Second pass deck 01

Question 1

erysipelas is most often caused by what organism?

Answer 1

group A strep (pyogenes)

Question 2

how do you treat the severe tonsillar enlargement that could be a prelude to airway obstruction in infectious mononucleosis?

Answer 2

IV corticosteroids

Question 3

• hypo / hyperpigmentation
• hyperkeratosis
• stocking glove neuropathy

what type of poisoning?

Answer 3

arsenic (chronic)

Question 4

• vomiting
• watery diarrhea
• QTc prolongation
• profound pancytopenia and hepatitis
• garlic breath

what type of poisoning?

Answer 4

arsenic (acute)

Question 5

what is the treatment for arsenic poisoning?

Answer 5

• dimercaprol (first line)

- DMSA, succimer

Question 6

mees lines (horizontal striations of fingernails) is characteristic of:

Answer 6

arsenic poisoning

Question 7

what is susceptibility bias? how do you prevent it?

Answer 7

• when the treatment regimen selected for a patient depends on the severity of the patient’s condition
• prevent by random assignment, intention-to-treat analysis to avoid counting crossover patients

Question 8

what is the treatment for symptomatic neonatal thyrotoxicosis from maternal graves disease?

Answer 8

• methimazole

- beta blocker

Question 9

what is the treatment for paroxysmal nocturnal hemoglobinuria?

Answer 9

eculizamab

Question 10

what is the mechanism of trousseau syndrome in the context of latent visceral malignancy?

Answer 10

tumor release mucins that react with platelets to form platelet-rich microthrombi

Question 11

elevation and equalization of intracardiac pressures is indicative of ________________

Answer 11

tamponade

Question 12

which anti-seizure medication is associated with acute pancreatitis?

Answer 12

valproate

Question 13

what is the a) initial and b) maintenance therapy for cryptococcal meningoencephalitis?

Answer 13

• initial: amphotericin B and flucytosine

- fluconazole

Question 14

• fevers
• headaches
• increased intracranial pressure (papilledema)
• HIV patient

Answer 14

cryptococcal meningitis

Question 15

which vaccinations should HIV patients receive?

Answer 15

• hep B
• PCV13 then PPSV23 eight weeks later then five years later and at age 65
• varicella if born after 1979 (CD4 must be over 200)

Question 16

isoniazid causes what kind of liver damage?

Answer 16

hepatitis with panlobular mononuclear infiltration and hepatic cell necrosis

Question 17

gonococcal conjunctivitis occurs within what time frame? chlamydial? what are the treatments?

Answer 17

• gonococcal: 2-5 days (single IM dose 3rd gen ceph)

- chlamydial: 5-14 days (PO macrolide)

Question 18

what is a potential GI side effect of erythromycin and azithromycin in infants?

Answer 18

pyloric stenosis

Question 19

which medication should be given in the weeks to months following an MI to prevent dilation and remodeling of the ventricles?

Answer 19

ACE inhibitors

Question 20

which type of heparin is CONTRAindicated in end stage renal disease?

Answer 20

LMWH

Question 21

what is the preferred long-term oral anticoagulant in end stage renal disease?

Answer 21

warfarin

Question 22

the ice pack test is used for ____________

Answer 22

myasthenia gravis

Question 23

what are treatment medications for restless leg syndrome?

Answer 23

• pramipexole
• ropinirole
• gabapentin if comorbid insomnia, chronic pain, or anxiety are present

Question 24

how long may surgery be delayed to address an unstable comorbidity?

Answer 24

72 hours

Question 25

what medication is used for mild tourettes? more severe cases?

Answer 25

- mild: a2 agonists (clonidine, guanfacine) - severe: dopamine blocking antipsychotics (risperidone, haloperidol, pimozide) *haloperidol and pimozide are FDA approved, but risperidone is the best studied of the second generation

Question 26

osteitis fibrosa cystica is most often seen with what conditions?

Answer 26

- parathyroid carcinoma | - primary and secondary/tertiary (advanced renal disease) hyperparathyroidism

Question 27

buproprion and selegeline can cause false positives for what drug on tox screen?

Answer 27

amphetamines

Question 28

in patients with cirrhosis, both spider angiomas and palmar erythema arise due to __________ because ____________

Answer 28

- hyperestrinism | - impaired hepatic metabolism of circulating estrogens (which begins in the cyp450 system)

Question 29

what is the treatment for patients with tinea capitis? what about for contacts?

Answer 29

- patients: oral griseofulvin or terbinafine | - contacts: selenium sulfide or ketoconazole shampoo

Question 30

copper or rust colored nipple discharge?

Answer 30

intraductal papilloma

Question 31

normal pleural fluid pH is:

Answer 31

7.6

Question 32

transudative pleural fluid has a pH of:

Answer 32

7.4 - 7.55

Question 33

exudative pleural fluid has a pH of:

Answer 33

7.3 - 7.45

Question 34

patients at moderate to high risk of thromboembolic events due to systemic embolization should get what treatment?

Answer 34

non-vitamin K antagonist oral anticoagulation (apixaban, dabigatran, rivaroxaban, edoxaban)

Question 35

- sclerotic, cortical lesion on imaging with a central nidus of lucency - pain worse at night and unrelated to activity - pain relieved by NSAIDs

Answer 35

osteoid osteoma

Question 36

- pain, swelling, and decreased ROM at involved site - osteolytic lesions with "soap bubble" appearance - epiphyseal region of long bones

Answer 36

giant cell tumor

Question 37

what is the cushing reflex with respect to intracranial HTN? what is it indicative of?

Answer 37

- HTN - bradycardia - respiratory depression - indicative of brainstem compression

Question 38

what are the CHADS-2-VASc criteria?

Answer 38

- C = CHF (1) - H = HTN (1) - A = Age over 75 (2) - D = DM (1) - S2 = Stroke / TIA / thromboembolism (2) - V = Vascular disease (1) - A = Age 65-74 (1) - Sc = Sex category (female) (1) Max score = 9 Score 2 or greater = anticoagulation

Question 39

- a normal A-a gradient is under ____ | - what is the equation for A-a gradient?

Answer 39

- under 15 | - PAO2 - PaO2

Question 40

a non-diagnostic gastrin level (between 110 and 1000) in the setting of suspected zollinger-ellison syndrome requires follow up with what test?

Answer 40

secretin stimulation test

Question 41

why isnt PTU the preferred drug for hyperthyroidism?

Answer 41

black box warning for liver injury and acute liver failure *however, it is preferred during the first trimester of pregnancy due to the teratogenicity of methimazole

Question 42

what is the most common side effect of anti-thyroid drugs? what is the most serious?

Answer 42

- most common: allergic reaction | - most serious: agranulocytosis

Question 43

a patient is on an anti-thyroid drug and develops sore throat and fever - what is happening?

Answer 43

agranulocytosis

Question 44

when are antibiotics indicated for patients with COPD?

Answer 44

- MODERATE TO SEVERE (not mild) COPD exacerbation (two or more cardinal symptoms) especially with increased sputum purulence - mechanical ventilation requirement

Question 45

which empiric abx are used for COPD exacerbations?

Answer 45

- macrolides - respiratory fluoroquinolones - penicillin / beta lactamase inhibitors

Question 46

how does hypokalemia exacerbate hepatic encephalopathy?

Answer 46

intracellular acidosis (excreted intracellular potassium replaced by hydrogen ions to maintain electroneutrality) causes increased NH3 production (glutamine conversion) in renal tubular cells

Question 47

how does metabolic alkalosis exacerbate hepatic encephalopathy?

Answer 47

promotes conversion of ammonium (NH4), which cannot enter the CNS, to NH3, which can

Question 48

how does succinylcholine cause cardiac arrhythmias?

Answer 48

- severe hyperkalemia | - triggers influx of sodium ions and efflux of potassium ions - depolarization ensues

Question 49

patients with recurrent renal calculi should be advised to restrict ____________

Answer 49

sodium

Question 50

what sail sign on pediatric CXR references the ____

Answer 50

thymus