace inhib: what increases? Angiotensin 1dec? MOA! ACE inhibitors block the
conversion of angiotensin I (AI) to angiotensin II (AII).[4] They thereby lower arteriolar
resistance and increase venous capacity; decrease cardiac output, cardiac index, stroke
work, and volume; lower resistance in blood vessels in the kidneys; and lead to
increased natriuresis (excretion of sodium in the urine). Renin increases in concentration
in the blood as a result of negative feedback of conversion of AI to AII. AI increases for
the same reason; AII and aldosterone decrease. Bradykinin increases because of less
inactivation by ACE. Kallikikrein is increased and this causes the cough in patients with
ACEi. So long story short: (he was put on ACEI and asked what would dec)

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.

55).Gay guy ppx: Prophylaxis Pneumococcal and Influenza, hep B

Vaccinations:

#) Copd 4 q: diagnosis and treatment


CODP is obstructive disease so it will follow an obstructive pattern. low FEV1,
low FEV1/FVC ratio, high TLC, high RV and DLCO incr to normal. the DLCO for
emphysema is low!! but the rest of the parameters are same for emphysema.
Treatment is done by gold standard. but keep in mind that Iprotropium
anticholinergic are most effective! you wanna give these guys flu shots and
pneumo vacc because these guys are very prone to infections, most of their
exacerbations are due to viral/bact, therefore when admited for exacerbat they
are usually given antibiotics along with antichol, steroids .
56) Cystic fibrosis: clogging of bowel, what you give prophylactic? Pancreatic
enzymes or? N-acetylcysteine? GIVE pancreatic enzymes because you will help
in breaking up the clogs in the intestine and help move food and mucus along.
57) UTI questions- most common organism in UTI is ecoli gram neg rods
Dx: UA, urine culture
Rx: Nitrofurontoin, amox-clavulinic, fosfomycin, TMP SMX, ciprofloxacin
58). A guy was bringing up some yellow sputum was chronic for like 2 years or
something and he was a chronic smoker and he had clubbing they were like what
is causing his symptoms, the amount of sputum was just 1 teaspoon which is too
little I think choices were a)pneumonia b) bronchieactasis c)COPD and some
other garbage but it def was not pneumo he had no fever and no lobar
consolidation and it cant be bronchia, it had no assc. Cyst fib or blood tinged or
any of that so I went with COPD.(sounded like chronic bronhitits smoking hx and
and coughing with sputum)
COPD: Dx: 1. CXR, 2. PFT
Rx: Ipratrupium
Exacacerbation: 2 bronchodilators, O2, Steroids (IV) , antibiotics
(macrolides) NPPV, intubate
59) Pneumonia 1 q- Asked for tx forgot choices but I think it was atypical penumo
and macrolide was the answer
Atypical pneumonia: rx: outpt: Macrolide or doxy, if comorbidities: fluoroquinoline
Inpt: ceftriaxone+ azithromycin or fluoroquinolone
HAP: P or I or C ( pipercillin, imepineme, cefepine or ceftazidime)
VAP: 1 of PIC, 1 amino or flouro, 1 vanco or linozolide
60) Murmurs!!!-->MVP what increased it Valsalva, standing, ACEI, or any dilators
97. The best initial test when suspecting any murmur is TTE even though TEE is
more accurate its not the first test, always choose non-invasive test first.
Indications for TEE = Afib
98. Marfans, pectus excavatum: MVP clearly told you heard click
#). A guy was undergoing chemotherapy and head signs of heart failure know diff
between dilated cardiomyopathy and restrictive cardiomyopathChemo: cardiac
problems sign of heart failure: answer due to chemo drug-->uremia induced
cardio problems its called uremia induced restrictive cardiomyopathy. ( he had
other things that could have caused his HF and asked what could cause his heart
failure)
61). Cardiac tamponade: Inc JVD, muffled heart sounds, can give a restrictive
pattern if severe. Do pericardio if unstable. They mentioned on inspiration the
systolic dropped and so did the diastolic this is pulsus pardoxus ( just asked what
the condition was, straight up)
~ dx: Echo
~ Rx: pericardiocenthesis
62). Parahyperthyroid- most commmon cause of hypercalcemia is due to a single
adenoma of the parathyroid. ( he had hypercalciema and asked what the cause
was) (ca >10.2)
63). Hypercalcemia: IV fluids and then furosemide. DONT GIVE THIAZIDE it
will worsen. Other choices were like oral hydration, calcitonin, dronates, thiazide
and loops..and asked most initial management!!! The calcium levels were like 14
if 14 then give IV fluids, if >14 with symtpoms give IV fluids, loops, and possibly
even calcitonin. BUT DEF IV FLUIDS FIRST
~ Ca: >14: IVF, calcinotin,
ca: <14: bisphosphonates
64) Woman had hysterectomy and was bleeding a lot so they gave her blood
finally her bp stabilized and they give IV fluids also, then they put a foley in after
flushing it to measure urine output and there is no urine in the bladder..why??
defective foley? Ligated ureters? Some other choices I picked ligated urteres
(she had the procedure and now not peeing)
. Tx for hypercalcemia??First give IV fluids and once the patient is well
hydrated give furosemide a loop diuretic to vause calcium diuresis.
Thiazides are contraindicated because they increase serum alcium levels. Other
treatments include phosphorus administration give ORAL phsop not IV because
IV can be dangerous for patient. Give calcitonin, bisphosphonates, pilcamycin or
prednisone especially if high calcium is due to malignancy. symptoms of
hypercalcemia are stones bones and groans!! Try to treat the underlying cause
for example if it is due to hyperparathyroidism then do surgery and remove that
gland.
65). Lung cancer: This type of cancer is called the Non small cell lung cancer.
and the treatment for NSCLC is usually surgery. there are diff types. the
Sqamous cell is usually centrally located and therefore do a broncho and try to
get a biopsy . these will release a PTHrP and will have similar effects as PTH.
trash the phosphate and increase the calcium. BE CAREFUL dont always think
phosphate will be low KEEP IN MIND THIS IS A PTHrP not PTH so the
phoshpate can be normal!! increased hypercalc is a definite(parathyoriod like
peptide) / squamous cell

#). 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 preventAFP 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 problemischemic 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 parainfluenzasupportive 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

For CARDIOGENIC shock DOBUTAMINE IS FIRST LINE add NE or


Dopamine if not improving, pale, cool skin, lung congestion, hypotension,
tachycardia
Neurogenic shock is self limited, place patient in supine or trendelenburg position
Septic ShockIV resuc with volume, IV antibiotics, Pressors ONLY if IV volume
resuc doesn’t help and if you need to give pressor your first choice should be
NOREPINEPHRINE.
133.For hemorrohagic shock secure ABC’s first!
shock questions!

81).Primary biliary cirrorhosis: Inc levels of what? Alk phosphatase Serology

o serum alkaline phosphatase levels greater than 1.5x the


upper limit of normal
o typically normal serum total bilirubin levels

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)

88) Hypochondriac, planning his funeral, tanning in sunRx with psychotherapy


and close follow up with primary care. (he kept going to doctors and never found
anything)
145. She had inc liver enzymes: took acetominohen for 4-5 days daily /
VS….nonoalcoholic steahe (NASH), SHE doesn’t drink and I don’t think she was
overweight or had diabetes to suggest non alc steatohep…check this.. I think
values were in the low 80s for both AST AND ALT. Patients with delayed
presentation (>24 hours after ingestion) consisting of laboratory evidence of liver
injury (ranging from mildly elevated aminotransferases to fulminant hepatic
failure) and a history of excessive acetaminophen ingestion. Patients with
delayed presentation and hepatic injury should be managed in consultation with
a regional poison control center

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. 

104) Delta wave on ECG= WPW


105) PT with HTN, ate out every night, 4-5 glasses of wine a night, high lipids. What do
you recommend she does first to decrease her risk of heart disease?
WEIGHT REDUCTION
106) Femur fracture post accident-
Fat emboli
107) Hearing loss in kid listening to loud music- loud music is the cause of his hearing
loss
sensory neuro problem
108) kid with ARDS- what to do to help him breath?
PEEP.
~ ARDS: new onset worsening dyspnea, hypoxemia, tachypnea, bilateral crackles
~CXR: initial: bilateral opacities (white out) , no signs of heart failure ( no JVD or
anything)
Accurate: CT
~ Rx: PEEP (up to 15), TV (6ml/kg), FIO2: ~ 40
109)Small bowel obstruction –
do abdo XR
~ crampy abd pain, hx of prior surgery, hyperactive bowel sounds( as opposed to ilius)
high pitched tinkling sounds, bilious vomiting, constipation,
Dx: Ab xray: multiple air fluid levels, Accurate: CT
Rx: NPO, IVF, if complete obstruction do surgery
109) Postpartum bleeding with forceps delivery- most likely due to

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:

extensor pollicus brevis, abductor polics longis


dx: pain on radial wrist
dx: Finkelstein's test
ulnar deviation of the hand with the thumb clenched in the palm produces pain
Rx: rest, NSAIDS, thumb spica cast, and steroid injection
117) one ques on isoniazid and what vitamin goes with it? –
b6
118) 87 year old forgets where his keys are but loves hanging out with his grandchildren
etc. he's happy and still enjoys things. gets 2/3 objects correct after recalling in 5 mins. –
normal aging
119) nurse injects herself and now has Hep B surface Ag. (no previous hep b
immunizations) what do you do? –
give her hep b vaccine and hep b immunoglobins
120) patient had polycythemia vera –
hepatic vein thrombosis
~ PCV: plethoric face, splenomagelay, inc HCt >60, HTN, bleeding from engorged bvs,
thrombosis from hypervescosity
labs: low epo, np PO2, dec Fe in B.M
Rx: phlebotomy, aspirin, and hydroxyurea
#) . one ques on patient with bronchiectasis and then asked its relation to CF ? - Cl
channel relation
121) 2 african american siblings present with headache lethargy, mom brings them to
hospital. then they're immediately better
- i think CO poisoning
~ lightheadedness, headaches, pink color, bright cherry lips
labs: metabolic acidosis, low ph low HCO3, nl Po2
dx: carboxyhb levels
rx: 100% O2, or hyperbaric O2
Cyanide poisiong: looks just like CO poisioning have to do carboxyHb levels to find out
Rx: amilyl nitrate, hydroxychobalamin, Na thiosulfate
#) i think one question's answer was adjustment disorder (bc his wife was gonna divorce
him and he already had generalized anxiety disorder)
. SIADH question (low serum osmo) - how do u treat? answer choices had
demecocycline and fluid restriction. i put
fluid restriction ( acute: fluid restriction if neuro symptoms: 3% saline , demeclycylin for
chronic management)
#) patient has lithium in the vignette. shows a bunch of labs. has increased serum
osmolality and increased serum sodium. –
failure of receptors of ADH to work
122) parents want to have daughter. what do you tell them? –
i think you can't selectively choose
123) there was a question about a man who knew he was gonna die. he even changed
his will around. he wants to die comfortably bc he knows he will. his wife is with him
and she agrees the same. later some estranged son shows up and tells them to do
whatever they can to save him. what do you do? –
i put continue palliative care
124) 3 months old baby Baby turned blue when feeding and crying around lips …
asked something forgot what it asked exactly…TOF so know everything about
# thalasemia : Croatia

#) A 32yr old male presents with anterior and posterior cervical


lymphadenopathy. His mother had thyroid cancer, his dad died of a heart attack.
He complains of fever and you notice a white discoloration on his tongue. What is
your next step a) treat for thyroid disease b) treat for diabetes c)
order an hiv test (I chose this)
126) A 9 year old girl repeats the same words, she flips on the switch 3 times,
she randomly checks on her parents because she fears that if they leave, they
will get killed in an accident, …. What do you prescribe her a)
SSRI B) Haloperidol Ans: is SSRI (or Clomipramin TCA) , because it treats
OCD, whereas Haloperidol treats Tourettes
127) A man with a past medical history of diabetes complains of ED, which
medication should be watched out for before placing him on sidelnafil – watch out
for
NITRATES ( the combined effect of dec BP can lead to myocardial ischemia)
127) A young Indian boy who is of normal appearance, otherwise healthy but for
a 2/6 sytolic murmur you noticed on examination. What is the next step 2)
prophylaxis antibiotics at the dentist b) do nothing- I chose do nothing.

#) 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:

Screen for Endometrial cancer – postcoital bleeding is cervical cancer unless


otherwise identified
#) Know bilateral hydronephrosis….. one was a picture
#) There was a mono nucleosis question…asked organism and cerval LAD
#) Alcoholic MCV >110
 Folate def
#) SIADH- what is 1st line treatment demeclocycline,
fluid restriction
#) was on corticosteroid dependent and stopped taking it
 adrenal insuff
#) Student with high BP, what do you do next, BMI was normal
 check BP again in one month
#) fat lady had polycystic ovarian syndrome, increased risk for 
DM
#) young girl had vag diaphragm placed, kept getting a UTI
 take out diaphragm and use different method of contraceptive
#) Lady lying on her back and asked what lobe will be affected?-->
aspiration pneumonia- upper right lobe pneumonia
1. Painless chancre genital lesion (syphilis)  tx Pencillin
2. Tick bite camping (didn’t see tick) – RSMF  tx: (check MTB2
tick bite management –no symptoms – tx prophylactic
doxcycline)
3. Kid with asthma, father quit smoking 2 months ago --- what is
greatest risk factor  SMOKING …or FHx
4. Cocaine induced MI  gave nitroglycerin – patient felt better 
next step Aspirin, tpa, etc …..
5. Patient who received steroids for something and few days later
get pyschosis sx – cause  steroid induced psychosis
6. Patient with ASTHMA and did PFT will see  ans is Increase
TLC / Normal FVC / decrease FEV1
7. Patient with ACS – did an EKG – next step is …..give one of
MONA
8. Patient with STD, sexually active, Tx  Azithromycin and
Ceftriaxone (must tx both gonorrhea & Chlamydia)
9. Teenage boy who has bilateral boobs, father worried  NORMAL
puberty
10. 62 year old male all is normal, screen and prevention 
Annual influenza vaccine
11. male with buccal mucosa lesions, weight loss, dry cough
Pneumonia bilateral infiltration (PCP), most likely get  HIV
12. 2 EKG questions –give u vignettes and ask what is most
likely diagnosis –
a. q1  Ventr. TACHYCARDIA (“wide complex”)
b. q2  TACHYCARDIA SINUS (all normal except “increase
HR”)
13. Patient with heart problems – gave 2L IV fluid yet still
HYPOTN – next step  Epinephrine* …or dopamine
14. Patient with heart problems – describe Adrenal
Insufficiency –tx Hydrocortisone
15. Describe chronic granulatous disease (CGD) and positive
Tetrablue testCGD
16. Patient with Increase AST, ALT, LDL, diabetic obese and
NON alcoholic –dx NonAlcoholic Fatty Liver
17. Cor pulmonale– what is the cause of of RV failure 
Vasoconstriction***** (not decrease BQ to Pulm. Artery)
18. Lady with panic attack and ask next step  breath into bag
19. Mom bring 2 kids winter time with anemia symptoms
(fatigue, pallor, dry mucosa) and mom had similar sx last week –
most likely because - Carbon Monoxide poisoning
20. EKG (electrical alternans) and pulsus paradoxus--- dx
Cardiac Tamponade
21. Cardiac tamponade –how to dx- ECHO
22. Post viral infxn with hx of radiation and heart problem
dx: Constrictive percarditis
23. Q on NNT
24. Q on PPV  ans. 88%
25. Guy with grave symptoms who want lose weight, LOW RAIU
– dx  exogenous T3 hormones
26. Describes Arterial insufficiency (absent/low pulses), skin
shiny – initial dx  venous duplex (most accurate angiogram)
27. Old guy with increase murmur with SQUAT (incr. Preload)
dx: Aortic Stenosis
28. Patient with Marfan symptoms and murmur (CLICK) dx:
MVP
29. Guy with peripheral artery disease –pain with walking, low
pulses, relief with rest, Ankle Brachial Index 0.7–dx PAD
30. Aortic dissection, each arm diff BP, give medication low
BP because ????????????
31. Baby with TEF and renal problems –how to dxNG tube
(will recoil b/c TEF)
32. Kid with ambiguous gentialia and increase 17OH
progesterone dx: 21 OH Deficiency
33. Patient with polydipsia with labs Osmolality of Urine (<50)
and serum (=250) diagnosis  SIADH, DI, polygenic
34. Lithium induced Nephrogenic DI because  ADH receptor
resistance
35. SIADH tx  Fluid restriction
36. DKA and confusion – confusion because  low SODIUM
37. Mom with newborn 3 months who has ulnar deviate and
thumb palm pain caused by (answer???)
a. Answer choices were ulnar nerve compression, gayon canal
compression, median nerve compression….
b. I blvd Q. describe de quervain tenosynovitis – a
tenosynovitis of the sheath or tunnel that surrounds two
tendons that control movement of the thumb (2 tendons
are extensor pollicis brevis and abductor pollicis longus
muscles) caused by repetitive strain injury – very common
in newborn mom b/c holding baby.
38. Patient has Polycystic Ovarian Syndrome (PCOS) – increase
risk for - DIABETES
39. 14 week gestation week but uterus size only 6 weeks,
normal vitals (no fever), ultrasound show gestation sac with NO
fetal cardiac activity – most likely dx  ectopic prego, gest
troblastic (usually fundus greater then GA), septic abortion, etc….
other 2 choices never seen before diigyi…diff spelling
40. Kid with signs of thyroglossal duct that moves with
swallowing – diagnosis by  Fine needle aspiration (FNA)
41. Patient with very high Calcium - treatment  IV FLUID ***
42. Lady with bilateral hilar adenopathy - dx: sacrodosis
43. Lady hasn’t see dr over 10 years, everything normal except
BP 160/100  give Thiazide (b/c low compliance maybe wont
come)
44. Elderly lady with osteoporosis with BP 150/85 – would
advise her to - lower salt intake
45. Patient undergoes surgery given lidocaine and midazolm –
gets numbness and tingling around mouth because  =
Midazolm*** or lidocaine (not sure plz look up)
46. Guy with headache, BP 200/120, mass lateral to umbilicus –
dx  No its renal artery stenosis. Do u/s or ct of abdomen
47. Diabetic kid, N/V/D/dehydration, patient is confusion
because  hypoNatriemia (low SODIUM)
48. Diabetic and gave ABG (metabolic acidosis) and glucose
over 300 – dx  DKA
49. Diabetic lady taking metformin then gets pregnant
management is -switch to INSULIN
50. Diabetic with HTN – decrease progression nephropathy by
drug (acei) which causes  LOW ANG 2
51. Diabetic with FOOT ULCER (PIX) because  low
sensory**** …. Or macrovascular problems
52. Know about metabolic syndrome (not sure)
53. Patient with COPD and ask arrow q – know Increase TLC,
RV, etc and decrease FEV1, FVC
54. Lady with hoarseness, all physical exam are normal – next
step  CT chest
55. Patient smoker who has cough 2 years mc cause  chronic
bronchitis (COPD)
56. Patient with bronchiectasis productive sputums and CF
symptoms – will see  Chloride channel defect
57. Elderly guy who smoker and COPD with (-) HBs Ab – which
vaccines - Pneumonia, Influenza, HEPATITIS B**
58. Acute excerabation of COPD  tx: Steroid (along with
bronchodilator, Antibiotics)
59. Patient whose close contact Uncle has TB with PPD>10 
tx: INH and B6 for 9 months
60. TB patient given INH then develops neuropathy- can avoid
by giving  Vitamin B6 (pyroxidine)
61. Lung cancer – hilar mass (squamous cell) will see  PTHrP
62. Lung cancer – hilar mass (squamous cell) will see 
hypercalicemia
63. Lung cancer (small cell) with facial swelling (dx Superior
Sulcus tumor) dx by  CT chest (accurate) …. (initial is CXR)
64. Lung cancer who can’t stand from sitting position (lambert
eaton syndrome) dx: nerve conduction study or EMG
65. Guy who worked in plastic factory >20 years and dyspnea
symptoms  dx: pneumoconioses (occupation)
66. Pulmonary Embolism – most accurate dx  CT spiral
67. Diver who get dyspnea  Air embolism
68. Motor vehicle accident, Bone fracture who gets dyspnea,
PETECHIAE**** RASH CHEST FAT embolism
69. Recurrent PE despite tx –next step  IVC filter
70. Obstructive sleep apnea (OSA)- dx  polysomnography
71. Pre-operative patient evaluation – EF 40%, low PFT,
PaO2=60  which is contraindication to surgery  ABG**
findings
72. Patient with sleep apnea and BMI>35 -dx 
obesity/hypoventilation syndrome (look for high HCO3)
73. IRDS, breathing problem despite given 100% oxygen still
low PaO2 (60)- next step  given OXYGEN*
74. Lady with osteoarthritis, give PIX of hands, involve DIP –
XRay will show  osteophytes
75. Not sure … gout and ask treatment  indomethcin
76. Patient with symptoms of Anklosing spondylitis (better
with movement) – initial dx  XR sacroiliac
77. Lady with vaginal bleeding, + FHX ovary and lung cancer -
must Rule out/ do  Endometrial BIOPSY
78. Lady with symptoms of Carpal tunnel syndrome  tx: wrist
splint
79. Lady with PIX dupuytren contracture (look up pix)
pathophysiology is  hyperplasia palmar fascias
80. Lady (high heels) with HEEL pain because  plantar
fasciitis
81. Patient with Rheumatid Arthritis and ANEMIA – mc cause
 Chronic Inflammation
82. Patient with Hepatitis B – increase risk for - vasculitis
(PAN)
83. Young kid with rash, fever, and arthritis –dx  Juveulline
RA
84. Patient with SLE – dx by  Double Strand AB
85. Sjogren Syndrome –next step Parotid U/S or CT ?? (most
accurate is biopsy but not sure if choice)
86. Patient with bilateral occipital Headache (mc Giant cell
arteritis) – will see  Increase ESR
87. Patient with purpura, joint pain, hemoturia (dx HSP) on
biopsy will see  Leukocytoclastic vasculitis**
88. Patient with Ulcerative colitis – link to  primary sclerosing
cholangitis
89. Patient with Crohn and has small bowel obstruction
because  strictures
90. Patient with hyperPTH and renal failure – should advise pt
to  lower phosphorous
91. Pt had diverticulitis and tx AB – later gets diarrhea for 6
days because  AB induced toxin release or reinfection
diverticulitis
92. TB that spread to ovary by  hematogenous
93. Baby with Down Syndrome – could have dx early if screen
for  AFP
94. Patient with High MCV and anemia – mc cause  Alcohol
95. Young lady who uses vaginal diaphragm as contraceptive –
keep getting UTI – what should do  I put change contraceptive
method not sure tho..
96. Lady who get tubal ligation – increase risk for  ectopic
pregnancy
97. Patient with Narcolepsy – dx polysography
98.
STOP HERE: rest is repeat

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