Académique Documents
Professionnel Documents
Culture Documents
QId: 2819
32yoF
weakness, tingling, and numbness of her extremities.
K 2.9
Cl 88; Bicarbone 37
pH 7.56
Q = likely cause of pt's condition?
A = Self-induced vomiting
-------
why: urine chloride; metabolic alkalosis....
sline responsive met alk = low urine chloride & vol contraction (corrects w/saline infusion alone)
QId: 3085
DIURETIC ABUSE ?? water excretion & electrolytes....?dehydrated, wt loss, orthostatic HoTN,
hyponatremia, hypokalemia
abnml serum & UA: hyponatremia, hypokalemia, hypochloremia, & increased UA Na & K.
DIURETIC ABUSE
Na: 73 (~20)
K 68 (5-15)
Q = likely etio of pt's sx?
A = Diuretic abuse
QId: 3322
Systemic Sclerosis
1
ss: skin telangiectasia, sclerodactyly, finger ulcers, calcified skin; joint pains, msk pains. esoph
dysmotility, dysphagia, dyspepsia; raynaud
risk: interstitial lung dz; pulm art HTN. kidney: htn, scleroderma renal crisis (oliguria, plt low,
MAHA) heart fibrosis, pericarditis; effusion
-----
*anti-smooth msk abx a/w autoimmune hepatitis.... LFT ? hepatosplenomegaly, cirrhosis, liver
failure
Medicine - Rheumatology/Orthopedics & Sports
QId: 3325
Tetanus prophylaxis
stepped on nail
additional interventions for tetanus prevention is appropriate in pt?
A = single dose of Tdap vaccine
-------
Medicine - Infectious Diseases
QId: 3575
Lateral Epicondylitis (tennis Elbow)
dt: noninflammatory angiofibroblastic tendinosis @ extensor origin....caused by repetitive,
forceful wrist extension
exam: tender @ lateral epicondyle & pain w/passive flexxion or resisted extension @ wrist.
Elbow Pain.....vague, achy pain at left elbow radiates to forearm; airport baggage handler
wrong:
*Olecranon bursitis dt repetitive pressure or friction on elbows
QId: 3910
QT Prolongation...risk for syncope, ventricular arrhythmias, sudden cardiac death
2
h/o for BL cochlear implantation @age 2 for sensorineural hearing loss.
EKG shown....
Q = which is for pt?
A = Propranolol and pacemaker
QT prolongation:
acquired: E-lytes (hypocalcemia, hypokalemia, hypomagnesium)
Acquired: medication-induced (antibiotics -eg: macrolide, fluoroquinolones) psychotropics (eg:
antipsychotics, TCAs, SSRIs); opioids (methadone, oxycodone); antiemetics (ondansetron);
antiarrhythmics (quinidine, procainamide, flecainide, amiodarone, sotalolol)
------
wrong:
*
Pediatrics - Cardiovascular System
QId: 4101
AORTIC REGURGITATION
------------
Medicine - Cardiovascular System
QId: 4204
ANTERIOR CORD SYNDROME:.....complication of aortic aneurysm repair
Spinal cord infarction ? neuro exam: flaccid paraplegia & loss of pain sensation over lower limbs
(UMN spasticity & hyperreflexia...develops over days to weeks)
BILATERAL deficits
Elderly had SURGERY REPAIR of descending thoracic aortic aneurysm. Weakness in both
lower limbs & urinary retention.
--
wrong:
*Epidural hematoma - NOT COMMON complication of aortic aneurysm
3
paresthesias)
*Ischemic stroke dt right carotid artery atherosclerosis ss: contralateral neuro deficits
*Acute vertebral compression - old men with osteoporosis (MC in postmenopause women)
Surgery - Nervous System
QId: 4304
Calcium high...... Primary HYPERPARATHYROID
Adult
recurrent kidney stones
CALCIUM 10.8***
Parathyroid hormone 800
T score -2.5 at lumbar spine...consistent w/osteoporosis
Q = likely cause of pt's hypercalcemia?
A = Primary hyperparathyroidism
------
Medicine - Endocrine, Diabetes & Metabolism
QId: 4447
Osler-Web-Rendu syndrome
hereditary hemorrhagic telangiectasia (Autosome Dominant)....diffuse telangiectasias (ruby-
colored papules that blanch w/pressure); recurrent epistaxis; widespread arteriovenous
malformations
AVMs in lungs can shunt blood from right to left side of heart, causing chronic hypoxemia, digital
clubbing, & reactive polycythemia.
-----
wrong:
*Polycythemia vera - myeloproliferative disorder causes increased production of all 3 blood cell
lines & splenomegaly. (NO telangiectasias & digital clubbing); median age for pts w/P vera is
60.
*Pulm htn & polycythemia ? pulm htn by increases blood viscosity in pulm vessels.
*Carbon monoxide poison decreases O2 that can be carried by blood.... body reflexes by
pushing out 2ndary polycythemia more RBC.
*Lots CO2 (lung conditions) can cause Polycythemia.....but it's not the hypercarbia itself that
causes ?RBC production****
Medicine - Hematology & Oncology
QId: 4562
4
ARDS
QId: 4649
Acute arterial occlusion
of lower limb....dt thromboembolism in setting of Afib
QId: 4714
Spleen abscess case: dt Infective Endocarditis...blood spread/seeding...septic emboli to spleen
5
Nph 60%; bands 15%
-----wrong
*Malaria ss: fever, chills, fatigue; anemia, plt low; jaundice
*Hodgkin Lymphoma ss: fever, chills, wt loss. Lymphoma a/w splenomegaly (but doesn't cause
splenic abscess or infarction)
*Lung adenocarcinoma - ss: fever, wt loss, dyspnea, pleural effusion..... mets to liver, bone,
brain, adrenal glands
Splenic abscess is not seen in absence of additional infxn process
*TB ss fever & wt loss. GI TB (mc involves liver, intestine, peritoneum)..... (DOES NOT
INVOLVE spleen)
Surgery - Infectious Diseases
QId: 4848
Bipolar + depression
--------
wrong:
*Carbamazepine & Lamotrigine to treat Bipolar disorder & seizures
Carbamazepine ? APLASTIC ANEMIA & SiADH
Lamotrigine ? Rash (mild to Stevens=Johnson sd)
QId: 4875
1yrM
MCV 60
RCDW 13% (nml 11.5-14.5%)
6
Reticulocytes 4% (nml 0.5%-1.5%)
Q = most likely cause of pt's anemia?
A = Thalassemia minor
----
wrong
*folate def ss: macrocytic anemia (MCV >100) & occurs in ppl w/poor diet intake of vegetables
or increased requirements dt chronic hemolysis
QId: 10301
22yoM
screened for sexually transmitted STDs check.... had no prior STD screening.
Routine HIV testing
one time testing between age 15-65.
Annual test or more frequent if individuals in high risk groups: men ses men, IVD users, sex
workers, sex partners of HIV positive ppl, h/o of anotehr STD, unprotected sex...porn
QId: 11790
Medication induced psychotic disorder ss: onset delusions and/or hallucinations a/w use of new
medication
Steroids (high dose) implicated in new onset psychotic symptoms in pts who have no underlying
psych illness
case:
he sees "evil children" there.... doctor ***added a new oral medication***
Exam: responds to internal stimuli.
Q = likely diagnosis?
A = Medication induced psychotic disorder
-----
wrong:
*Brief psychotic disorder - psychotic ss >1 day -<1month
*Cannabis (marijuana) ss: euphoria, perceptual changes, increased appetite, red eyes, slowed
reflexes, dizziness, impaired coordination
Psychiatry - Psychiatric/Behavioral & Substance Abuse