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Dit Rapid Review

Dit Rapid Review

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Published by Anne Ndoe Essono

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Published by: Anne Ndoe Essono on Dec 22, 2013
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3 year old with an abdominal mass, hematuria and HTN.

WHat is the most likely diagnosis

Wilms Tumor

A 4 month old child presents with nonbilious vomiting despite changing formulas from milk-based to soy based. What is the most likely etiology?

Pyloric Stenosis

A 60 year old male presents to the clinic for a well male exam and on DRE a hard nodule is palpated on the prostate. Lab work up shows an elevated PSA. WHat is next step in the management of the patient

transrectal needle biopsy

60 year old male smoker is found to have a varicocele that does not empty when the patient is recumbent? what should you be suspicious of in this patient?


RCC (dont biopsy, just take out)

A 60 year old woman leaks urine when laughing or coughing. What are her nonsurgical options 5a .

Stress Incontinence Kegel Exercises Estrogen Replacement to thicken tissue Pessary 5b .

Albuminocytologic dissociation (increased protein in CSF with only modest increase in cell count) 6a .

Guillen Barre Syndrome 6b .

Antidote for following ODs Opiods Heparin Benzodiazepenes Babrituates CO 7a .

dialysis 100% O2 7b .Naloxone Protamine Sulfate Flumazanil Bicarb to alkanize urine.

Antihistone antibodies are seen in what condition 8a .

Drug Induced Lupus (Hydralazine) 8b .

At what age should nocturnal enuresis be treated? What are the treatment options 9a .

enuresis alarm (most effective long term therapy) 2nd line = pharmacologic IMIPRAMINE (Tofranil) short term up to 6 weeks Indomethacin suppository 9b . scheduled waking up bathroom breaks. restrict fluids before bed. motivational therapy.CANT be diagnosed before 5 y/o Treatment is usually delayed until the child is at least 7 years of age 1st line = behavioral interventions toliet training. nighttime chaperone.

At what point does grief/bereavement become pathological 10a .

and renengage in life by 6 months 10b . worthlessness or guilt suicidal ideation distressing feelings do not diminish in intensity by 6 months inability to move-on. helplessness. trust others.Grief becomes pathological when any of the following are found Depression criteria met for at least 2 weeks after the first 2 months following hte loss Generalized feelings of hopelessness.

molindone. moderate or high potency antipsychotics or atypical olanzapine. thiothixene. trifluoperazine. fluphenazine. laxopine. chlorpromazine.Categorize as low. haloperidol. risperidone. clozapine. aripiprapzole 11a . quetiapine. thioridazine.

ziprasidone. risperidone. thiothixene. loanzapine. perphenazine Low: thioridazine.High Potency: haloperidol. droperidol Medium: trifluoperzine. chlorpromazine Atypical: clozapine. sertindole. paliperidone. fluphenazine. apripozle 11b . quetiapine.

Classify the antidepressants: Notriptyline Setegiline Buproprion Mirtazapine Fluvoxamine doxepin Phenelzine Fluoxetine Clomipramine Imipramine Amitriptyline Nefazodone Minacipran Desipramine Sertraline Venlafaxine Paroxetine Tranycypromine Duloxetine Escitalopram Citalopram Trazodone 12a .

Notriptyline .MAOI Fluoxetine .TCA Amitriptyline .SSRI Trazodone 12b .TCA Imipramine .NDRI Mirtazapine .TCA Sertraline .MAOI Duloxetine .TCA Nefazodone .SSRI Venlafaxine .TCA Selegiline .MAO-I Buproprion .SNRI Desipramine .SSRI doxepin .TCA Phenelzine .SSRI Citalopram .SNRI Minacipran .Tetracyclic Fluvoxamine .SSRI Clomipramine .SNRI Escitalopram .SNRI Paroxetine .SSRI Tranylcypromine .

DIG FAST 13a .

Characteristics of manic episodes DIstractibility Insomnia Grandiosity (feelings) Flight of ideas Activity (increase in goal oriented) Speech (pressured) Taking Risks 13b .

Discuss Posterior Urethral Valves 14a .

megaureter.Most common obstructive urethral lesion in infants and newborns esp males Abnormal tissue folds in the distal prostatic urethra --> thick walled bladder and weak urinary stream and obstruction (bilateral hydronephrosis. UTI) Diagnosed with a voiding cystourethrogram Definitive care = transurethral ablation of the abnormal tissue or urinary diversion 14b .

An elderly female with a history of cholelithiasis presents with a 5 day history of vague. recurrent abdominal pain and vomiting. What diagnosis do you immediately suspect? 15a .

Gallstone Illeus MC in elderly 70 year old females caused by impaction of gallstone in ileum after being passed through a billiary-enteric fistula 15b .

Fever + Rash + elevated Creatinine + Eosinophilia. What is the diagnosis 16a .

sulfa. aminoglycosides)) 16b .Acute interstitial Nephritis (drug induced . penicillin. nsaids.

Glomerulonephritis + bilateral sensorineural deafness 17a .

Alports 17b .

How are sodium levels corrected for high glucose 18a .

4 mEq/L per 100 after glucose levels exceed 400 mg/dl) 18b .1.6 mEq/L for every 100 mg/dl of plasma glucose (2.

How are total calcium levels corrected for low albumin 19a .

Albumin goes below 4 --> Ca drops 0.8 mg/dL for every 1 mg drop in Albumin 19b .

visual changes. infection.How can testicular torsion be differentiated from epididymitis in regards to onset. support. cremasteric reflex and UZ and Tx 20a .

dysuria. fever.TORSION Onset = acute. abrupt and often associated with a physical activity Infection = no signs of infection Visual Change = Testicle may be raised and horizontal Support = No pain relief Cremasteric Reflex = absent UZ = compromised blood flow TX = Surgical detorsion with bilateral orchiopexy within 6 hrs EPIDIDYMITIS Onset = subacute and may be associated with STDs and/or anal intercourse Infection = possible signs of STD (urethral discharge. erythema) Visual changes = testicle in normal position and lie Support = partial relief Cremasteric Reflex = Present UZ = normal blood flow < 35 yo treat for Gonorhea/Chlamydia (ceftriaxone IM then doxycycline) > 35 yo think Enterobacteriacease and give Fluoroquinolone 20b .

How do sign and symptoms of testicular torsion differ from epididymitis 21a .

TORSION Onset = acute. erythema) Visual changes = testicle in normal position and lie Support = partial relief Cremasteric Reflex = Present UZ = normal blood flow < 35 yo treat for Gonorhea/Chlamydia (ceftriaxone IM then doxycycline) > 35 yo think Enterobacteriacease and give Fluoroquinolone 21b . abrupt and often associated with a physical activity Infection = no signs of infection Visual Change = Testicle may be raised and horizontal Support = No pain relief Cremasteric Reflex = absent UZ = compromised blood flow TX = Surgical detorsion with bilateral orchiopexy within 6 hrs EPIDIDYMITIS Onset = subacute and may be associated with STDs and/or anal intercourse Infection = possible signs of STD (urethral discharge. fever. dysuria.

How does adjustment disorder with depressed mood differ from major depressive disorder 22a .

3 month period and disappear within 6 months after stressor is removed 22b .

how is acute stress disorder different than PTSD 23a .

symtpoms lasting less than 4 weeks = acute stress symptoms > 4 weeks = PTSD 23b .

How is BPH diagnosed? 24a .

postvoid residual. maximum urinary flow rate 24b . calculi or prostatitis Serum Creatinine to detect possible renal or prerenal disease Serum PSA.Clinical diagnosis based on symptomatic scoring system R/O other pathologies that may cause similar symptoms Digital Rectal Exam to detect malignancy Urinanalysis to detect hematuria indicating infection.

How is depression managed in pateints with bipolar disorder 25a .

mild depression --> lithium or lamotrigine moderate --> add 2nd mood stabalizer (lamotrigine) or add an atypical antipsychotic (olanzapine. quetiapine. risperidone) severe --> consider ETC 25b .

How is TCA overdose managed 26a .

ABCs Activated Charcoal 1 g/kg up to 50kg (unless ileus is present) Continuous cardiac monitoring for at least 6 hours --> if no problems. Chem 7. EKG If ingestion < 2 hrs ago --> gastric lavage If hypotension --> IVF (LR or NS) --> NE if ineffective If QRS > 100 msec --> trial sodium bicarb then infusion if effective If seziures --> Benzos. barbituates. then clear for psych eval Frequent neuro checks Lab studies: TCA level. and/or propofol (but not phenytoin which is ineffective against toxin-induced seizures) 26b .

Hyponatremia + low serum osmolality + high urine osmolality 27a .

SIADH 27b .

Immunodeficiency with a + nitroblue tetrazolium test 28a .

Chronic Granulomatous Disease 28b .

In what time frame would you expect to see parkinson symptom side effets in a a patient taking antipsychotics 29a .

4 months 29b .4 days .

In which group of patients is bupropion (welbutrin) contraindicated? 30a .

Eating disorders (bulemia --> electrolyte imbalances) Seizure disorders Drug lowers seizure threshold 30b .

IN which immunodeficiency is there an absence of a thymic shadow on newborn chest xray 31a .

DiGeorge SCID 31b .

Infectious cause of aplastic crisis in sickle cell disease 32a .

Parvo B19 32b .

What is the most common cause of congenital urethral obstruction? 33a .Newborn male has a distended palpable bladder and oliguria.

Posterior Urethral Valves 33b .

A patient has signs of peritonitis and his clinical scenario favors rupture of the bladder (blunt trauma to a fully distended bladder) --> what portion of the bladder must have been injured to allow for a chemical peritonitis to have developed? 34a .

Dome of bladder any where else contained in pelvic region 34b .

A patient on haloperidol develops fever. and diaphoresis --> drug of choice? 35a . muscle rigidity. confusion.

Dantrolene 35b .

his BP was 145/90.A patient presents to clinic for follow up and is found to have a BP of 150/85. You note in the chart that during his last visit 1 month ago. What is the next step in the management of this patient 36a .

Repeat BP in 2-4 weeks b/c you need 3 increase BP on 3 separate occasions


A patient presents with a painless, pruritic papule with regional lymphadenopathy that evolves over 7-10 days into a necrotic ulcer with a black eschar. What is the diagnosis and treatment?

Cutaneous Anthrax Penicillin or Doxycycline


A patient previously diagnosed with schizophrenia arrives at the psych ER with a severe neck spasm that forces his head to be maintained in an unusual position? What is the treatment


Acute dystonia (torticollis in this case) due to antipsychotics --> benztropine/diphenhydramine (both have anti-cholinergic activity)


A patient treated with haloperidol develops a sustained contraction of the neck muscles --> what is the treatment of choice?

Diphenhydramine or benztropine or amantadine (anticholinergic)


Pediatric Patient with Red Currant Jelly Stools

Intussception 40b .

Positive P-ANCA is a/w what conditions?

Pauci immune glomerulonephritis Microscopic Polyangitis Churg Strauss

A post op patient has poor urine output, a BUN of 85, creatinine of 3, clear lungs. What is next step in management of this patient

IV fluids (assess fluid status) BUN/Cr > 20 = pre-renal clear lungs = tolerate fluids

A pt presents to the ER with a very painful irreducible inguinal mass. What is the next step in the management of this patient?

OR incarcerated inguinal hernia


Characterisitcs of major depressive disorder Sleep disturbances (insomnia) Interest loss Guilt Energy reduction (fatigue) Concentration Impairment Appetite changes Psychomotor disturbances Suicidal Ideation

Tachycardia + wild fluctuations in BP + headache + diaphoresis + panic attacks 45a .

Pheochromocytoma 45b .

What are 4 potassium sparing diuretics 46a .

Spironolactone Amiloride Triamterene Eplerenone 46b .

What are 5 etiologies of temporary hematuria 47a .

UTI Nephrolithiasis Exercise Trauma Endometriosis BPH 47b .

What are Ranson's Criteria in determing the Prognosis in patients with acute pancreatitis? 48a .

GA LAW. C HOBBS Glucose AST LDH Age WBC Calcium Hct P02 BUN Base Deficit Sequestration of Fluid 48b .

What are the 4 symptoms of atypical depression? what medications work well for atypical depression? 49a .

Hypersomnia Psychomotor retardation (leadened paralysis) Hyperphagia Hypersensitivity to rejection MAO-I work well (SSRI = 1st line for traditional depression) 49b .

What are the 6Ds of hypernatremia causes 50a .

Diuretics Dehydration Diabetes Insipidus Drs (iatrogenic) Diarrhea (and vomiting) Disease of Kidney (hyperaldosteronism) 50b .

What are the available treatments for a patient with erectile dysfunction 51a .

1st line = phosphodiesterase inhibitors sildenafil (viagra). vardenafil (levitra). tadalafil (cialis) 2nd line = penile self injectable drugs papaverine. phentolamine. alprostadil vaccum and constriction devices 3rd line = penile prosthesis implantation Other = androgen replacement if hypogonadism 51b .

What are the casues of Euvolemic Hyponatremia 52a .

Polydipsia SIADH Hypothyroidism 52b .

What are the causes of a normal anion gap metabolic acidosis 53a .

RTA Diarrhea TPN 53b .

What are the characterisitc features of a varicocele 54a .

non-solid. Transilluminates Dull achy scrotal pain usually on left side Testicular atrophy on affected side Infertility is common (present in 25% of infertile men) Color doppler ultrasound shows retrograde flow to the scrotum May point to a RCC 54b .Dilation of the pampiform plexus of scrotum Presents as scrotal mass.

What are the characteristic features of serotonin syndrome 55a .

disorientation) Autonomic excitation (diaphoresis. restlessness. diarrhea) Neuromuscular hyperactivity (tremor. delirium. muscle rigidity. tachycardia. myoclonus. hyperreflexia) Ocular clonus . vomiting.slow continuous horizonatal eye movements Spontaneuous or inducible clonus babinski signs bilaterally (dont flex toes) 55b . agitation. hyperthermia.mental status changes (anxiety. hypertension.

What are the characteristic findings of hereditary spherocytosis 56a .

Jaundice and Gallstones (common with all hemolytic anemias) Splenomegaly Anemia with reticulocytosis and increased MCHC Higher incidence of pseduohyperkalemia as RBCs lyse after blood draw and intracellular potassium leaks Peripheral smear reveals spherocytes Positive osmotic fragility test 56b .

What are the classic findings of HenochSchonlenin Purpura? 57a .

intussception. proteinuria) Arthritis (Transient lower extremity) 57b . guiac + stool) Renal (Hematuria.Lower extremity palbable purpura GI (Abd pain.

What are the defining characteristics of nephrotic syndrome 58a .

Hypoalbuminemia Hyperlipidemia 58b .> 3g/day of protein.

What are the diagnostic criteria for adjustment disorder 59a .

clinically significant emotional or behavioral reaction causing marked distress or impairment in social or occupational functioning symptoms develop in response to an identifiable psychosocial stressor (divorce. peer problems) other than bereavement symptoms begin within 3 months of stressor symptoms disappear within 6 months of the disappearance of the stressor 59b . failure at school.

What are the diagnostic criterion for schizophrenia 60a .

lack of emotional reactivity) Social/occupational dysfunction Duration of at least 6 months 60b . poverty of speech.At least 2 of the following during a one month period: (Or 1 + auditory hallucinations) delusions (irrational belief that cant be changed by rational argument) hallucinations disorganized speech (incoherrence or derailment) grossly disorganized or catatonic behavior negative symptoms (flat affect.

What are the dietary recs in the treatment of nephrolithiasis 61a .

Hydration day and night Consume normal diet and Ca amounts Decrease Na intake Decrease dietary protein/oxalate 61b .

WHat are the different etiologies of SIADH 62a .

major abdominal or thoracic surgery) 62b . antineoplastic agents.CNS disease (head trauma. antipsychotics. brain tumor. CNS infection. stroke. carbamazepine. tumor) Drugs (NSAIDs. ecstasy. antidepressants. pituitary surgery) Pulmonary Disease (pneumonia. vasopressing. dDAVP) Other (HIV/AIDS.

What are the different treatments for acute dystonia tardive dyskinesia neuroleptic malignant syndrome 63a .

diphenhydramine tardive dyskinesia = stop agent. use atypical neuroleptic malignant syndrome = dantrolene 63b .acute dystonia = anticholinergic = benztropine.

What are the distinguishing characteristics of each type of renal tubular acidosis (RTA) 64a .

urine pH increased Hypo K .urine pH decreased .proximal .Distal .urine pH increased Hypo K .variable bicarb Type 2 .low bicarb Type 4 .hypoaldosterone .Type 1 .normal bicarb pH > or < 5.3 64b .Hyper K .

What are the indications for Electroconvulsive Therapy (ECT) 65a .

severe debilitating depression refractory to antidepressants pscyhotic depression severe suicidality depression with catatonic stupor depression with food refusal leading to nutritional compromise situations where a rapid antidepressant response is required (pregnancy) previous good response to ECT medical condition preventing the use of antidepressants (elderly) bipolar disorder/mania schizophrenia/psychosis (catatonic) 65b .

What are the most common cause of fever of unknown origin (FUO) 66a .

Infection Cancer Autoimmune 66b .

What are the most common causes of seizures in children aged 2-10 67a .

Infection Fever (febrile) Trauma Idiopathic 67b .

pO2. HCO3 for acidbase disorders 68a . pCO2.What are the normal ranges of pH.

pH = 7.7.105 (pCO2 x 2 = 90) HCO3 = 22 -28 (pCO2 / 2 = 22.45 pO2 = 75 .5) 68b .35 .45 pCO2 = 35 .

What are the potential side effects of lithium in use of tx of bipolar disorder 69a .

vomiting. wt gain) Teratogen (ebstein's anomaly) 69b . diarrhea. polyuria GI SE (nausea. metallic taste changes.CNS depression and tremor Thyroid changes (hyper or hypo or euthyroid goiter) Nephrogenic DI (reversible on discontinuation) -> thirst. polydipsia.

What are the proper steps in the evaluation of a patient presenting with erectile dysfunction 70a .

situational dysfunction? . psychological stressors and interpersonal conflict. cremasteric reflex (neuro dysfunction). prolactin. gynecomastia (prolactinoma) SERUM LAB TESTS total testosterone. symptoms of depression (SIG E CAPS).HISTORY onset and duration. medication and drug use. testes (hypogonadism). femoral and peripheral pulses (vasculogenic cause). +/. TSH.PSA if vasculogenic --> cardiac stress test to assess for cardiac endothelial damage as well 70b . penis (peyronie's disease). lower extremity sensation (neuro dysfunction). visual fields (pituitary tumor). presence of nocturnal or early morning erections (present if psychogenic) PE: anal tone (neuro dysfunction). secondary sexual characteristics (hypogonadism).

What are the protein and LDH criteria for an exudative effusion? 71a .

6 (pleural : serum) 71b .Protein Ratio > 0.5 (pleural : Serum) LDH Ratio > 0.

What are the recommeneded therapies for nocturnal enuresis 72a .

1st try behavioral modification (enuresis alarm) 2nd .Imipramine (short term 6 weeks) 72b .

What are the risk factors for bladder cancer 73a .

Smoking schistosoma aniline dye petroleum byproduct recurrent UTIs cyclophosphamide (antidote = MESNA) 73b .

What are the signs/symptoms of neuroleptic malignant syndrome? what is tx? 74a .

tachypnea.mental status change (agitated delirium with confusion rather than psychosis) muscular rigidity +/. labile or high blood pressure.tremor hyperthermia greater than 38-40 C Autonomic Instability . lower fever with cooling blankets. ice packs in the axilla. diaphoresis rhabdomylosys appearing over 1-3 days Stop offending agent supportive care in the ICU (IVF. tylenol) Reduce HTN with clonidine and/or nitroprusside (cutaneous vasodialtion can facilitate cooling) DVT prevention with heparin or Lovenox For agitation use Benzos DANTROLENE prevents rigidity and hyperpyrexia by inhibiting calcium release 74b .tachycardia.

What are the symptoms of OD with TCAs 75a .

ileus. hypotension. seizures) Anticholinergic (mydriasis. urinary retention) 75b . coma.Cardiotoxicity ( tachycardia. conduction abnormalities) CNS toxicity (sedation. obtundation. xerostoma.

What are the symptoms of serotonin syndrome 76a .

AMS Autonomic Excitation Nueruomuscular hyperactivity (ocular clonus) 76b .

What are the symptoms of serotonin withdrawal symptoms? which SSRIs are well known for causing this when stopped? 77a .

fatigue. nausea. anxiety. muscle aches. irratibility that begins within dyas of abrupt discontinuation and dissipates over 1-2 weeks Paroxetine Fluvoxamine 77b . chills.dizziness.

What are the symptoms of TCA overdose 78a .

Cardiotoxicity CNS toxicity Anticholinergic SE 78b .

What are the treatment options for Generalized Anxiety Disorder 79a .

Buspirone. Beta Blocker 79b .SSRI. Venlafaxine (SNRI).

What are the treatment options for PTSD 80a .

Psychotherapy including behavioral and cognitive therapy SSRI = 1st line Other antidepressants BENZOs should be avoided in PTSD due to lack of efficacy and potential for abuse Mood stabalizers (carbazemine/valproate) improve impulsive behavior. arousal and flashbacks alpha blockers (prazosin) improves nightmares and sleep disturbances Atypical antipsychotics if refractory to other thearpies 80b .

What biostatic calculation looks at individuals with and without a disease and determines the likelihood of exposure to a risk factor 81a .

Odds ratio 81b .

or hyperpigmentation. cafe au lait spots and short stature? 82a .What cause of aplastic anemia is associated with thumb abnormaliites. diffuse hypo.

Fanconis Anemia 82b .

What causes k+ shift into cells and thus HYPOkalemia 83a .

5. diarrhea) Renal Tubular Acidosis (Types 1 and 2) Aldosterone (high) Periodic Paralysis Hypothermia Insulin Excess Cushing's Syndrome Insufficient Intake Diuretics (loop. U waves GRAPHIC IDEA GI losses (vomiting. T wave flattening. thiazide) Elevate B-Agonists Alkalosis 83b .Insulin Beta-agonists Alkalosis (sodium bicarb (vomiting/diarrhea) Hyperaldosteronism Renal tubular acidosis types 1 and 2 Cell creation/proliferation K < 3.

What causes K+ shift out of cells and thus Hyperkalemia 84a .

0. radiation) Renal Failure Aldosterone deficiency Metabolic Acidosis Psuedohyperkalemia K+ sparing diuretics Insulin deficiency Tubular Acidosis type 4 84b . arrhythmias CRAMP KIT Catabolism of Tissue (trauma.Low Insulin Beta Blockers Acidosis Digoxin Cell Lysis (leukemia) Serum K > 5. tall peaked T waves on EKG. chemo.

WHat class of diuretic is commonly used in patients with renal stones due to hypercalciuria in patients with a normal serum calicum level 85a .

Thiazide 85b .

What condition may result from the rapid correction of hyponatremia? what are the manifestations 86a .

Central Pontine Myelinosis (Osmotic Demyelination) Occurs when sodium is corrected by more than 12-20 mEq/L over 24 hours or is overcorrected to above 140 Symptoms are irreversible and typically delayed 2-6 days after the correction of hyponatremia Dysarthria/Dysphagia Paraparesis or quadriparesis Behavioral disturbances Lethargy and Coma Head CT or MRI 4 weeks after the event reveals areas of demyelination 86b .

What disease causes glomerulonephritis with deafnesss 87a .

Alports 87b .

What diuretic or class of diuretic would be most useful in the following situation? a) acute pulmonary edema b) idopathic hypercalciuria (calcium stones) c) glaucoma d) mild to moderate CHF w/expanded ECV e) in conjunction with loop or thiazide diuretics to retain K+ f) edema a/w nephrotic syndrome g) increased intracranial pressure h) mild to moderate hypertension i) hypercalcemia j) altitude sickness k) aldosteronism 88a .

a) acute pulmonary edema --> Loop b) idopathic hypercalciuria (calcium stones) --> thiazide c) glaucoma --> acetazolamide or mannitol d) mild to moderate CHF w/expanded ECV --> loop (Ksparing) e) in conjunction with loop or thiazide diuretics to retain K+ --> spironolactone f) edema a/w nephrotic syndrome --> Loop or metolazone g) increased intracranial pressure --> mannitol h) mild to moderate hypertension --> thiazide i) hypercalcemia --> loop j) altitude sickness --> acetazolamide k) aldosteronism --> spironolactone 88b .

What drugs are known to cause psychosis in patients 89a .

EtOH widrawal. Benzo. Steroids 89b . Barb. PCP.LSD. Amphetamines. Cocaine.

What durgs are known for causing elevated prolactin levels 90a .

Atypical/Typical Antipsychotics Methyl Dopa Verapamil 90b .

What electrolyte abnormality fits the following descriptions? peaked T waves on EKG flattened T waves on EKG U waves on EKG QT prolongation QT shortening 91a .

peaked T waves on EKG (hyper K) flattened T waves on EKG (hypo K) U waves on EKG (hypo K) QT prolongation (hypo Ca) QT shortening (hyper Ca) 91b .

What evaluation should take place prior to the initiation of TCAs in children 92a .

Because TCAs can cause arrhythmias (prolonged QT) the following should be preformed: screen pts history for heart disease. long QT syndrome. near syncope screen family history for sudden death prior to age 40. palpatations. syncope. arrhythmias and hypertrophic cardiomyopathy EKG prior to initiation and again when medication is optimized 92b .

What features characterize tardive dyskinesia that may develop from the use of high potency typical neuroleptics 93a .

Lip smacking. trunk limbs 93b . chorea of tongue. neck. face.

What food substances should be avoided when taking MAOIs in order to avoid a tyramine induced hypertensive crisis 94a .

pepperoni. bologna. salami. shrimp paste. fermented or marinated contain tyramine Fermented cheeses (cream cheese and cottage cheese are ok) smoked or aged meats (sausage. smoked. miso soup Sauerkraut. pickled. aged. avocados Brewer's yeast and yeast extracts (baking yeast ok) 94b . bacon. most beers and wines Soy sauce. smoked or pickled fish) Chianti.Foods that are spoiled.

What happens if you ingest tyramine while on MAOIs 95a .

Hypertensive Crisis 95b .

What is "cradle cap" and what is the tx? 96a .

Infantile or neonatal seborrhic dermatitis (crust lactea) .skin rash in scalp Seleneium sulfide shampoo or topical antifungals 96b .

What is DDX for Respiratory Acidosis? 97a .

35 pCO2 > 40 97b .COPD Respiratory Depression Neuromuscular Diseases pH < 7.

What is definition of primary amenorrhea 98a .

absence of menses at 16 yo with everything else normal or no 2ry sexual characteristics by age 13 98b .

What is in your DDX for Metabolic Alkalosis 99a .

45 HCO3 > 24 99b .Vomiting Diuretics Cushing's Hyperaldosteronism Adrenal Hyperplasia pH > 7.

What is in your DDX for Respiratory Alkalosis 100a .

Hyperventilation HIgh Altitude Asthma Aspirin Toxicity Pulmonary Embolism pH > 7.45 pCO2 < 40 100b .

What is next step in the management of a patient with peaked T waves on EKG due to hyperkalemia 101a .

Ca-Gluconate to stabilize myocardium 101b .

What is pseudohyponatremia? how is this different from hyponatremia and hyperosmolality? 102a .

4/100 after glucose levels exceed 400) 102b . Here the plasma soidum level is expect to fall by 1.When the serum volume is expanded by a substance such as lipid or protein (multiple myeloma). the amount of sodium per volume of serum may decrease even though the amount of sodium per unit of water in serum is appropriate --> pseudo This is different than hyponatremia due to HYPERosmolality from elevated glucose or mannitol adminstration. the increase in serum osmols pulls water out of cells thereby diluting serum sodium. In the case of hyperosm.6 mEq/L for every increase of 100 mg/dL of plasma glucose (increases to 2.

What is the biggest risk factor for RCC 103a .

Smoking 103b .

What is the cause of bilious emesis in a newborn within hours after the first feeding? 104a .

Duodenal Atresia 104b .

fever and rhabdomyolysis in a schizophrenic patient 105a .What is the cause of muscle rigidity.

Neuroleptic Malignant Syndrome 105b .

What is the classic (but rare) EKG finding in pulmonary embolism 106a .

S in Lead 1 Q and inverted T in Lead 3 106b .

What is the classic presentation of a patient with hyperprolactinemia 107a .

Men --> Gynocomastia. impotence. Galactorrhea (rare). Infertility Hypogonadism: Low estrogen. decreased libido Women --> Amenorrhea. Low Testosterone 107b .

What is the classic presentation of poststrep glomerulonephritis 108a .

URI (strep throat) 1-3 weeks prior Brown Urine HTN ASO + titer 108b .

What is the classic presentation of pt with androgen insensitivity syndrome 109a .

46XY. NO fallopean tubes Has testes (may be found in labia majora) Increased Testosterone. Estrogen and LH 109b . androgen receptor defect Phenotypically Female Normal appearing females with rudimentary vagina No uterus.

What is the classic presentation of the most common renal tumor in children 110a .

aniridia.Wilms Tumor Most common age 2-4 y/o palpable flank mass abdominal pain hematuria hypertension possibly multiple other associated congenital anomalies including WAGR (wilms. GU abnormalities. retardation) 110b .

What is the classic presentation of varicocele 111a .

Dilation of the pampiform plexus of scrotum Presents as scrotal mass. non-solid. Transilluminates Dull achy scrotal pain usually on left side Testicular atrophy on affected side Infertility is common (present in 25% of infertile men) Color doppler ultrasound shows retrograde flow to the scrotum May point to a RCC 111b .

What is the clinical definition of HTN 112a .

140/90 on 3 separate occasions at least 2weeks apart 112b .

What is the consequence of correcting hypernatremia too rapidly? how rapidly can it safely be corrected? 113a .

Cerebral Edema 12 mEq / L / day 113b .

WHat is the consequence of correcting hyponatremia too rapidly? how rapidly can it safely be corrected? 114a .

Central Pontine Myelinosis 12 mEq/L/day 114b .

What is the DDX for Hypercalcemia (Ca > 10.5) ? 115a .

GI symptoms.CHIMPANZEES Calcium Supplementation Hyperparathyroidism (bones. AMS) Immobility Milk-Alkali SYndrome Pagets Disease Addisons Neoplasms Zollinger Ellison syndrome Excess vitamin A Excess vitamin D Sarcoidosis 115b . nephrolithiasis. groans) (fractures. moans. stones.

What is the DDX for HYPERvolemic Hyponatremia based on urine soidum levels 116a .

nephrotic syndrome FEna > 1 --> renal failure 116b .FEna < 1 --> CHF. cirrhosis.

What is the ddx for HYPOvolemic Hyponatremia based on urine sodium levels 117a .

pancreatitis) Insensible Loss (sweating. diarrhea. Addisons) 117b . extensive burns) Urine Sodium > 20 (Renal losses) Diuretics (thiazides) Salt-losing renal disease Partial urinary tract obstruction Adrenal Insufficiency (inadequate mineralocorticoid.Urine Sodium < 10 (Extrarenal Losses) GI losses (vomiting. NG tube) Fluid sequestration (peritonitis.

What is the defining characteristic of a hydrocele 118a .

Transillumination 118b .

What is the difference between major depressive disorder and adjustment disorder with depressed mood 119a .

adjustment occurs within 3 months of an identifiable stressor 119b .

What is the difference between schizophrenia and delusional disorder 120a .

non bizarre delusions in delusional and does not have hallucinations or negative symptoms 120b .

What is the difference between the following disorders Schizotypal Schizophrenia Shizoaffective Schizoid Schizophreniform Brief psychotic disorder 121a .

personality disorder with odd thoughts/behavior at least 6 months schizo + mood disorder schizod's "avoid" .personality disorder with volunatary social isolation phreniform < 6 months brief < 1 month 121b .

What is the differential Diagnosis for adult hematuria? Discuss the workup of hematuria? 122a .

Nephrolithiasis Thorough physical exam (UA. prostate). PCKD. over age 50. PSA) CT Scan abd/pelvis (no constrast) to r/o renal stone CT scan abd/pelvis (w/contrast) and post-CT palin film KUB to view radiopaque stones If low suspicion --> consider Tx for UTI and f/u UA in 3-5 days If smoker. nephrotic). Trauma Glomerular Disease (Nephritic. Exercise. kidney. Chem 8. UTI. cyclophosphamide use. or suspicion for cancer --> send urine for cytoloyg and perform cytoscopy If work up reveals no pathology consider IgA Nephropathy or Thin Basement Membrane disease F/U 1 year cytoscopy and renal sono 122b . CBC.INEPT GUN Idiopathic. Neoplasm (bladder. FH of Urinary tract cancer.

What is the differential diagnosis for elevated anion gap metabolic acidosis with high serum osmolality? 123a .

Iron tablets Lactic Acidosis Ethanol.MUDPILES Methanol Uremia Diabetic Ketoacidosis Paraldehyde Isoniazid. Shock 123b . Ethylene Glycol Salicyclate.

What is the differential diagnosis for metabolic acidosis with a normal anion gap? How can serum potassium be useful in narrowing the differential diagnosis 124a .

Normal Anion Gap = Diarrhea. TPN Low Serum K = diuretics. renal tubular acidosis type 4. diarrhea. hyperalimentation 124b . potassium sparing diuretics. renal tubular acidosis type 1 and 2. Renal Tubular Acidosis. Fanconi's syndrome HIgh serum K = addison's.

What is the drug category of choice for the treatment of the negative symptoms of schizophrenia 125a .

ziprasidone. sertindole. quetiapine. paliperidone) 125b . risperidone. olanzapine.Atypical Antipsychotics ( Clozapine.

What is the drug of choice in the treatment of bipolar disorder in a patient with renal failure 126a .

Valproic Acid and Carbamazepine (metabolized by liver) 126b .

What is the emergency treatment for hyperkalemia? 127a .

Stat EKG to identify peaked T waves Repeat K level to insure not lab error/lysis D50 1 amp IV followed immediately by 10 units R insulin IV Ca-Gluconate to protect myocardium if EKG changes NaHCO3 to cause hypokalemia Albuterol nebulizer (drive K into cells) Kayexalate (exchanges Na for K in the gut --> excretion of K --> 24 hr effect) Repeat K in 30 min Consider Lasix to increase K wasting in urine Replace Mg if it is less than 2.0 Determine cause 127b .

What is the first line treatment for seasonal affective disorder 128a .

phototherapy 128b .

What is the formula for anion gap? What is normal? 129a .

HCO3..Na ..normal = 8-12 Normal anion gap suggests HCO3 loss 129b .Cl ...

What is the general treatment for calcium nephrolithiasis? What are odds of passing? What is expected managment? When is surgery indicated? 130a .

impairment of renal function Extracorporeal Shock Wave Lithotripsy (ESWL) for stones in renal pelvis or upper ureter (<3mm) Ureter sotnes --> uretrorenoscopy with possible lithotripsy and possible stent placement Staghorn calculi --> percutaneous nephrostolithotomy (drainage) 130b . persistent infection.8-9 mm stones are about 50% likely to pass If in UVJ --> 80 % likely to pass If in proximal Ureter --> 50% likely to pass Strain urine with strainer --> bring stones to lab for analysis (if uric acid stone may require chronic urine alkalinization) Drink 3L of fluid daily Flomax (tamsulosin)/Nifedipine may relax sm muscle and facilitate stone passage in both genders Pain Meds (NSAIDS (diclofenac). complete urinary obstruction. Vicodin Cipro if signs of UTI w/o pyelonephritis or urosepsis Repeat CT stone protocol in 4 weeks --> CT w/o contrast 10-20% of all kidney stones require surgical removal Required if unable to pass stone after 4-6 weeks.

masicism and turning against self k) belief that external source is responsible for an unacceptable inner impulse L) changing ones character or identity to avoid emotional distress m) returning to an earlier level of maturation to avoid conflict n) offering an explanation for an unacceptable attitude. belief or behavior o) a thought that is voided is replaced by unconscious emphasis on the opposite p) turning mental conflicts into bodily symptoms q) temporarily inhibiting thinking but continuing to build more tension r) avoiding interpersonal intimacy to resolve conflict and avoid gratification s) extreme forms can result in multiple personalities t) chronically giving into an impulse to avoid tension for an unexpressed unconscious wish ie tantrum u) substituting a less disturbing unrealistic view of the world in place of reality 131a .What is the immature defense mechanism a) ignoring a piece of information as if it was never said b) involuntary witholding information from conscious awareness c) a veteran can describe horrific details without emotion d) a child abuser was himself abused as a child e) a man yells at his family when he has had a bad day at work f) homosexuals choosing to become priests g) a closet homosexual hates homosexuals because of the way they make him feel h) using intellectual processes to avoid affected expression (dr frasier crane) i) belief that people are either all good or all bad j) expressing agression through passivity.

a) denial b) repression c) isolation d) identification e) displacement f) reaction formation g) projection h) intellectualization i) splitting (borderline personality) j) passive agressive k) projection L) dissociation m) regression n) rationalization o) reaction formation p) somatization q) blocking r) schizoid fantasy s) dissociation t) acting out u) fantasy 131b .

lifethreatening complication of CML 132a .What is the late.

Blast Crisis 132b .

What is the most common cause of aortic regurgitation in a 70 year old man 133a .

senile. calcified. aortic valve 133b .

What is the most common cause of bloody nipple discharge 134a .

Intraductal Papilloma 134b .

What is the most common cause of death in dialysis patients 135a .

Cardiovascular disease 135b .

What is the most common cause of HTN in young women 136a .

OCPs 136b .

What is the most common cause of m&m in patients with SLE 137a .

ESRD .end stage renal disease Renal nephritis 137b .

What is the most common cause of nephrotic syndrome in African American males 138a .

Focal Segmental Glomerular Sclerosis 138b .

What is the most common food borne bacterial GI tract infection 139a .

Salmonella 139b .

What is the most common inherited cause of hypercoagulability 140a .

Factor 5 Leiden Def 140b .

What is the most common location of renal stone impaction 141a .

Ureto-vesicular junction 141b .

What is the most common side effect of olanzapine 142a .

dyslipidemia 142b .Wt Gain --> Diabetes.

What is the most feared complication of scaphoid fracture 143a .

Avascular necrosis 143b .

What is the most likely cause of aortic stenosis in a 50 year old patient 144a .

Congenital Bicuspid Valve 144b .

heat intolerance e) hyperkalemia f) episodic sweating.What is the most likely cause of secondary hypertension given the following findings a) hypertension measures in arms but low BP in LE b) proteinuria c) hypokalemia d) tachycardia. tachycardia 145a . diarrhea.

a) coarctation of aorta b) renal disease c) aldosterone secreting tumor d) hyperthyroidism e) renal failure or renal artery stenosis f) pheochromocytoma 145b .

What is the most problematic congenital malformation associated with maternal lithium use 146a .

Ebsteins Anomaly (Atrialization of ventricle) 146b .

What is the next step in the diagnosis of cholecystitis when UZ is equivocal 147a .

HIDA scan 147b .

What is the next step in the management of a 65 year old male that presents to the ER with inability to urinate and painful bladder distension? 148a .

Decompression of bladder with 14-18 gauge French Foley catheter If h/o BPH, may require a cath with a firm Coude tip to "power through the narrowed urethra If unable to pass urethral cath then suprapubic catheterization (using UZ guidance) In unable to pass urethral cath and non trained in suprapubic cath placemnt will be availble for hours then suprapubic needle decompression

What is the next step in the management of a child with severe asthma exacerbation and persistently low oxygen saturation despite medication

Supplemental Oxygen (O2 sat > 92%) Nasal cannuli Possible intubation (O2 sat < 92%, AMS, unable to speak b/c of work of breathing)


What is the next step in the management of a woman with an uncomplicated cystitis

TMP-SMX 2-4 days no urine culture EMPIRIC TX

What is the next step in the management of testicular torsion confirmed with UZ


Manually detorsion + surgery within 6 hours (BL orchiopexy)


What is the preferred diagnositic test for PE

CT w/IV contrast V/Q scan in renal patients 152b .

What is the treatement for hereditary spherocytosis 153a .

Folic Acid 1 mg daily RBC transfusions in cases of extreme anemia splenectomy in moderate to severe disease 153b .

What is the treatment for BPH 154a .

decrease growth of hyperplastic prostate tissue in histoculture) Saw Palmetto (as effective as finasteride. fewer SE and decreases prostate size w/o changing PSA values) Medical Intervention Non-selective alpha blockers (doxazosin = cardura) (prazosin = minipress) (terazosin = hytrin) (for high BP patients) Tamsulosin (flomax) (alpha 1 blocker) (not anti-htn) 5 alpha reductase inhibitors (finasteride = proscar) (dutasteride = avodart) Decrease PSA by 50% so double result if on these meds Surgical Intervention TURP .Alternative Medicine: Isoflavones (found in soy .transurethral resection of prostate (retrograde ejaculation may result) Prostatectomy 154b .

What is the treatment for Chronic Kidney Disease 155a .

..5 g/dL. increase risk of LVH by 32%) (usually requires iron and epo) Vit D replacement Phosphate Binders (Phos-Lo) Daily ASA 155b . (beta blockers) (Loop) (Dihydropyridine CCB). (Minoxidil in refractory cases) DM aggressive control to HgbA1C < 6.Most require > 3 medications (ACE-I or ARBs unless pt is hyperkalemic).Stop Smoking BP aggressive control to < 130/80. (Clonidine Patch).5% with insulin and oral agents (not metformin --> lactic acidosis) Lipid aggressive control with statins to LDL < 100 Anemia agressive control to Hgb 11-12 (For every decrease in Hgb of 0.

What is the treatment for epididymitis 156a .

< 35. enterobac. ceftriaxone/doxy > 35. tmpsmx/quinolones 10-14 days (prostatitis 4-6 weeks) 156b . gono/chlam.

What is the treatment for nephrogenic DI 157a .

HCTZ (+amiloride if Li toxicity) Indomethacin 157b .

What is the treatment for nephrogenic diabetes insipidus caused by lithium toxicity 158a .

HCTZ + Amiloride close the Na channel at the collecting tubules directly affected by Lithium 158b .

What is the treatment for prostatitis 159a .

1 month treatment if over 35 (bactram/quinolone) 159b .

What is the treatment for serotonin syndrome 160a .

paralysis should releieve the hyperthermia which is caused by muscle activity if agitation despite benzos --> serotonin antagonist (Cyproheptadine) After resolution of symptoms assess need to resume serotonergic agent 160b . cooling blankets. cardiac monitoring. esmolol or nitroprusside if tx for tachycardia needed) sedations with benzos if temp > 41. misting fans). IV fluids.1 degrees C --> sedation.discontinue all serotonergic agents --> symptoms resolve in 24 hours Supportive care to normalize vital signs (oxygen. paralysis and ET tube --> mechanical cooling (ice.

What is the treatment for superior vena cava syndrome 161a .

Radiation to decrease tumor size 161b .

What is the treatment for tardive dyskinesia 162a .

d/c drug and switch to atypical 162b .

What is the treatment for urethritis in men 163a .

ceftriaxone + doxy for 10 days 163b .

What is the treatment for uric acid renal stones 164a .

Alkalinize urine (sodium bicarb or sodium citrate) 164b .

What is the treatment of choice for OCD 165a .

SSRI Clomiprimine 165b .

What is the tx for an MI due to cocaine overdose 166a .

Ca Channel Blockers (B-Blocker DOC for noncocaine MI) Over age 35 get cardiac catheterization 166b .Give Atavan/Lorazepam.

What is the tx for the following diarrheal illneses Entamoebia Histolytica Giardia Lamblia Salmonella Shigella Campylobacter 167a .

Metronidazole Metronidazole Flouroqinolone or TMP-SMX Flouroquinolone or TMP-SMX Erythromycin 167b .

What is the Tx for Vfib 168a .

IMMEDIATE cardioversion 360J Cardioversion ---> Epi or Vasopressin --> Epi --> Epi 168b .

What is treatment of choice of mania with psychosis 169a .

Atypicals --> Haloperidol 169b .

What lab changes will be seen in a patient with hyperaldoseteronemia? 170a .

Decreased K (HYPOkalemia). Increased Na (HYPERnatremia). Metabolic alkalosis Increase 24 hour urine aldosterone 170b .

What labwork is included in the work up for erectile dysfunction 171a .

Total testosterone PSA Prolactin TSH 171b .

What medical conditions can cause severe depression 172a .

Hypothyroidism Hyperparathyroidsm Parkinsons Stroke (ACA) CNS CA Pancreatic CA 172b .

What medications are known for causing erectile dysfunction? 173a .

methyldopa Thiazide diuretics: Beta blockers Ketoconazole Cimetidine Antipsychotics (increased dopamine) 173b .Most antidepressants especially SSRI Spironolactone Sympathetic blockers: clonidine. guanethidine.

What medications are known for causing Hyperkalemia? hypokalemia? 174a .

ARBs. acetazolamide Insulin. ACE-I. Beta Agonists (albuterol) 174b . dig Hypo K: loops. thiazides.Hyper: K+ sparing diuretics. Beta blockers.

What medications are known for causing symptoms of depression in patients 175a .

Sedatives (alcohol. antihistamines) Stimulant withdrawal methyl dopa 1st generation antipsychotics (haloperidol) Antinausea drugs including Metoclopramide and prochloroperazine Steroids (can cause mania or depression) Insufficient thyroid replacement --> hypothyroidism alpha interferon (used in viral hepatitis treatment) 175b . benzos.

What medications are necessary in patients with ESRD (end stage renal disease) 176a .

Statins Vit D Iron Supplement EPO Aspirin Loops ACE/ARBs Phosphate Binders 176b .

What medications are used in the treatment of BPH 177a .

non selective alpha blocker tamsulosin (no htn) 5 alpha reductase inhibitor 177b .

What medications are used in the treatment of Wegners 178a .

Corticosteroids and Cyclophosphamide 178b .

What medications can be used to rapidly correct hyperkalmeia by shifting potassium into cells 179a .

Insulin Beta Agonists (albuterol) Loop Cayexalate 179b .

What might you see on neuroimaging of a patient with schizophrenia 180a .

Increase 3rd/lateral ventricular size Decrease cortical volume 180b .

What neurotransmitter changes do you see with the following diseases? anxiety depression mania alzheimers huntingtons schizophrenia parkinsons 181a .

decreased Ser.decreased ACh huntingtons .decreased NE. increased ACh 181b .decreased dopamine.anxiety .increase NE. Gaba/Gly depression .decreased ACh/gaba schizophrenia .increased dopamine parkinsons . Ser alzheimers .increased NE. dopa. Ser mania .

What organism is known for causing infection in burn victims? 182a .

Pseudomonas 182b .

What rash presents with herald patch followed by a Christmas tree pattern 183a .

Pityriasis Rosea 183b .

What scale can be used to detemrine a patients risk for suicide? 184a .

may need commitment involuntary 184b .SAD-PERSONS Scale Sex (men = 1 pt) Age (<19 or > 45) Depression Prior Attempts EtOH Rational Thought Process (psychotic symptoms) Support Lacking Organized Plan No spouse/family Sickness 0-2 pts = outpatient follow up 3-4 = supervised/supported outpatient follow up 5-6 = consider hospitalization 7-10 = generally requires hospitalization.

WHat should always be done prior to Lumbar Puncture 185a .

assess ICP especially papilledema 185b .

WHat size calcium renal stone has a 50% likelihood of passing without surgical intervention 186a .

8-9 mm 186b .

What skin blistering disease has a positive Nikolsky Sign 187a .

Pemphigus Vulgaris 187b .

What two disorders should come to mind when a neonate has meconium ileus 188a .

Hirschsprungs CF 188b .

What type of acute renal failure would you suspecti n patient with FEna < 1% 189a .

Pre Renal (Hypovolemic/Shock) 189b .

What type of diuretic is the following drug a) triamterene b) hydrochlorothiazide c) spironolactone d) ethacrynic acid e) metolazone f) furosemide g) torsemide h) acetazolamide i) bumetanide j) chlorothiazide k) mannitol l) chlorthalidone m) amiloride 190a .

aldosterone antagonist d) ethacrynic acid = loop. non-sulfa e) metolazone = thiazide (used in cirrhosis) f) furosemide = loop g) torsemide = loop h) acetazolamide = carbonic anhydrase i) bumetanide = loop j) chlorothiazide = thiazide k) mannitol = osmotic l) chlorthalidone = thiazide m) amiloride = k+ sparing 190b .a) triamterene = K+ sparing. non-aldosterone b) hydrochlorothiazide = thiazide c) spironolactone = K+ sparing.

What type of oral contraceptive can be given to lactating women 191a .

Progestin Only Estrogen suppress milk production 191b .

involved coronary arteries h) most common vasculitis i) a/w hep B infection j) occlusion of ophthalmic artery can lead to blindness k) perforation of nasal septum l) unilateral headache.What type of vasculitis fits the following description a) weak pluses in upper extremities b) necrotizing granulomas of lung and necrotizing glomerulonephritis c) necrotizing immune-complex inflammation of visceral/renal vessels d) young male smokers e) young asian women f) young asthmatics g) infants and young children. jaw claudication 192a .

a) Takiyasu b) Wegners c) PAN d) Bergers e) takiyasu f) churg strauss g) Kawasaki h) Temporal Arteritis (giant cell) I) PAN J) Temporal Arteritis K) Wegners L) Temporal Arteritis 192b .

What urine and serum osmolality would you expect to see with the following causes of euvolemic hyponatremia? 1) SIADH 2) Psychogenic Polydipsia 3) Thiazides 4) Alcoholism 5) Hypothyroidism 193a .

Uosm< 100 3) Thiazides (Hypo or Eu) (Una increased. Una > 20. Una < 20 . Uosm Increased > 100) 2) Psychogenic Polydipsia (FEna < 1. Una < 20 /Uosm < 100) 5) Hypothyroidism (FEna > 1.1) SIADH (FEna > 1. Uosm increased) 4) Alcoholism (partial diuretic. Una/Uosm increased 193b .

What volume status would you expect ot find in a patient with hyponatremia due to the following causes 1) Thiazide Diuretics 2) SIADH 3) Hepatic Cirrhosis 4) Addison's Disease 5) Hypothyroidism 6) Renal Failure 7) Psychogenic Polydipsia 194a .

Euvolemic (FEna > 1) 3) Hepatic Cirrhosis .Dehydration (FEna > 1) or Euvolemic 2) SIADH .Fluid Overload (FEna > 1) 7) Psychogenic Polydipsia .Euvolemic (FEna > 1) 6) Renal Failure .Dehydration (FEna > 1) 5) Hypothyroidism .Euvolemic (FEna < 1) 194b .Fluid Overload (FEna < 1) 4) Addison's Disease .1) Thiazide Diuretics .

What would you suspect in an ER patient with blood in the urethral meatus or a high riding prostate? 195a .

Trauma to urethra Bladder Rupture (dont place a foley) 195b .

Whats the mature defense mechanism a) Voluntarily choosing not to think about bad news b) indiana jones using comedy to express feelings of discomfort c) arsonist donates money to fire department d) using ones agression to succeed in business ventures e) realistically planning for future discomfort f) consciously postponing inner conflict until a big project is completed g) redirecting impulses to a socially favorable object 196a .

a) Suppression b) humor c) altruism d) sublimation e) anticipation f) suppression g) sublimation 196b .

When would you suspect thrombocytopenia due to heparin use? What is the most feared complication of HIT? 197a .

platelt count drops by more than 50% HIT --> hypercoaguable -> DVT/PE/Ischemic Stroke 197b .

Which Antibiotics should be avoided during pregnancy due to potential teratogenic effects 198a .

Tetracycline Flouroquinolones Aminoglycosides Sulfonamides 198b .

Which antidepressant matches the following: SE = priapism lowers the seizure threshold workds well with SSRIs and increases REM sleep Appetitie stimulant that is likely to result in Wt gain Can be used for smoking cessation can be used for bedwetting in children 199a .

Trazodone Buproprion Trazadone Mirtazapine Bupropion Imipramine 199b .

Which antidiabetic agent is a/w lactic acidosis


Which drugs should not be taken with SSRIs becuase of risk of serotonin syndrome

SSRIs SNRIs MAOIs L-Dopa St Johns Wort Tryptophan Cocaine/amphetamines Ecstasy


Which Genetic disorder is associated with multiple fractures and is commonly mistaken for child abuse

Osteogenesis Imperfecta Type 1

Which glomerular disease would you suspect most in a pt with the following findings 1) most common nephrotic syndrome in children 2) IF: granular pattern of Immune complex deposition; LM = hypercelleluar glomeruli 3) IF = linear pattern of immune complex deposition 4) kimmelsteil-Wilson lesions (nodular glomerulosclerosis) 5) most common nephrotic syndrome in adults 6) EM: loss of epithelial foot processes 7) nephrotic syndrome a/w hep b 8) nephrotic syndrome a/w HIV 9) anti-gbm antibodies, hematuria, hemoptysis 10) EM = subendothelial humps and tram track appearance 11) nephritis, deafness, cataracts 12) LM = crescent formation in the glomeruli 13) LM = segmental sclerosis and hyalinosis 14) purpura on back of arms and legs, abdominal pain, IgA nephropathy 15) apple green birefringence with congo red stain under polarized light 16) Positive ANCA 17) anti-dsDNA antibodies 18) EM = spike and dome pattern of the BM


1) minimal change 2) post strep nephritis 3) goodpasture 4) diabetic nephropathy 5) membranous glomerulonephritis 6) minimal change 7) membranoproliferative 8) focal segmental 9) goodpastures 10) membranoproliferative 11) alports 12) crescentic/rapidly progressive 13) focal segmental 14) henoch scholen purpura 15) renal amyloidosis 16) crescentic 17) lupus nephritis 18) membranous


Which hernia carries the highest risk of incarceration? 204a .

Femoral (more common in women) 204b .

bad taste d) Best effect on HDL e) Best effect on triglycerides/VLDL f) best effect on LDL/cholesterol g) binds C Diff Toxin 205a . myositis c) SE = GI discomfort.Which lipid lowering agent matches the following description? a) SE = facial flushing b) SE = elevated LFTs.

a) niacin b) statins/fibrates c) cholestyramine (bile acid binding resin) d) niacin e) fibrates f) statins g) cholestyramine 205b .

Which neuroleptics are known for their extrapyramidal side effects 206a .

thiothixene) 206b . fluphenazine.High potency (haloperidol. droperidol.

Which type of lung cancer is a/w the following paraneoplastic syndrome elevated ACTH --> gluccocorticoid excess --> Cushing's syndrome elevated PTH-rP --> hypercalcemia elevated ADH --> SIADH --> hyponatremia Antibodies to presynaptic Ca channels --> Lambert eaton 207a .

Small cell Squamous Small Cell Small cell 207b .

Which vaccines should not be given to an HIV + person 208a .

Hep B. Strep Pneumo Men having sex with men should also have Hep A 208b .Dont give Live Vaccines Varicella Zoster Influenza Intranasal Oral Polio BCG (Tb) Anthrax Yellow Fever Oral Typhoid/Smallpox CAN GIVE MMR!!! (If CD4 > 200) SHOULD GIVE: Influenza.

What do you suspect? 209a .Young black male presents with painless hematuria.

Sickle Cell Trait 209b .

and abnormal body image 210a .A young female with amenorrhea. bradycardia.

Anorexia Nervosa 210b .

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