Important que from exam...

Subject: Important que from exam... Fri Jul 10, 2009 5:05 pm

GI questions:
- pt c hematemesis, not actively bleeding -> sclerotherapy
- pt had hematochezia and bluish dicoloration of the cecum
-> I donâ€

t know I put angiodysplasia
- toxic megacolon, NPO/IVF/NGT wasnâ€

t enough, then more
pain and more fever c free air in abdomen ->laparotomy
- kid swallowed some acid, what to do in ER ->
esophagoduodenoscopy
- no questions on h.pylori
- easy question to diagnose achalasia
- question on sjogrens what is next step -> SSA/SSB Ab or
parotid biopsy
- guy had halitosis -> zenkers
- several questions on gout -> trial of PPIs
- question on esophageal scleroderma -> trial of PPIs
- guy has heartburn well controlled with antacids, used to
have trouble swallowing only steaks, now cannot swallow many
solids but liquids is ok -> PPIs or EGD
- diagnose esophageal cancer
- diverticulitis -> ct scan
- woman with jaundice, only + result was HAV IgG, what is
she at risk for in the future? HAV, HBV, Hemachromatosis,
Hepatocellular Ca, etc.
- pt with hepatic encephalopathy and high Cr -> dialysis
- question was very long, said pt had epigastric pain
radiating to upper quadrants, fever, no jaundice, labs
werenâ€

t that bad (mildy elevated alk phos) what does she
have -> cholecystitis, choledochilithiasis, pancreatitis,
bla bla blaâ€¦
- Cholecystitis -> abdm U/S
- Older woman with h/o CABG and history of A.fib gets
diffuse abdm pain after eating, and has abdm bruit, what
does she have? Embolis in SMA, abdm aortic aneurysm,
polycystic kidney disease?
- Acute pancreatitis question
- Question on malabsorption, pt had steatorrheaâ€¦ lol I
donâ€

t remember the rest
- Guy had bloody stools and passed out on the floor, recent
history of aortofemoral bypass -> I put fistula
- Dx pyloric stenosis
- What is the cause of intussuseption of small bowel in a
65yo? Idiopathic, tumor, cancer of small bowel,
lymphadenitis?
- Dx meckels bounce

Subject: Important que from exam... Fri Jul 10, 2009 5:05 pm

CARDIO
- Question said positional chest pain, showed EKG of diffuse
ST elevation -> pericarditis
- Had two heart murmur audio questions
- IVDA and vegetations on the heart -> tricuspid regurge
- Guy with angina and a.fib -> I put ECG stress test
- Which is the greatest risk factor for CAD? LDL-chol
ration, HDL chol ratio, triglycerides, lipids
- Murmur got worse with standing and valsalva -> HOCM
- Kid with cyanosis in the 1st 24hrs of life ->
transposition
- Diagnose tamponade
- Kid with holosytolic murmur -> left to right shunt (itâ€

s
a vsd)
- Diagnose MVP (said mid-systolic click)
- Diagnose ASD (said wide, fixed S2)
- Endocarditis prophylaxis for dental procedure in a kid
with h/o reaction to ampicillin -> clinda
- Teenager with cramps in the legs, muscles on top are
bulky, weak on the bottom, bad LE pulses -> coarctation
- Hyperaldosteronism -> PRA ratio
- 3 questions on temporal arteritis (2 dx 1tx)
- woman with renal artery stenosis what is elevated? Rennin
- diagnose dissecting aortic aneurysm -> TEE
- pt had low Na, low K, high Cl on thiazides and ACEI what
is the reason for the labs? I put thiazide and ACEI
reaction, other choices were hyperaldosteronism,
hypoaldosteronism, other stuff

Subject: Important que from exam... Fri Jul 10, 2009 5:06 pm

SKIN
- picture of some bad bad acne -> proprionobacterium
- HSV
- How do you treat ringworm > clotrimazole, permethrin,
hydrocortisone?
- Pt had dermatitis herpetiformis -> gluten free diet
- Pt had optic glioma what will you find on skin -> cafÃ

au
lait
- Guys nose had a pearly looking thing on it -> basal cell
- Mentally retarted kid with seizures and a skin disorder ->
tuberous sclerosis
- Acathosis nigrans -> check glucose
- Kid with DIC
- Picture of a hand with DIP inflammation and said his ankle
was very tender -> gout
- Kid went into the woods now has itchyness and rash in a
linear pattern -> contact dermatitis
- Mom wants to prevent daughter from getting sunburns
->advise not to go out before 2pm
- Contact dermatitis question -> cell-mediated
hypersensitivity

Subject: Re: Important que from exam... Fri Jul 10, 2009 5:06 pm

ENDOCRINE
- Guy is depressed after his wife died and labs show high
tsh, low t4 -> depression due to medical conidition, other
choices were MDD, Adjustment disorder
- Graves disease what Abs are after -> TSH receptor
- Guy with A.fib what must you rule out -> hyperthyroid
- SOOO many questions on diabetes I and II soooooo many. Guy
with DKA (give fluids and what type of insulin), guy with DM
and foot ulcer (angiography or foot amputation), soooo many
know your DM inside out
- Health care worker comes in after fainting has sugar of
40, normal c-peptide -> took insulin
- Guy with low insulin and high c-peptide -> insulinoma
- Guy with rash and high sugar -> glucagonoma
- Dx hyperparathyroidism
- Guy on lithium -> nephrogenic DI
- Dx SIADH
- Guy with loss of facial hair, small testes and is
infertile -> check pituitary
- Pt cannot lactate after birth, had postpartum hemorrhage,
what is deficient? GnRH, inhibin, progesterone?
- Dx PCOS

Hematology
- 3-4 questions on B12 deficiency
- 3-4 questions on folate deficiency
- what is low in goats milk? folate
- What is low in breast milk? Vit D
- Guy from Saudi
Arabia has
rash on the face that resolves, MCV is low? Thalassemia
- Sickle cell crisis, after analgesia what do you give?
Fluids or transfuse?
- 4-5 questions on iron deficiency
- kid eats anything now has low MCV -> lead poisoning
- I had like 4 questions that starts with a pt who had
recurrent nosebleeds.
- One said pt c recurrent nosebleeds on lithium, bupropion
and valproic acid, lithium levels are too high what to do
next? D/c lithium, d/c valproic acid, d/c buproprion, check
platelet level, check AST levels?
- Dx Hemophilia A (question said effusion of blood in the
knee)
- Dx von Willebrands
- Question said besides the stockings how else can you
prevent DVT? LMW heparin, warfarin, aspirin, tPA.
- Question on HUS (said history of recent infection)
- Dx Henosh-schonlein (said palpable purpura)

Subject: Re: Important que from exam... Fri Jul 10, 2009 5:06 pm

ID
- Dx otitis media
- Hard question on sinusitis, know how to differentiate
chronic s/s from acute.
- Kid with barking cough -> laryngotrachietis
- A lot of wheezing questions in children
- CSF has RBCs -> HSV
- Pt exposed to so many things, one of them was
unpasteurized milk, CSF was normal -> listeria
- Ring-enhanced lesion in the brain in an aids pt
prophylaxis -> TMP-SMX
- Kid with h/o meningitis what is the diagnosis to the most
common sequela -> confused between tympanometry or
air-conduction hearing studies (I know the answer was
hearing loss)
- Encephalitis question -> HSV
- Kid c wheezing and has tonsillar inflammation and had
trouble opening his mouth but uvula was not displaced and it
showed a picture of the lateral neck and asked what it was->
peritonsillar abscess or retropharyngeal abscess im not to
sure, know the pix
- Dx pharyngitis
- Nurse with pernichila (the finger infection) that gets it
drained, warm compress and Abx, what is next? Keep her away
from pts, prophylax all pts, treat all the pateints she was
exposed to, etc.
- 2 questions on mycoplasma dx (college students)
- 2 questions on aspiration pneumona
- PPD positive next step -> cxr
- Guy with white fluffy things that donâ€

t scrap off, what
is next test? HIV
- 3 questions on Lyme disease
- MANY MANY STD questions, all of them like syphilis,
chancroid, gonorrhea, chlamydia, trichomonas (like 4),
candida (2)â€¦at least 2 on each one
- Guy with everything that seemed like gout, what is next
step? Aspirate fluid from joint (treatment wasnâ€

t an
option)
- Had maybe 9-10 questions on the immunodefiencies, know
them real well.
- Guy with indurated 5cm mass on thigh and fever, what do
you do next? Surgical debridement or I&D?
- Pt has on several meds gets hearing loss, what is the
cause? Gentamycin
- CO was
low, resistance was high, PCWP was low, what kind of shock?

Subject: Re: Important que from exam... Fri Jul 10, 2009 5:07 pm

Rhematology
- How do you treat pseudogout? Indomethacin, hyaluronidase
injections, aspirin?
- 3-4 questions on RA
- 2-3 questions on Gout
- 1-2 questions on OA
- pt c psoriasis what else should you find? Clubbing of the
finger
- 3 questions on Kawakakiâ€

s disease (2 to dx, 1 to tx)
- dx polymalgia rheumatic
- tx SLE (prednisone)
- how do you treat fibromyalgia
- dx polymyositis
- dx DMD
- kid with recurrent fractures and blue sclera -> collagen 1
deficiency
- Showed picture of carpal tunnels -> median nerve at wrist
- Dx slipped capitus femoral (fat kid with a limp)
- Dx Osgood shlatter (showed picture of tibial tuberosity)
- Dx developmental hip displasia (said mom heard popping
when changing diapers)
- Picture of chondrocalcinosis -> pseudogout

OBGYN
- Almost every other question started with G-P- (my test was
A LOT of obgyn)
- Dx and tx ectopic
- 4 questions on mole (2 dx like HTN in 1st TM and enlarged
uterus 2 tx)
- pt is 31weeks and gets in a car accident now has vaginal
bleeding and uterine tenderness -> abruptio placenta
- pt is 11 weeks and has passage of fetal contents but no
fetal parts noted, very high hCG -> 46XX
- Pt with TOA keeps getting worse and fever getting higher
-> surgery
- Pt c cyst on labia majora, nowhere else, only on the
majora -> labial abcess, bartholins abscess, bartholin cyst
- HSV at 39 weeks c 4min contractions c no breakouts while
pregnant but she feels weird and said that usually when she
feels weird she breaks out, what do you do? C-section,
augmentation of labor, tocolysis
- 10cm dilation and after 10 minutes all you get is a
â€œpalpable minimal caputâ€? what do you do next? Vacuum,
continue contractions, c-section
- 37yo c breast mass and gets lumpectomy and after it showed
noninvasive intraductal cancer without margins, what is next
step? Tamoxifen, radiation, chemo, observe, or sentinel node
bx
- Woman at 28wks had an amnio before and got RhoGAm what do
you do now? Administer rhogam again
- Woman has baby thatâ€

s too small for gestation age,
stress test shows late decelerations what is the cause of
the IUGR? Uteroplacental insufficiency
- Mom is smoker while pregnant? IUGR
- What is high in a pt with gestational DM? HPL
- Mom is 34wks and gets severe preeclampsia what will the
child suffer from? Sepsis, pulmonary insufficiency (thatâ€

s
what I put).
- High AFP on triple screen? Anencephaly (other choices were
trisomy 21, 13, 18)
- Tx gbs
- Pt with vaginal discharge, turns out fern+ what is the
d/c? PROM
- Pt with postpartum hemorrhage, what do you do? Give
oxytocin, give prostaglandin, surgery, artery ligation
(massage was not an answer)
- Macrosomic kid whose mom had gestation DM gets seizures ->
hypoglycemia, hyperglycemia, hypo or hypercalcemia, kalemia,
natremia, etc.
- 3 questions on cervical dysplasia
- woman with PCOS is at risk for -> endometrial cancer
- woman who has BMI 33 is at risk for ->endometrial cancer
- woman with menopause and fracture -> dexa
- 2-3 questions on endometriosis
- 2 questions on fibroids
- 57yo with vaginal pruritis -> vulvar cancer
- 14yo girl has not had menses, all her friends make fun of
her, physical exam is completely normal, what is the dx? Normal,
hypothalamic problem, adrogen insensitivity, turners, etc.
- post menopausal bleeding -> endometrial cancer
- obese F with menstrual cycle problems that when you take
pap smear what else should you do? Endometrial biopsy
- woman feels bulging from her vagina, she had a total
hysterectomy in the past, she has absolutely no other s/s
besides the bulging which gets worse when she stands up ->
cystole, rectocele, uterine prolapse?
- Guy who gets urge to pee but pisses on himself before he
makes it to the bathroom -> detrusor hyperactivity.
- Know how to treat your STDs!!
- Bloody discharge -> intraductal papilloma
- 37yo woman with breast mass -> mammo, FNA, biopsy,
sonogram?
- Menopause lady wants to prevent bone fractures that she
seen in her sister, takes no HRT, what should she do?
Calcium supplements, estrogen replacement, etc.

Subject: Re: Important que from exam... Fri Jul 10, 2009 5:07 pm

SURGERY
- Bleeding from urethral meatus ->retrograde urethrogram
- Dx tension ptx
- Stab wound to stomach -> ex lap
- Guy was on motorcycle crashed into truck and now feels
abdm pain, VS are stable, what do you do next? DPL, CT,
ex-lap
- Picture of a severely displaced radial bone and pt had no
pulses, loss of sensation, and pallor. They said the feeling
of the forearm was still very soft, what do you do next?
ORIF, fasciotomy, angiography, cast.
- Not too much surgery

Growth development/preventative medicine
- 3yo rides a tricycle, still pees in his bed, can say two
worded sentences, is he normal delayed (in each field like
social, developmental, motor)
- dx separation anxiety
- kid wants to get circumcised, want should you tell him?
Need parents consent
- no formula questions (sensitivity, specificity, odds
ratio, bla bla bla)
- dx t-test
- what is the best test to measure incidence? Cohort study
- no bias questions
- if an HIV ELISA test is 99% sensitive and 95% specific,
what happens to the sensitivity and specifity if you do
â€œanother testâ€? (I donâ€

t know if that meant another
ELISA test or a western-blot, so I assumed another elisa and
put stays the same)

NEURO
- carotid stenosis of 90% in an asymptomatic pt -> CEA
- how to treat cluster headache? Oxygen
- 3 questions on temporal arteritis
- a question about tremor at rest, not with motion or
walking, the answer was related to parkinsons
- Showed a picture of the brain and said the pt had no
memory problems but had personality changes, frontal area
and temporal area looked atrophied -> Picks
- Guy is taking care of his wife (both really old) and she
is getting worse, he promised he wont send her to a nursing
facility. He cant afford a nursing aid anymore. Now his wife
is making sexual advances and hes disgusted by it. What do
you do? Put his wife in assisted living, give him sexual
therapy, give him SSRI, give her diazepam.
- Woman with alzheimers is getting more crazy (screaming at
her son for stupid reasons), what do you do? Tell her son
its normal
- A LOT of dementia questions (not that hard)
- Wet wacky wobbly -> normal pressure hydrocephalus
- Woman who is one week ok and one week very bad (demented c
loss of motor function), has history of CABG and her BP is
still high -> multi-infarct dementia
- Dx MS
- 2 questions on Guillian barre (both diagnosis, one was
hard)
- One question was on ALS, where is the problem -> motor
neuron
- Dx subarachnoid
- One question asked what is the fastest way to treat high
intracranial pressure? Intubation and hyperventilation,
manitol, trendelenburg, head elevation
- Dx Narcolepsy
- Construction worker in the sun all day gets an episode of
confusion (just confusion), he is otherwise healthy and on
no medications, what is the dx? Heat stroke, malignant
hyperthermia, some other dumb answers.
- Old pt with long history of DM and HTN gets progressive
loss of vision, on physical exam the eye has no hemorrhages,
no cotton wool spots, no neovascularization, what is the dx?
Glaucoma, DM retinopathy, HTN retinopathy, cataracts

PULM
- Acute asthma attack tx
- Pt with situs inverses, recurrent pneumonia and
bronchiectasis (so your thinking CF) but it says
sweat-chloride was negative -> nasal scrapings
- Many questions on pneumonia
- No questions on pulmonary effusions
- 2 questions on sarcoidosis
- Dx asbestosis
- Dx chronic bronchitis (really easy)
- One question said what is the pathyphysiology of chronic
bronchitis (what happens to the vessel walls, something
about elasticity)
- 13month old kid with sudden inspiratory wheezing, CXR
shows hyperinflation of just the right lung but no foreign
object what is next step? Scope
- Dx Aspiration pneumonia. One question said what is the
pneumonia consisting of? Gram + only, gram â€“ only, both,
gram + and anaerobes, gram â€“ and anaerobes, etc.
- Dx TB (question even said positive PPD)
- Dx atelectasis (fever a few hours after surgery)
- 2-3 questions on ARDS
- One on neonatal ARDS, what to tx with? Surfactant
- Women suspected of having PE, the V/Q scan was negative
what do you do next? Spiral CT,
d-dimer, CXR, ekg (angiography wasnâ€

t there)
- Pt with PE what do you give? Heparin

Subject: Re: Important que from exam... Fri Jul 10, 2009 5:07 pm

RENAL
- I had about 10-15 renal questions, some really hard. 6 of
them were in that category where you have a million answers
and they give you 2 or 3 questions on the same answers. What
else can I say but know your renal!!
- Guy had testicular mass, ultrasound confirms that it is a
solid mass, what is the next step? Excisional biopsy or
orchiectomy?
- 2 questions on BPH (dx)
- Pathophysiology of post-strep GN? I put destruction of
foot processes (they didnâ€

t have fusion)
- Muddy casts -> ATN
- Pt in car accident, CK level is off the roof, what is he
at risk of? ATN

PSYCH
- Pt with depression and starts hearing voices for ONE week
-> MDD, schizoaffective, schizophrenia, bipolar.
- Guy with narcolepsy, how to treat? I put methylphenidate
- Dx ADHD
- Dx anorexia
- Dx delerium
- Kid wondering the street at 2am, high BP, dilated pupils,
combative and paranoid, what drug did he abuse
- Girl is found unconscious, high BP, dilated pupils, what
drug?
- Woman is found wondering the streets, not oriented,
dilated pupils, question said what should you give her, I
put thiamine (other choices were naloxone, flumazenil, etc)
- Guy feels spiders on hit feet when hes trying to fall
asleep, and he cant fall asleep because of it, what is the
dx? Restless leg syndrome
- Another question on restless leg syndrome, the drug is
aimed at what? Dopamine, serotinin, NE, Ach, etc.
- Girl is in love with the TV anchorman, keeps writing him
letters, waits at his job, believes they will marry, what is
the dx? Delusional
- 2 questions on the adverse effects of phenytoin, one was
rash
- dx adjustment disorder
- dx normal bereavement
- Professor gets sweating and nervous when he gets on stage
in any other place but his own university â€“ panic disorder
- Dx social phobia
- Person feels like theyre in another place (sounds like
depersonalization), but it happened after they were put at
gunpoint and robbed. Now she has nightmares and can never go
to the same place again, but denies having flashbacks ->
PTSD, depersonalization, and other stupid answers
- Dx primary insomnia
- Woman has twins that are 2yo and now she feels loss of
interest, cant sleep, hates doing anything, what is the next
step? Assess suicide.

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